What Are Wisdom Teeth?
Wisdom teeth, also known as third molars, are the last teeth to develop at the back of the upper and lower jaw. They usually erupt between the ages of 17 and 25. In many people, there is insufficient space for these teeth to come through normally, which can lead to problems.
Why Might Removal Be Recommended?
Removal of a wisdom tooth may be advised if it is causing, or is likely to cause, problems such as:
- Recurrent infection (pericoronitis)
- Pain or swelling
- Decay affecting the wisdom tooth or the neighbouring tooth
- Gum disease affecting the surrounding area
- Damage to the adjacent tooth
- Associated cysts or pathology
- Difficulty cleaning the area adequately
Alternative Treatments
In some cases, symptoms may be managed with:
- Improved oral hygiene
- Short courses of antibiotics (not a long-term solution)
- Monitoring with regular review
- Coronectomy – a different surgical procedure in which the tooth roots are left in-situ
However, these options may not prevent symptom recurrence.
Before Your Surgery
- Continue your normal medications unless advised otherwise
- Stop smoking if possible — smoking increases the risk of infection and dry socket
- Arrange time off work or study (typically 3–7 days, depending on recovery)
- If having sedation or general anaesthetic:
- Arrange for an escort home
- Do not eat or drink as instructed before surgery
Risks and Complications
Common
- Pain, swelling, and bruising
- Bleeding
- Difficulty opening the mouth (trismus)
- Food trapping in the socket during healing
- Dry socket – delayed healing with pain, usually 3–5 days after surgery. There is some evidence that PRF placement reduces this.
Uncommon
- Infection
- Damage to the neighbouring tooth, especially if this has a large filling or is decayed
- Lower wisdom teeth – altered sensation of the lip, chin, and/or tongue (temporary: approximately 10%; permanent: approximately 1%)
- Upper wisdom teeth – communication from the mouth into the sinus, via the tooth socket, after tooth removal. This may need to be treated by a further procedure.
Rare
- Jaw fracture (very rare)
- Delayed healing requiring further treatment
Dry Socket & PRF
Dry socket is a condition that can happen after any extraction, but is particularly common after extraction of lower wisdom teeth. Although dry socket cannot always be prevented, several measures have been shown to reduce the risk.
For the first 72 hours after a tooth extraction, it is important to avoid anything that may disturb the blood clot within the socket. This includes:
- Smoking or vaping
- Drinking through a straw
- Vigorous mouth rinsing
- Forceful spitting
- Excessive physical exertion
In higher-risk extractions, your surgeon may recommend Platelet-Rich Fibrin (PRF) treatment to reduce the likelihood of dry socket. PRF is prepared from a small sample of your own blood, taken while you are asleep. The blood sample is then centrifuged, prepared, and the resulting PRF is placed into the extraction socket after tooth removal. PRF acts as a biological scaffold that supports clot stability and tissue healing.
Systematic reviews and clinical studies (1,2) have found that PRF can reduce postoperative pain and lower the incidence of dry socket compared with standard healing alone.
While no treatment can completely prevent dry socket, PRF is one of the better-supported preventive interventions currently available and is increasingly used following surgical wisdom tooth removal and other higher-risk extractions.
It is important to understand that PRF reduces risk rather than guarantees prevention, and patients should still follow all postoperative instructions carefully.
Recovery
Recovery varies between individuals, but the following is typical:
Day 1
- Avoid rinsing the mouth or spitting vigorously as this may dislodge the blood clot in the socket, resulting in bleeding and/or dry socket
- Avoid smoking or vaping for 7 days
- Sleep more upright than usual (use extra pillows) to minimise swelling
Days 2–3
- Swelling and discomfort peak
- Regular painkillers required (e.g. paracetamol every 6 hours + ibuprofen every 6-8 hours)
- Rinse gently with water or chlorhexidine mouthwash after food
- Some blood in the saliva and difficulty opening the mouth are normal
Days 4–7
- Swelling and pain gradually improve
- Most people can return to light activities and gradually discontinue painkillers
2 weeks
- Stitches dissolve
3 months
- Socket fills in
Clinic Review
A review appointment is typically arranged 2-3 weeks after wisdom tooth removal to check healing.
References
- Canellas JVDS, Ritto FG, Medeiros PJD. Evaluation of postoperative complications after mandibular third molar surgery with the use of platelet-rich fibrin: a systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2017 Sep;46(9):1138-1146. doi: 10.1016/j.ijom.2017.04.006. Epub 2017 May 1. PMID: 28473242.
- Ye L, He Y, Ma W, Zhou F, Liu J. Effect of platelet-rich fibrin on the recovery after third molar surgery: A systematic review and meta-analysis. J Craniomaxillofac Surg. 2024 Oct;52(10):1095-1108. doi: 10.1016/j.jcms.2024.06.022. Epub 2024 Jun 15. PMID: 39003218.
