Wisdom teeth typically erupt around the age of 20. They can also erupt at a later age, but it is rarer after the age of 26. Approximately 90% of those aged 20 have at least one unerupted or incompletely erupted wisdom tooth. Not all people have wisdom teeth, as approximately 2% of Finns completely lack congenital wisdom teeth.

Should a wisdom tooth be extracted?

Usually, wisdom teeth need to be extracted. A dentist makes the decision on the extraction. If the wisdom tooth has enough room in the dental arch or it is completely within bone, the dentist may find extraction unnecessary.

The eruption of wisdom teeth is often associated with problems because they behave unlike other permanent teeth, which are useful in terms of occlusion and usually become fully visible when erupting. If it is likely that the wisdom tooth will cause problems once it erupts, it will be extracted. 

In fact, pain and aching caused by a wisdom tooth is the most common reason why young adults seek a dentist’s help.

A symptomatic wisdom tooth is often treated by extraction because wisdom teeth are not usually important in terms of occlusion. The most common reasons for the extraction of wisdom teeth are eruption in an unfavourable position, lack of space in the dental arch, dental decay or inflammation of the pulp.  Pericoronitis, or inflammation of the wisdom tooth, often also leads to the extraction of the wisdom tooth. However, this is only performed once the acute inflammation has calmed down.

Pericoronitis, or inflammation of a wisdom tooth

Pericoronitis, or inflammation of the mucosal tissue surrounding a wisdom tooth, is one of the most common reasons for extracting a wisdom tooth. In particular, incompletely erupted wisdom teeth are predisposed to it. This is because an incompletely erupted tooth opens a way for bacteria to the pocket between the tooth and gum, which is deeper than normal and covered by a mucosal flap. In this case, it is impossible to clean the incompletely erupted tooth and surrounding gingival pocket, which makes it possible for the bacteria to proliferate and usually ultimately results in inflammation.

Inflammation of a wisdom tooth usually occurs in the eruption phase, and therefore it is rare among those aged over 30. Lack of space for the lower jaw teeth, the tooth’s eruption posture and incomplete eruption contribute to the inflammation of the tissue surrounding a wisdom tooth.

Wisdom teeth erupting on the lower dental arch are particularly predisposed to pericoronitis and also cause stronger symptoms, as 95% of diagnosed cases of pericoronitis occur in the region of the lower wisdom teeth.

Symptoms of wisdom tooth inflammation

The symptoms of wisdom tooth inflammation (pericoronitis) include pain, swelling, bad taste in one’s mouth, bad breath and pus from the gingival pocket of the wisdom tooth. The inflammation can also cause more severe symptoms, such as fever, abscesses or problems opening the mouth, in which case the symptoms require urgent care. When observing symptoms of inflammation, it is important to contact a dentist because pericoronitis is difficult to treat at home.

Treatment of wisdom tooth inflammation

Pericoronitis is often treated by extraction of the wisdom tooth, because the inflammation readily reappears. If the wisdom tooth is not extracted or the extraction is postponed to the next appointment, the dentist can prescribe a course of antibiotics and painkillers and instruct the patient to use mouthwash containing chlorhexidine, available from pharmacies.

The symptoms caused by pericoronitis can be alleviated by careful oral hygiene, i.e. careful brushing of the teeth. Brushing teeth can cause pain and discomfort due to inflamed mucosa. Nevertheless, it is important to clean the inflamed area. If brushing the teeth is not possible, it can be cleaned by gargling chlorhexidine-containing mouthwash for a few weeks.

How is a wisdom tooth extracted?

Before the extraction of a wisdom tooth, the dentist examines the oral region and the tooth to be extracted and plans the extraction. An X-ray is taken of the wisdom tooth to find out, among other things, the position of the wisdom tooth and its roots as well as the relationship of the roots with the surrounding tissue.

More detailed additional images can also be taken of the wisdom tooth, often with three-dimensional micro-CT imaging. Wisdom teeth are extracted surgically under local anaesthesia. The extraction can be an easy or demanding procedure, depending on the situation.

Wisdom tooth surgery

Extracting an incompletely erupted wisdom tooth, for example, can be a more demanding procedure than an ordinary tooth extraction, and also require surgical extraction. After extraction, a gauze pad is placed over the wound. Biting it for approximately 20–30 minutes reduces blood circulation and haemorrhage, resulting in a blood clot that protects the wound from drying.

After wisdom tooth extraction

After wisdom tooth extraction, the patient is given self-care instructions. It is important to follow them so that the would will heal.

After the extraction procedure, the dentist prescribes a course of painkillers and possibly antibiotics as well to decrease post-extraction inflammations.

When there is inflammation associated with the tooth to be extracted or the procedure is a demanding one, a course of antibiotics can also be given before the operation. In this case, the antibiotics are started approximately 30–90 minutes before the extraction and continued after the extraction for 2–7 days as well.