Wisdom tooth removal: when it is necessary and how it works

Wisdom teeth do not automatically have to be removed. Removal makes sense above all if a wisdom tooth does not have enough room, repeatedly causes inflammation, is decayed or puts neighbouring teeth at risk. The procedure is usually carried out as an outpatient under local anaesthesia, and healing generally takes a few days to about a week.

At our dental practice in Küsnacht near Zurich, surgical procedures like this are carried out by Dr. Tanja Karamousli. On this page you can find out when removal is advisable, how the procedure works and what helps if you are anxious about it.

What are wisdom teeth?

Wisdom teeth are the rearmost molars, also known as third molars. Dentists often call them the ‘eights’ because, counting from the middle of the jaw, they are in eighth position. They are the last teeth to come through, often in young adulthood, but sometimes only partially or not at all.

Because they sit so far back, wisdom teeth are hard to reach when brushing. In some people they grow in straight, are easy to clean and never cause any problems. In that case they can stay and are monitored at regular check-ups.

When does removal make sense?

Whether a wisdom tooth should be removed is something we decide together with you after an examination and an X-ray. Common reasons are:

• Lack of space: The tooth cannot come through properly, remains stuck in the jaw or lies at an angle.
• Recurring inflammation: With partially erupted teeth, bacteria can become trapped under the gum. Inflammation of the gum around the tooth is called pericoronitis and is often painful.
• Tooth decay: Areas that are hard to reach are difficult to clean, whether on the wisdom tooth itself or on the neighbouring tooth.
• Cysts: In rare cases, cysts that weaken the bone can form around a tooth that has remained in the jaw.

If a wisdom tooth causes no problems and is easy to care for, we do not recommend surgery as a precaution. As with any procedure, we weigh up the benefits and risks in each individual case.

How the procedure works

1. Examination and X-ray: We assess the position of the tooth and its roots. If necessary, a three-dimensional scan (CBCT) completes the picture, for example to see the distance to the nerve in the lower jaw. Find out more on the page X-ray technology at our practice.
2. Information: You learn what is planned, which anaesthesia is an option and what the risks are.
3. Anaesthesia: Local anaesthesia is usually sufficient. Depending on the case, general anaesthesia is also possible; for this, a specialised anaesthesia team comes to our practice.
4. Removal: The gum is opened and the tooth is carefully removed. Sometimes it is divided into sections to do this. The wound is then usually stitched.
5. Aftercare: You receive instructions for the first few days and a follow-up appointment.

After the procedure: healing and possible risks

Swelling and pain in the first few days are normal. Healing usually takes a few days to about a week, or longer depending on the position of the tooth and the extent of the procedure. These tips will help:

• Cool your cheek from the outside, taking breaks.
• In the first few days, eat soft foods that are not too hot and not spicy.
• Brush your other teeth as usual, but be gentle around the wound.
• Take any medication as we have discussed with you.

Like any operation, wisdom tooth removal carries risks, such as secondary bleeding, wound infections or delayed wound healing. Rarely, a nerve may be irritated, which can lead to temporary – and very rarely longer-lasting – altered sensation in the lip or tongue. We discuss your personal risk with you before the procedure. If severe pain, swelling or fever increase again after a few days, please get in touch with us.

Nervous about the procedure?

Many people put off having their wisdom teeth removed because they are afraid. That is understandable, but inflamed wisdom teeth often do not get better by waiting, and the symptoms can get worse. Talk openly about your fear: that is the first and most important step.

We get to know you first and only start treatment when you are ready. A detailed conversation, clear explanations and breaks whenever you need them help many patients relax. For anxious patients, we also offer nitrous oxide sedation. You can read more about this under Fear of the dentist: how we help anxious patients.

How we work at our practice

We start with an examination and an X-ray. Our practice has a 3D X-ray unit (Orthophos SL 3D). This allows us to assess the position of difficult wisdom teeth precisely before we make a recommendation.

We then discuss with you whether removal is necessary, which teeth are affected and which type of anaesthesia is suitable. The costs depend on the number and position of the teeth and on the complexity of the procedure. On request, we will prepare a cost estimate for you in advance.

Frequently asked questions

Does every wisdom tooth have to be removed?

No. Healthy wisdom teeth that have fully come through and are easy to clean can stay. We check them at your regular examinations.

Dentist or oral surgeon: who removes wisdom teeth?

A dentist can often treat straightforward cases. Deeply embedded or angled teeth are removed in a surgical procedure. At our practice, Dr. Tanja Karamousli carries out surgical procedures herself, so many procedures can be carried out directly with us.

Are all wisdom teeth removed at once?

That depends on your situation and your preference. Sometimes it makes sense to remove them all in one session, sometimes one side at a time. We discuss this during planning.

How long will I be restricted after the procedure?

Most patients need to take it easy for a few days. Healing usually takes a few days to about a week. Do not schedule any physically demanding commitments directly after the procedure.

Are you having problems with a wisdom tooth, or would you like to know whether your wisdom teeth can stay? Book an appointment at our practice in Küsnacht.