The wisdom teeth, or third molars, are the final set of teeth to develop, typically emerging in the late teens or early twenties. Jaws often lack the space to accommodate these late arrivals, leading to complications like impaction, crowding, or pain. The decision to remove them is common, and the procedure may be performed by different dental professionals depending on the case’s complexity. The best practitioner for the extraction depends entirely on the tooth’s position and the surgical difficulty involved.
General Dentists and Simple Extractions
General dentists are fully qualified to perform many routine tooth extractions, including certain wisdom teeth. An extraction is considered “simple” when the tooth is fully erupted through the gum line and is visible in the mouth. In these cases, the tooth is accessible with forceps and elevators, requiring no extensive cutting of gum tissue or removal of surrounding bone.
This procedure typically relies only on a local anesthetic, allowing the patient to remain fully conscious. The general dentist gently loosens the tooth from the socket before removal. However, if an examination or X-ray reveals impaction or complex root structure, the general dentist will often refer the patient to a surgical specialist.
When is Wisdom Tooth Removal Necessary?
Wisdom tooth removal is often necessary due to a lack of space, which prevents full eruption, a condition known as impaction. An impacted tooth can grow at an angle, horizontally, or remain trapped entirely within the jawbone. This misalignment is a primary reason for extraction because it can cause pain, swelling, and damage to adjacent teeth.
Impaction also creates a high risk for infection, particularly pericoronitis, which is the inflammation of gum tissue around a partially erupted tooth. The gum flap over the tooth can trap food and bacteria, leading to persistent infection. Removal may also be indicated if the tooth develops extensive decay that cannot be easily repaired due to its difficult location. Extraction is also required if an impacted tooth is associated with a cyst, which can damage the surrounding jawbone.
The Role of Oral and Maxillofacial Surgeons
Oral and Maxillofacial Surgeons (OMS) handle complex wisdom tooth procedures. They complete four years of dental school, followed by an additional four to six years of hospital-based surgical residency training. This training includes rotations in anesthesiology, internal medicine, emergency medicine, and general surgery, qualifying them to manage the entire spectrum of oral and facial surgical needs.
A referral to an OMS is standard practice for bony impactions, where the tooth is partially or completely covered by the jawbone. These cases require a surgical approach involving a gum incision, removal of bone tissue, and often sectioning the tooth into smaller pieces for safe removal. Specialized expertise is also necessary when the tooth’s roots are close to sensitive anatomical structures, such as the inferior alveolar nerve or the maxillary sinus.
OMS professionals are trained and licensed to administer all levels of anesthesia, a capability that distinguishes them from most general dentists. For complex or multiple extractions, they can safely provide intravenous (IV) sedation or general anesthesia, allowing the patient to be deeply relaxed or completely asleep during the procedure. This advanced anesthesia capability is a significant factor in patient comfort and safety. The surgeon acts as both the anesthetist and the operator, monitoring and managing the patient’s vitals throughout the surgery.
Post-Procedure Care and Healing
The healing process following extraction involves managing localized swelling and pain. Patients are advised to apply ice packs to the face in 20-minute intervals for the first 24 to 48 hours to minimize inflammation. Pain management is addressed with prescribed medication or over-the-counter anti-inflammatory drugs.
A primary goal of post-operative care is preventing alveolar osteitis, or “dry socket,” which occurs when the protective blood clot in the tooth socket dislodges prematurely. To protect the clot, patients must strictly avoid creating suction in the mouth, meaning no smoking, spitting, or using straws for several days. Diet should consist of soft, cool, or lukewarm foods initially, and oral hygiene is maintained by gently rinsing with warm saltwater starting 24 hours after the surgery. The initial recovery period usually lasts about a week, with full soft tissue healing taking up to two weeks.