Wisdom tooth removal, the extraction of the third molars, is a common surgical procedure often recommended when these teeth are impacted, causing pain, infection, or damaging adjacent teeth. While the procedure is generally safe and complications are infrequent, certain negative outcomes can arise during the healing process. Understanding these potential issues allows patients to recognize symptoms and seek appropriate follow-up care if their recovery deviates from the expected timeline.
Understanding Dry Socket
The most frequent complication following wisdom tooth extraction is dry socket (alveolar osteitis). This condition occurs when the protective blood clot in the socket either fails to develop or becomes dislodged prematurely. The clot’s primary function is to protect the underlying bone and nerve endings. When the clot is lost, this exposure leads to an inflammatory response and intense, throbbing pain, significantly worse than typical post-operative discomfort.
Dry socket pain typically develops two to five days following the surgery, often radiating from the extraction site toward the ear, temple, or neck. The condition may also be accompanied by a foul odor or an unpleasant taste originating from the empty socket, which can appear whitish due to visible bone. Treatment involves cleaning the socket with saline irrigation and placing a medicated dressing or paste directly into the site. This medicated packing helps soothe the exposed tissue and provides pain relief. Healing of the exposed bone naturally takes about seven to ten days.
Damage to Nerves and Adjacent Structures
A less common complication involves damage to the nerves or surrounding anatomical structures. Lower wisdom teeth are situated close to branches of the trigeminal nerve, specifically the inferior alveolar nerve and the lingual nerve. The inferior alveolar nerve provides sensation to the lower lip and chin, while the lingual nerve controls sensation and taste on the front two-thirds of the tongue.
Trauma to these nerves, which can involve stretching, bruising, or, rarely, severing during extraction, results in a condition called paresthesia. Paresthesia is characterized by altered sensation, such as numbness, tingling, or a “pins and needles” feeling in the lip, chin, or tongue. While most nerve disturbances are temporary, resolving within weeks or months, a small percentage of cases can result in permanent sensory changes. The risk of nerve injury is higher with deeply impacted teeth or in older patients, necessitating careful pre-operative imaging to assess nerve proximity.
When upper wisdom teeth are removed, an oro-antral communication—a small opening between the mouth and the maxillary sinus—may occur. This risk exists because the roots of the upper molars can be close to, or within, the floor of the sinus cavity. Patients may notice air passing between the mouth and nose when breathing, or liquid flowing into the nose when drinking. Small openings often heal spontaneously, but patients must avoid forceful nose blowing or sucking through straws to prevent pressure changes in the sinus.
Other structural complications include a fracture of the jawbone (mandible) or damage to the temporomandibular joint (TMJ). Mandibular fractures are usually associated with the removal of deeply embedded teeth in patients with weakened bone structure. TMJ issues, such as pain or difficulty opening the mouth, may arise due to the prolonged hyperextension of the jaw required during the surgical procedure.
Post-Operative Infection and Excessive Bleeding
Post-operative infection is a risk in any surgical site, as the mouth naturally contains a high concentration of bacteria. A developing infection typically presents several days after surgery, differing from normal healing. While initial swelling and pain are normal, an infection is signaled by symptoms that worsen after the third day post-operation, rather than improving.
Specific indicators of infection include persistent, severe pain not relieved by medication, increasing or spreading swelling, and the presence of pus or a yellowish discharge from the socket. Systemic signs like a fever or swollen lymph glands also suggest a spreading infection. Antibiotics are typically necessary to treat the bacterial proliferation, and sometimes the surgeon may need to drain the site.
Excessive Bleeding
Some oozing or pink-tinged saliva is normal for up to 48 hours after the procedure while the body forms a stable blood clot. Excessive bleeding is defined as a continuous flow that quickly soaks multiple gauze pads or any bleeding not controlled by firm pressure after several hours. Initial management involves biting down on a clean, folded gauze pad for 30 to 60 minutes to apply consistent pressure. Using a moistened black tea bag can also be helpful, as the tannic acid promotes blood clotting. If bleeding remains profuse or restarts heavily, immediate contact with the oral surgeon or seeking emergency medical care is necessary.