Wisdom teeth

Wisdom teeth are the last molars to erupt, usually between the ages of 17 and 24. To identify them, surgeons use a standard numbering system. Wisdom teeth are tooth number 8 in each quadrant. They are numbered 18 to 48 according to their position:

• 18: upper right wisdom tooth
• 28: upper left wisdom tooth
• 38: lower left wisdom tooth
• 48: lower right wisdom tooth

During an extraction, particular attention is paid to the surrounding anatomy, especially the inferior alveolar nerve (located near the roots of the lower wisdom teeth, responsible for sensation in the skin of the chin and lower lip) and the lingual nerve (responsible for sensation in the tongue). Medical imaging, such as a panoramic X-ray or a CT scan (cone beam), makes it possible to precisely locate these nerve structures and minimise the risks.

The consultation is an essential step in planning the procedure.

• For children and teenagers, the goal is to assess the best time for extraction. The surgeon analyses the development of the roots to determine the optimal age at which the risk of complications is lowest, often before the roots are fully formed. This is generally coordinated with the orthodontic treatment.
• For adults, the consultation focuses on a complete assessment of the teeth and their position. We analyse the X-rays to determine the complexity of the surgical procedure and discuss the details with you.

The choice of anaesthesia is discussed with the patient, depending on their level of anxiety and the difficulty of the surgical procedure.

Wisdom tooth extraction can be performed at the practice, under local anaesthesia.

o The patient feels comfortable with the procedure and has no dental phobia.

o The procedure is not considered long or particularly difficult (the majority of cases).

This approach allows for a quick recovery and an immediate return home after the operation.

In other situations, the extraction can be performed under general anaesthesia, at the clinic. This option is recommended for several reasons:

• Complexity of the procedure: wisdom teeth in a difficult position may require specific operating conditions.
• Patient anxiety: For patients who are stressed or have a phobia of dental care, general anaesthesia allows the procedure to be carried out without any apprehension.

If general anaesthesia is being considered, a preoperative consultation with an anaesthetist will be arranged. The procedure is performed as outpatient surgery (over half a day) and requires fasting beforehand.

To promote good healing:

• Apply ice to the cheek to reduce swelling.
• Take the prescribed medication (painkillers, anti-inflammatories, antibiotics if necessary).
• Eat cold, soft or blended foods during the first few days.
• Avoid smoking, drinking alcohol, and eating hot, spicy, hard or crunchy foods.
• Rest and avoid intense physical exertion.
• Brush your teeth gently, avoiding the operated area for the first few days, and use a mouthwash from the following day.

Whichever technique is used, 2 to 5 days off work may be prescribed, depending on the complexity of the procedure and your occupation. You will be given postoperative instructions: applying ice packs to reduce swelling, following a soft diet for a few days, and taking medication to manage pain. Swelling and pain generally subside within a few days. The sutures used are dissolvable.

For any questions, or to determine the best approach for your case, please do not hesitate to contact us.

No, extraction is not systematic. It is recommended if the wisdom teeth:

• Are erupting in an impacted or horizontal position, which can cause pain, infections or damage to the neighbouring teeth.
• Do not have enough room to erupt, and remain impacted under the gum.
• Are decayed and difficult to reach for effective brushing.
• Need to be extracted as part of an orthodontic treatment.

The procedure is painless thanks to the anaesthesia. After the operation, pain is managed with the prescribed painkillers. Swelling (oedema) and difficulty opening the mouth are common and generally last a few days.

Yes, it is entirely possible to remove all four wisdom teeth in a single procedure. This approach is in fact often recommended, as it concentrates the recovery into a single period, thereby avoiding multiple absences from work and having to go through the recovery process several times.

• The duration of the surgery varies depending on the complexity of the case. On average, the extraction of all four wisdom teeth takes about 30 to 40 minutes.

If your wisdom tooth is located close to the inferior alveolar nerve (which provides sensation to the lip and chin) or the lingual nerve (which provides sensation to the tongue), a thorough analysis is essential. After a complete radiological assessment (often a 3D cone beam scan), the maxillofacial surgeon studies the anatomical relationship between the tooth and the nerve. In these delicate situations, the surgeon’s expertise is crucial to perform a meticulous extraction and minimise the risk of nerve injury.

A supernumerary tooth is an extra tooth that develops beyond the usual 32 teeth. Although rare, it is possible to have more than four wisdom teeth. These are sometimes called “duplicate” wisdom teeth. These extra teeth may remain impacted or erupt. Their presence can create complications, such as cysts or displacement of the other teeth, and often requires extraction.

A dentigerous cyst can form around an impacted (unerupted) wisdom tooth, particularly if it has remained in the jaw for a long time. This cyst is a fluid-filled sac that develops at the expense of the bone. Although generally benign, it can grow and weaken the jaw, thus requiring extraction of both the tooth and the cyst.

To reduce postoperative swelling (oedema), it is recommended to:

• Apply ice packs to the cheeks, intermittently, during the first 24 to 48 hours.
• Keep your head elevated (higher than your heart), especially while sleeping, by using several pillows.
• Avoid intense physical exertion (sport, carrying heavy loads) for one week.
• Stay hydrated and walk 30 minutes to an hour a day. This helps improve lymphatic drainage.

It is generally advised to avoid flying within 48 hours of the procedure, particularly if the extraction was complex or close to the sinuses (upper, maxillary wisdom teeth). Changes in cabin air pressure can potentially increase discomfort, pain or the risk of bleeding. Travelling by train, on the other hand, generally poses no problem, as there is no pressure variation. It is nevertheless recommended to stay near the practice for the first two days.

Although rehabilitation is mainly postoperative, preparation may be recommended. The physiotherapist can:

• Assess function: carry out a precise assessment of jaw mobility, tongue position, swallowing and speech.
• Correct dysfunctions: begin working on bad habits (such as poor tongue positioning) and any muscular imbalances to prepare the muscles for surgery.

The physiotherapist can step in from the very first days to relieve the patient and initiate recovery:

• Fighting swelling: by performing manual lymphatic drainage of the face and neck to help reduce the swelling.
• Relieving pain: through gentle massage and relaxation techniques, the physiotherapist helps manage postoperative pain.
• Ensuring good nasal breathing, which is often affected by the swelling.

This phase is the most important and continues over several weeks. The physiotherapist supports the patient and helps them:

• Regain mobility: through gentle mobilisation exercises and stretching, the physiotherapist helps the patient recover the jaw’s range of motion, which is initially limited by the swelling and the surgery.
• Retrain the muscles: targeted exercises are provided to strengthen the chewing muscles and restore efficient, comfortable chewing function.
• Work on orofacial functions: by retraining speech, swallowing and tongue position so that these functions adapt to the new position of the jaws.
• Improve healing: specific massages help soften scar tissue and prevent adhesions that could hinder movement.
• Advice and independence: the physiotherapist teaches the patient self-rehabilitation exercises to do at home to maintain progress and stabilise the results over the long term.

Physiotherapy is prescribed by the surgeon or the orthodontist. It is important to make an appointment at the start of the protocol (as soon as the braces are fitted), in order to carry out an assessment and establish a schedule consistent with the orthodontic and surgical treatment plan.

There are physiotherapists who specialise in maxillofacial surgery; you can find their contact details on the website of the international society of lingual and oro-maxillofacial physiotherapy (https://siklomf.fr)