Having problems with your wisdom teeth is not unusual. These are the last adult teeth to break through the gums and, for reasons that are not entirely clear, modern humans often do not have sufficient space in their jaw for this process to be easy and wisdom tooth extraction is a common operation. Eruption of the wisdom teeth usually starts in the late teens, but it may take until the early 20s for all four teeth to become fully visible.

Sometimes this never happens; the wisdom teeth become lodged under a spur of bone, causing frequent toothache and soreness in the gum. If the teeth are impacted like this, or they come through at an angle, wisdom tooth extraction is the only effective treatment. Your main choice is whether to have the wisdom tooth extraction surgery done by a National Health Service (NHS) dentist or hospital, or whether to opt for private treatment.

What is the function of the wisdom teeth?

As the final set of large molars to erupt through the gums at the very back of the jaw, they function in the same way as the other molars, providing an efficient grinding surface for chewing food that is tough. Wisdom teeth in modern humans are obviously not really necessary as so many people today have wisdom tooth extraction in early adulthood. The other sets of molars do the job of chewing pretty well, and modern humans don’t eat food such as sinewy meat and tough roots as they did when the human jaw first evolved.

Do I need wisdom tooth extraction?

If you are having frequent problems with your wisdom teeth coming through, your dentist will probably recommend wisdom tooth extraction. The most common problems that occur are:

  • Impacted wisdom teeth: if there is not enough room for wisdom teeth to come through, they tend to emerge from the gum at an angle and can then become impacted, or trapped under a spur of jaw bone or lodged against the neighbouring tooth.
  • Non-erupting wisdom teeth: some wisdom teeth may be straight but just do not push up sufficiently to clear the gum. They can be near to the surface, so can cause frequent gum ulceration that can only be relieved by wisdom tooth extraction.

There is no need for wisdom tooth extraction if the impacted tooth is not painful or causing infection or decay. However, impacted or non-erupting wisdom teeth often cause inflammation that can lead to gum disease, infection, cysts or decay because food becomes trapped or plaque builds up and there isn’t enough space to clean it away. As well as pain in the tooth, this can also lead to bad breath and stiffness or soreness in the jaw muscles.

Can I avoid the extraction?

It may be a good idea to wait a few months to see what happens, but most people get to the point when the thought of having a wisdom tooth extraction becomes more appealing than experiencing the pain and discomfort their wisdom teeth are causing. Some dentists will use an interim measure to trim the gum away from non-erupting wisdom teeth, or may drill away the spur of bone if an impacted wisdom tooth is coming through straight. If these are successful and your wisdom teeth then come through fine, a wisdom tooth extraction may no longer be necessary.

Choosing between private and NHS

A private or NHS dentist or dental surgeon can carry out a wisdom tooth extraction, and the processes and standards of care for wisdom tooth removal should be the same. However, unless you are already registered with an NHS dentist, it may be difficult to find a practice to accept you as a new NHS patient. You can check out online the practices in your local area that are still accepting NHS patients.

If you have severely impacted wisdom teeth, your wisdom tooth extraction may be too complex to be done in the dentist’s chair and you will need a referral to a dental hospital. This can involve a wait for an initial appointment and then a further wait for the actual wisdom tooth extraction. Unless you are under 18 or exempt from dental treatment charges, there will also be a fee for the wisdom tooth extraction. This will vary according to the work required, but is likely to cost less than having the operation done privately.

Finding a private dental practice for wisdom tooth removal is generally easier and there is less likely to be a wait either for the initial appointment or for the subsequent operation. It is usually also possible to have some say in the timing of the wisdom tooth extraction if it has to be done under hospital conditions, to fit in with work and other commitments. The cost of the wisdom tooth extraction is, of course, likely to be higher than going through the NHS.

What to expect

Once you have made your choice to go with an NHS dentist or a private dentist, the process should be very much the same.

An X-ray will tell your dentist if it is possible to carry out the wisdom tooth removal under a local anaesthetic. This just numbs the gum, and you will be awake for the wisdom tooth extraction, though you may be given a sedative to make you feel relaxed. Single wisdom tooth extraction can take up to three-quarters of an hour, but often only takes a few minutes. The dentist or dental surgeon may be able to simply loosen the tooth in its socket to complete the wisdom tooth extraction very quickly.

If the wisdom tooth extraction is likely to be complicated, a dental surgeon may need to do the operation under a general anaesthetic. He or she may have to cut a flap in the gum to remove the tooth, and then drill away a piece of the jawbone.

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Wisdom tooth extraction – should I go private?