Wisdom tooth removal in Rabat

Why do wisdom teeth so often cause problems?

Wisdom teeth, or third molars, sit right at the back of the mouth, behind the second molars. There are usually four of them, but some people have fewer, or none at all.

Over the course of evolution, our jaws have become shorter while these teeth have kept their size. They therefore arrive last in a space that is already occupied. Several situations are possible:

• the tooth comes through fully and finds its place, causing no trouble;
• it remains impacted, meaning entirely within the bone;
• it is partially erupted: part of it breaks through the gum while the rest stays covered;
• it grows at an angle, lying against the neighbouring molar or tilted towards the cheek.

Problems arise mainly in the last three cases, sometimes after years without symptoms.

Do wisdom teeth always need to be removed?

No. A well-positioned, healthy wisdom tooth that can be brushed properly has no reason to be removed. Likewise, a fully impacted, deep tooth with no sign of disease can simply be monitored with regular X-rays.

Extraction is, however, recommended when the tooth is causing a problem or poses a real risk:

• repeated episodes of pericoronitis, inflammation of the gum that partly covers the tooth;
• decay on the wisdom tooth itself or on the hard-to-reach back surface of the second molar;
• bone loss or resorption of the root of the neighbouring molar;
• a cyst forming around the crown of the impacted tooth;
• an indication arising from orthodontic or prosthetic treatment.

Age matters too: in young adults, the roots are often less developed and the bone more flexible, which generally makes the procedure and healing easier. However, this alone is never a sufficient reason to operate on a tooth that causes no problems.

The X-ray assessment before extraction

Before deciding, a panoramic X-ray is taken. It shows all four wisdom teeth, their orientation, the shape of their roots and their relationship with neighbouring structures.

For the lower teeth, the most important point is the position of the inferior alveolar nerve, which runs through the jaw and provides sensation to the lower lip and chin. When the roots appear very close to this nerve, a three-dimensional scan may be requested to clarify their relationship and adapt the technique. For the upper teeth, the proximity of the maxillary sinus is checked.

This assessment also helps organise the procedure: removing a single tooth, the two on one side, or all four in one or more sessions, depending on difficulty and your preference.

How wisdom tooth removal is carried out

The procedure takes place at the practice in Rabat, under local anaesthesia. If you are particularly anxious, say so beforehand: the dentist will take the time to explain each step and adapt how the session runs.

A wisdom tooth that has fully erupted and is well aligned is removed like any other tooth. For an impacted or partially erupted tooth, the procedure is surgical: the dentist opens the gum, frees the tooth by removing the minimum of bone necessary, then often divides it into several pieces to remove it without forcing on the neighbouring structures. The area is then cleaned and closed with stitches.

The duration depends on the number of teeth and their position. During the procedure, you feel pressure and hear noises, but no pain. At the end, you are given written instructions and a prescription, and a check-up is scheduled if needed. For more on the procedure in general, see also our tooth extraction page.

Recovery: swelling, mouth opening and eating

Recovery after removing an impacted wisdom tooth is often more noticeable than after an ordinary extraction. Swelling of the cheek is common; it usually peaks around the second or third day, then goes down. A bruise may appear on the cheek or neck, and mouth opening may be limited for a few days.

A few simple measures help you through this phase:

• apply cold to the cheek at intervals, especially on the first day;
• take the prescribed medication at regular times, without waiting for pain to set in;
• sleep with your head raised;
• eat cold or lukewarm soft food: yoghurt, purées, cooled soups, scrambled eggs;
• do not smoke, spit or use a straw;
• resume gentle brushing from the next day, and mouthwashes if prescribed.

If possible, plan a few quieter days, with no intense physical effort or major events, so you can recover calmly.

Risks and complications to be aware of

Clear information is part of good care. Complications are uncommon, but they do exist:

• dry socket, intense pain a few days after the procedure, more frequent in smokers, treated at the practice;
• infection, shown by swelling that increases instead of decreasing, sometimes with fever;
• injury to the inferior alveolar nerve or the lingual nerve, which can cause tingling or reduced sensation in the lip, chin or tongue. It is most often temporary, but can exceptionally be long-lasting. The X-ray assessment serves precisely to evaluate and reduce this risk;
• an opening into the sinus for upper teeth, managed with specific instructions and sometimes a stitch.

These risks are explained during the consultation, in light of your own X-ray.

Sudden pain or swelling: what to do in an emergency?

A flare-up of pericoronitis can come on suddenly: pain at the back of the jaw, swollen gum behind the last molar, an unpleasant taste, difficulty opening the mouth or swallowing. While waiting for your appointment, rinse the area gently and brush it carefully, without applying heat to the cheek.

Swelling spreading towards the neck or eye, fever, or difficulty breathing or swallowing require immediate care. Our dental emergency in Rabat page explains how to reach us quickly. Outside an emergency, the extraction is planned once the inflammation has settled, which makes it more comfortable. To have your wisdom teeth assessed, you can book an appointment at the Agdal clinic.