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Improved & Targeted Oral Hygiene

A wisdom tooth that is only partially through the gum or has prone to decay, gum disease or inflammation-infection of the tissues surrounding the tooth’s crown.

If the wisdom tooth does not need to be removed (see the NICE Guidance on the Extraction of Wisdom Teeth), then it can be kept but will need targeted oral hygiene.

This involves very scrupulous cleaning around the tooth (± operculum) possibly using such adjuncts as antiseptic mouthwashes or gels (Corsodyl is very good for this).

Problems with the procedure:

Future flare-ups with the wisdom teeth can still occur especially if stressed, moving house, sitting exams etc.

May be regarded just as a stop-gap measure, delaying the day that the tooth may need to be removed.

The NICE Guidelines emphasise the link between the presence of plaque and peri-coronitis (inflammation / infection around the crown of the wisdom tooth, NICE Guidance on the Extraction of Wisdom Teeth, 1.4).

Exodontia / Tooth Extraction

Wisdom teeth are removed only if the reason for removal is mentioned in the NICE guidelines.

Wisdom teeth cannot be prophylactically / preventively removed.

Just because wisdom teeth are present, it does not mean they have to be removed.

The guidelines boil down to waiting for some pathology to develop – decay, gum disease, infection around the tooth crown, cyst development etc. This is regarded by some as supervised neglect.

Problems with the procedure:

  • temporary / permanent nerve damage effecting the lip, chin ± the tongue
  • extraction socket infection
  • bleeding
  • temporary local swelling
  • pain
  • restricted mouth opening

Patients should not be exposed to these risks of a surgical procedure unnecessarily.

Molar Uprighting

It is always worth considering, if there is enough space for the wisdom tooth and that it would be functional, to orthodontically disimpact the wisdom tooth and bring it into a position where it is in an optimal position, functional and does not compromise adjacent teeth. This is not a quick fix and may require the use of mini-screws / implants to provide anchorage to facilitate the orthodontic movement of the tooth. These screws / implants are removed afterwards.

Operculectomy ± Opposing Tooth Removal

If the flap of gum overlying the wisdom tooth (the operculum) is causing the problem, then this can be removed by a number of means (‘cold steel’, glacial acetic acid, laser or cautery).

Problems with the procedure:

It possible that this may grow back and the operculectomy may need to be repeated.

In the area where the operculum is removed, runs the Lingual Nerve that supplies sensation to the tongue (and if this is effected by the operculectomy, a numb tongue may result as well as loss of taste on that side of the tongue; the numbness can last up several months) and sometimes aberrant blood vessels (that can be surprisingly vigorous in bleeding).

Coupled with this, it can be quite sore afterwards and there may be limitation of mouth opening.

If the wisdom teeth flare-ups have been quite episodic, then it may be hard to know if the operculectomy has in itself, been successful.

An operculectomy is sometimes considered if the upper, opposing wisdom tooth is traumatising the operculum. SIGN suggests pain associated with the lower wisdom tooth is commonly exacerbated by the upper wisdom tooth biting on the gum flap (operculum), causing pain and discomfort.

Alternatively, if the upper wisdom tooth is easy to remove and is non-functional, then immediate removal of that tooth will often dramatically relieve the pain from the area. This is particularly useful where there is likely to be delay in the removal of the lower wisdom tooth and can be regarded as an interim measure (after referral but prior to surgery).


If the roots of the wisdom tooth seem to be in very close proximity to the nerve that supplies sensation to the lip and chin (the Inferior Dental Nerve) or if the tooth itself is deep within the lower jaw so that total removal of the tooth may be impractical / ‘tricky’ / damage the nerves / lead to a possible broken jaw, then only the crown of the tooth may be removed (coronectomy / intentional partial odontectomy).

Problems with the procedure:

If, when the tooth is being decoronated, the roots are found to be mobile, then the roots have to be removed as well (hence, the original problems of nerve damage etc are not circumvented).

The roots left behind often migrate away from the nerve so that if they give any more problems, the roots can be removed with reduced risk to the nerve.

Problems with the procedure:

Uprighting wisdom teeth may be regarded as futile exercise as there may be:

  • Insufficient space
  • Abnormal root morphology (shape)
  • Not very actively involved in mastication (chewing)
  • Would need lot of bone removal to create space for the roots.
  • Proximity to vital structures like Inferior Alveolar Canal, Lingual Nerve etc
  • Difficult in 3 dimensional stabilisation
  • Difficult to maintain hygiene

I think the latter 2 may be more important as you would consider the others prior to uprighting the tooth; if these were not valid, then you wouldn’t proceed to molar uprighting.