What happens during wisdom tooth removal?

It starts not with a scalpel but, quite literally, with a little piece of cotton wool: gel is applied to the gum so that the injection feels more like a gentle touch than a needle. The gel tastes pleasant. This is the one part of the whole procedure about which nobody has any complaints.

Then comes the injection. In the upper jaw, it's fairly straightforward: anaesthetic is injected near the tooth, and within a couple of minutes a blessed numbness settles in. The lower jaw is trickier. A long, thin needle has to reach the nerve that supplies one whole side of the lower jaw. Afterwards, not only the tooth but also the lip, chin and part of the tongue go numb. You can accidentally bite your cheek and not discover it until you're back home having dinner.

Some people feel a little unsettled after the injection. Their hearts suddenly race, their hands tremble, and a vague sense of anxiety appears for no obvious reason. They begin to suspect that something more than a dental appointment is taking place. Let me reassure you: there's nothing mystical about it. It's a side effect of the anaesthetic, and it passes by itself within ten to fifteen minutes.

Before picking up the instruments, the dentist checks that the anaesthetic has worked. They press the gum with something blunt and ask, "Can you feel that?" If the answer is, "I can feel something touching it, but it doesn't hurt," we can begin. If it's, "I can feel it, and it hurts," we need to wait a little longer.

What happens next depends on the tooth you've been dealt.

If it has come through properly, taken its place in the row and behaved itself, we don't do anything to it at all. It simply gets on with its life under observation, like the quietest tenant in the building.

A tooth that has decided to live inside the bone and never show its face is another matter. That calls for an incision. The dentist cuts the gum with a scalpel to see what's going on underneath, and usually discovers that something was in the way: the neighbouring tooth was too close, or there was too much bone in that particular spot. Taking the tooth out in one piece is generally impractical. Space is tight, the angle is awkward, and the neighbours deserve to be spared. So the tooth is divided into sections with a rotary instrument chosen for the job. Not too fast, or it could overheat the tissue; not too slow, or we could be there all evening. The pieces are removed with a luxator. The forceps most people associate with tooth extraction hardly feature here. They belong more to an old dental horror film than to the main toolkit for these cases.

Once the tooth has left the premises, small bone fragments are cleaned out of the socket. No "filling" of any kind goes in: no bone chips, no gels. The body fills the space with a blood clot, and interfering with that process only does harm. Dissolvable stitches are then placed and deliberately left slightly loose: the wound may still bleed a little during the first twenty-four hours, and closing it too tightly would cause swelling.

Some teeth are easier: those that have come through part of the way. They involve less fuss. Sometimes no incision is needed because access is already there. Others have roots bent like hooks. Those roots are first separated with an instrument and then removed one by one, as delicately as possible, as though each were a particularly stubborn negotiator.

Then there's the tooth that hasn't even come through yet but has already made its neighbour's life difficult by preventing it from coming through properly. In that case, it isn't a fully developed tooth that is removed, but the tooth germ, its early developing form. The procedure is short and barely noticeable. X-rays taken three weeks apart show how quickly the neighbouring tooth moves into line in the dental arch once the obstruction is gone.

And then comes the most interesting part: life after the extraction.

The patient is given a list of things they absolutely must not do and, as a rule, immediately forgets half of it. So let's go through it again.

Don't rinse your mouth or apply heat to the sore area. It's easy to wash away that blood clot, without which healing takes much longer. Put physical exertion on hold for a couple of days: the more active you are, the higher your blood pressure, which is the last thing a fresh wound needs. Saunas and hot baths are temporarily off the menu for the same reason. Don't eat until the numbness has completely worn off, or you may badly bite your lip, tongue or cheek and not notice until the evening. Once you can eat, chew on the opposite side so you don't disturb the fresh socket.

You still need to brush your teeth, using a soft toothbrush and taking particular care around the extraction site. If a white coating appears, don't panic: it isn't a sign of inflammation but fibrin, a normal part of healing.

On the day of the operation, apply ice to the cheek in short sessions to help prevent swelling. Don't overdo it, though: over-chilling your lymph nodes would be quite an achievement.

The dentist usually also prescribes antibiotics and anti-inflammatory medication. Inflammation likes to turn up uninvited where wisdom teeth are concerned, so it's better not to let it in. It's also worth looking after your gut flora: a plain yoghurt over the next few days certainly won't go amiss.

If the patient hasn't improvised and has listened to the dentist rather than the neighbour with forty years' experience on internet forums, complications are rare. But they do sometimes happen. So after the extraction, we have a simple agreement: we explain what to do next, and you don't turn recovery into a personal science experiment. If something isn't going as we discussed at the appointment, or simply worries you, contact the clinic and ask. You don't need to become an expert in every complication the internet can dig up before you call us.

P.S. Having a wisdom tooth removed doesn't make you any less wise. Especially if you're wise enough to ask your dentist rather than convene a panel of experts in the comments section.