Wisdom tooth extraction surgery waiting times update

Wisdom tooth extraction summary

Most people's wisdom teeth grow normally, but if your mouth does not have enough room for them other teeth can obstruct their growth and can affect dental health significantly.

In most cases, wisdom teeth should not need to be removed, but if you develop or keep getting infections then extraction may be necessary.

Do wisdom teeth always need extracting?

If you have enough room in your jaw, wisdom teeth will generally emerge, end up in a good position and should cause no problems. You may feel some discomfort as your wisdom teeth come through, but as soon as they are fully in position the sensation should go away. Wisdom teeth that have failed to grow properly are termed 'impacted', but may not necessarily cause you any problems.

Types of impacted wisdom teeth

Wisdom teeth can become impacted in different ways:

• Mesial impaction - the wisdom tooth grows at an angle facing toward the front of the mouth
• Horizontal impaction - the wisdom tooth grows horizontally and pushes against the neighbouring tooth
• Distal impaction - the wisdom tooth turns away from the tooth next to it and stays in that position
• Vertical impaction - the wisdom tooth grows down but impacts against the neighbouring tooth

Complications of impacted wisdom teeth

If the wisdom tooth has grown awkwardly, it may be difficult to keep clean. Plaque may start to build up around it, leading to an infection called pericoronitis that causes pain and swelling. A build-up of plaque can also cause tooth decay (dental caries) in the wisdom tooth itself or in the tooth next to it. Gum disease (periodontal disease) can affect the surrounding teeth as well as the bone. Cysts can also form around a developing wisdom tooth, if it cannot grow through properly.

Antibiotics can clear up infection, but they will not stop it from reoccurring. The only permanent solution is to have the offending tooth (or teeth) removed.

How are wisdom teeth extracted?

Wisdom tooth removal is one of the most commonly performed operations in the UK ⁽¹⁾.

Depending on the individual patient and how difficult the operation is going to be, wisdom tooth extraction can be performed under a local anaesthetic - you will be awake during the procedure - or under a general anaesthetic, where you will be asleep the whole time. If you are having a local anaesthetic you will not feel any pain, but if you feel nervous you may also be given a sedative drug to relax you.

Wisdom teeth can be taken out easily most of the time, but if the tooth has failed to come through fully, the dentist or surgeon may need to cut into the gum.

If the tooth is growing in such a way that it is partly stuck underneath the bone, some of the bone will be removed, usually by being drilled away. In more complicated cases, the tooth may have to be broken into several pieces (again using a drill), which are then removed separately.

Once the tooth has been removed, you may need dissolvable stitches to repair any cuts in your gums.

The operation itself may last from just a few minutes to 20 minutes ⁽²⁾.

NHS versus private

If you do not want to be put on a waiting list for wisdom tooth removal, or you feel that the waiting times are too long, then you can have private treatment.

The cost of removal of wisdom teeth will vary according to the difficulty of the procedure and whether it is being carried out in a dental practice or hospital. You should get a written estimate before starting treatment.

Waiting times for wisdom tooth extraction surgery

Government targets have gone some way to reducing waiting times, especially for high-volume procedures, such as wisdom tooth extraction surgery.

Dr Foster Health data shows that waiting times for wisdom tooth extraction surgery by Strategic Health Authority (SHA) rose in 2006/7 but fell again in 2007/8:

What is a Strategic Health Authority? Strategic Health Authorities (SHAs) were formed by the government in 2002 to manage the local NHS on behalf of the Secretary of State. There are now 10 SHAs whose key role is to act as a link between the Department of Health and the NHS.

Hospital length of stay for wisdom tooth extraction surgery

Figure 2 below shows you how long you can expect to stay in hospital after wisdom tooth extraction surgery according to your age group. Wisdom tooth extraction surgery is generally a day case, which means you will probably not need to stay overnight in hospital.

Inpatient spell: a patient's stay in hospital, consisting of at least one finished consultant episode (period of care under one consultant/team)

When is wisdom tooth extraction appropriate?

Wisdom teeth were often removed in the past, even if they were not causing any problems. These days things are different - impacted wisdom teeth that do not cause any problems are left alone. The reason for the change of focus in wisdom tooth extraction surgery was due to a number of clinical studies ⁽³⁾ which found that there was little benefit to the patient for the removal of disease-free wisdom teeth. The studies also noted that it was not worth operating on healthy impacted wisdom teeth, because the procedure carried significant risks, such as damage to facial nerves and neighbouring teeth ⁽⁴⁾.

The British Dental Association and the Royal College of Surgeons advised against the operation and in 2000 the National Institute for Health and Clinical Excellence (NICE) ruled against the practice.

NICE Guidance regarding wisdom teeth removal surgery states that there is no reliable clinical evidence to suggest there is any benefit in removing wisdom teeth that cause no problems.

Wisdom tooth extraction operations have fallen from nearly 130,000 a year back in 1995 to the present figure of 60,000 a year. The reduction in unnecessary wisdom tooth extraction surgeries has saved the NHS more than £10m ⁽⁴⁾ and has also reduced unnecessary risk to patients.