Wisdom Tooth Removal in Ukraine

Wisdom teeth are the third molars, the last in the row. They are the last to come through, usually at 17–25 years of age, when the jaw is fully formed and there is often no room left in the dental arch. As a result, a wisdom tooth either does not come through at all (impaction) or comes through partially and at an angle (malposition).

Removal is needed when the tooth is causing a problem. The indications are: an impacted tooth presses on the neighbouring second molar, and resorption or decay appears on its root or back surface; the flap of gum over a partially erupted wisdom tooth becomes inflamed (pericoronitis) and the inflammation keeps coming back; the tooth itself is destroyed by decay, and its canals cannot be reached with instruments and filled; a follicular cyst is visible on the scan around an impacted tooth; an orthodontist is planning to move teeth, and the wisdom tooth is in the way.

Now the other side, which is mentioned less often. A properly erupted, upright wisdom tooth that has an opposing tooth, does not hurt and can be reached with a toothbrush does not have to be removed. Removing all four wisdom teeth "just in case" has not been shown to be beneficial: when there are no symptoms, monitoring with an examination and a scan every year or two is an acceptable approach.

In some situations a planned extraction is postponed or agreed with another specialist first: the acute phase of an infectious disease, uncontrolled diabetes, taking anticoagulants, treatment with bisphosphonates or denosumab, a history of radiotherapy to the head and neck, pregnancy. The surgeon asks about each of these before the procedure, not after it.

MediUkraine is a service that finds and coordinates treatment; it is not a clinic. Oral surgery for our patients is carried out at Vidnova Dental Clinic in Lviv. We arrange the date, pass on the quote and support patients, including those travelling from abroad. Whether you need an extraction is decided by the surgeon after an examination and a scan.

If the panoramic X-ray shows the roots close to the nerve canal, the doctor orders a CT scan, and it determines the further plan. It shows how many roots the tooth has, which way they are angled, whether the tips are curved, how dense the surrounding bone is and, above all, where the mandibular canal with the inferior alveolar nerve runs. When a root lies right against the canal, the plan changes: a different technique is chosen, and sometimes the roots are deliberately not removed in full. On a panoramic X-ray, indirect signs suggest the canal is close: darkening of the root where it crosses the canal, narrowing or deviation of the canal, interruption of its cortical outline; if these are seen, the surgeon orders a three-dimensional scan.

For upper wisdom teeth a different neighbouring structure is critical: the floor of the maxillary sinus. The roots of the third molar are often separated from it by a layer of bone less than a millimetre thick, and sometimes protrude into the sinus. The CT scan shows this in advance, so the surgeon can work more cautiously and, after the extraction, check that the sinus floor is intact with a nose-blow test.

The tooth's position is described using standard classifications: by how deep it lies relative to the neighbouring molar and the ramus of the jaw, and by its angle of tilt. A wisdom tooth may stand upright, tilt forward towards the second molar (mesioangular position) or backward (distoangular), or lie horizontally. A mesioangular tilt is what most often causes decay in the neighbouring tooth, while distoangular and horizontal positions are considered the most difficult to extract.

Anaesthesia for work on the lower jaw is a nerve block: the anaesthetic is delivered near the inferior alveolar nerve, and half of the jaw goes numb together with the lip and tongue. For upper teeth, infiltration anaesthesia is enough. Articaine with a vasoconstrictor is used; for patients with cardiovascular disease there are forms with a reduced concentration of adrenaline or with none at all. If you find dental treatment hard to cope with, sedation is added, either inhaled, with a mixture of oxygen and nitrous oxide, or intravenous, and an anaesthetist is then present at the appointment. General anaesthesia is rarely used for this procedure, and only when specifically indicated.

Simple extraction applies to a tooth that has fully erupted and can be reached with instruments. The surgeon releases the gum attachment around the tooth, loosens it with an elevator to break its attachment to the socket, and removes it with forceps. The socket is then inspected, granulation tissue and remnants of the dental follicle are cleared, and the edges of the gum are brought together. A stitch is not always needed. It takes about 15–20 minutes.

Complex (surgical) extraction is needed when the tooth is impacted or lies at an angle. The sequence is as follows. First the surgeon makes an incision in the gum and lifts a mucoperiosteal flap, exposing the bone over the tooth. Then, using a bur with constant irrigation, they remove only as much of the bone over the crown as is needed for access. Next the tooth is sectioned into fragments: the crown is cut away from the roots, the roots themselves are separated from each other if needed, and each fragment is removed separately. This is the step that keeps the operation conservative: removing the tooth in pieces is easier than levering it out whole, and less bone has to be removed. Finally the socket is rinsed, sharp edges are smoothed, and the flap is put back in place and secured with sutures. Sutures are removed on day 7–10, unless absorbable sutures were used.

When a root lies tight against the mandibular canal, a coronectomy is discussed: deliberate removal of the crown only, leaving the roots in the bone. The logic is simple: the roots are not pulled out, so the nerve next to them is not injured, and over time bone grows over the retained roots. The method has its limits: it is not suitable when the roots are infected or mobile, and some patients later need a repeat procedure because the retained roots migrate upwards. The decision is made after the CT scan and a discussion with you.

Piezosurgery may be used on the bone instead of a bur. An ultrasonic tip selectively cuts mineralised tissue and does not damage the soft tissue, blood vessels or nerve on accidental contact. The procedure takes longer, but some patients have less swelling afterwards. The choice of instrument depends on the specific case and on the clinic's equipment.

Age matters too. At 18–25 the roots of a wisdom tooth are often not yet fully formed, the bone is more elastic, the procedure is tolerated more easily and the socket heals faster. After 35–40 the roots are fully formed and sometimes fused with the bone, so both the operating time and the recovery period increase. This is one of the arguments for dealing with a problematic wisdom tooth without delay.

Extraction is not the only option, and it is worth asking about the alternatives. With pericoronitis, the acute inflammation is treated first, and the flap of gum is sometimes removed (operculectomy): this helps, but if space is short the inflammation returns, so it is regarded as a temporary measure. The wisdom tooth itself can be given root canal treatment if it stands upright, can be reached with instruments and is needed to support a prosthetic restoration or is the only molar on that side. Sometimes a wisdom tooth is deliberately kept so that it can later be moved orthodontically into the place of a lost second molar. The final choice between treatment, monitoring and extraction depends on the scan, the condition of the neighbouring teeth and plans for prosthetic work.

The first two hours set the tone for the week. Bite on the gauze pad for 20–30 minutes and then remove it: there is no point keeping it in longer, as it becomes soaked and itself turns into a source of infection. A blood clot should form in the socket; it is what covers the bone and the nerve endings. Do not eat or drink for two hours.

Do not rinse your mouth on the first day. Vigorous rinsing washes out the clot, and without it the bone is exposed and alveolar osteitis develops: a dry socket with sharp pain on the third or fourth day. For the same reason, do not drink through a straw, spit, smoke or apply heat to the cheek: suction and heat are equally dangerous for the clot. From the second day, use mouth baths instead: take the solution into your mouth, hold it there without swishing and let it out.

Swelling is not a complication but an expected tissue reaction. It builds up and peaks on day 2–3, then subsides; trismus, which makes it hard to open the mouth wide in the first days, passes at the same time. Apply cold only in the first 24 hours, for 15–20 minutes at a time with breaks.

Pain is strongest on the first and second days and is relieved with ordinary painkillers, ibuprofen or paracetamol, at the dose the doctor specifies. An antibiotic is not prescribed for everyone, only where indicated: purulent inflammation before the procedure, a long traumatic operation, or coexisting illnesses with reduced immunity. Do not start one on your own "as a precaution".

For the first few days, eat soft, warm (not hot) food and chew on the other side. Avoid alcohol, saunas, swimming pools, bending over and the gym for at least 3–5 days. Brush your teeth from the first day, steering around the socket: skipping hygiene does more harm than a careful touch.

Typical timelines: most people return to their normal routine within 3–7 days, sutures are removed on day 7–10, the soft tissue over the socket closes in approximately 2–3 weeks, and the bone continues to remodel for another 3–6 months, which is why a follow-up X-ray, if needed, is taken no earlier than a few months later. See a dentist urgently if pain gets worse from the third or fourth day, a foul taste appears, your temperature is above 38 °C, swelling increases after the third day, bleeding does not stop, or numbness of the lip lasts more than a day.