Are you around your early twenties? Are the teeth at the back of your mouth, commonly called the wisdom teeth, aching? Does it hurt when you bite down or drink hot or cold liquids? You may have to go for wisdom teeth extraction. This is a common case that dentists see often, but if this is the first time your tooth is hurting you might not know what to do. Let me, Dr Feng, guide you through what to do when your wisdom teeth are in trouble.
What is a wisdom tooth?
A wisdom tooth refers to the tooth, specifically the third molar, that grows at the back of the mouth between ages 17-25. People can have up to 4 wisdom teeth. They are the last set of teeth to grow.
Wisdom teeth normally emerge when there is enough room for them to grow. However, there are cases where they can cause problems, such as when they grow inwards or get stuck and grow at an angle. In these cases, we call the wisdom teeth ‘impacted’. 
What can cause wisdom teeth to ache?
Impacted wisdom teeth may ache as they try to grow but are blocked by another tooth. Sometimes, if your wisdom teeth have partially grown, properly called partially erupted teeth, they may cause issues such as Pericoronitis. This refers to inflammation and infection of the gum around the partially erupted wisdom teeth. Wisdom teeth, like other teeth, may fracture and cause pain. 
An aching tooth may feel like a throbbing, sharp, or constant pain that is focused around a gum area. The pain may get worse when you bite down or when hot or cold liquid passes over the aching tooth. 
Who can be affected by wisdom teeth problems?
While the statistics are not clear, It seems up to 40% of the population can have impacted wisdom teeth. More males than females seem to have issues with their wisdom teeth.   Whether or not there are problems, wisdom teeth extraction is a common procedure.
What happens if I do not seek treatment for my aching wisdom teeth?
Within a short period of time, aching wisdom teeth probably means that you will not be able to use that side of the mouth to chew. If left untreated for a long period of time, the effects of an untreated toothache can cause toothache with swelling. Tooth decay can start in other teeth, and you may end up needing a root canal treatment. So do see a dentist as soon as you can once your teeth, start aching. 
I have a bump on my gums. Is this from wisdom tooth growth or simply an infection?
It is hard to know whether a bump is caused by a wisdom tooth growing or an infection without any knowledge in the dental field. To find out, it is best that you consult your dentist. They will first examine the mouth so as to find the cause of the bump, but more often than not a bump can develop due to:
soft tissue factors - bony growth and tooth
A bump can also be caused by gum, bone, or tooth issues. There are tests to check for these conditions. Another reason for a bump is trauma. Often, trauma will affect soft tissues. For example, if a bump is caused by a gum issue, a gum inflammation test will pick it up. However, in some cases, it could be a combination of issues. For example, I see a lot more patients coming in with a combination of gum and teeth problems.
What should a patient know before committing to a wisdom tooth extraction?
It is very important to know the risks that come along with wisdom tooth extraction. This includes rare complications such as nerve damage and radiation. To ensure that you are fully aware of the possible risks, you will have to sign a consent form before any treatments can be done. You should also be informed of the costs of your treatments or procedures.
One common question my patients usually ask me is how long the downtime is after the extraction. Depending on the severity of the case, downtime length will vary. Downtime often also means different things to different people. It could mean different things such as:
- When will the extraction hole close?
- How long will I have pain for?
- How long will it swell for?
Therefore it is good to ask your dentist more specifically what you mean by downtime. 
What should I ask my dentist during the consultation?
Here are some questions you can ask your dentist:
- Do I really have to go through the procedure? Why?
- How much is it?
- Will there be any potential problems?
- Are there any other ways apart from extraction?
- Do I need sedation?
How would a patient know how complex their wisdom tooth extraction cases are without a medical professional?
The important question to ask is whether you can see your wisdom tooth through a mirror. Being able to see the wisdom tooth popping out through the gums means that it is a less complex case. In other words, the more buried the tooth is, the more complex the case. When the tooth is more superficial and further away from the nerve, it is easy to remove it. I will take a lot of time uncovering your tooth as that is time well spent.
If the tooth is lying flat but I can still see it, it will be an easier extraction as compared to a buried tooth. This is because when the tooth is more superficial and further away from the gums I will spend a lot less time uncovering your tooth. But a tooth that is cracked is automatically more difficult to remove.
How much does it typically cost to have wisdom teeth extracted?
If the procedure is non-surgical, it will usually be just over $100. If it requires surgery, it may range between $500-$1000 as a private patient in a public institute,  to $500- $2200 in private clinics. Below is a table of the costs of extracting impacted wisdom teeth in Singapore.
Impacted Wisdom Tooth surgery cost (average)
Changi General Hospital (CGH)
Khoo Teck Puat Hospital (KTPH)
National Dental Centre Singapore (NDCS)
Ng Teng Fong General Hospital (NTFGH)
National University Centre for Oral Health, Singapore (NUCOHS)
Tan Tock Seng Hospital (TTSH)
Assuming you visit a private clinic, the price varies according to:
- The location of your clinic,
- The experience of your dentist - a specialist will cost much more,
- The severity of your extraction.
It also depends on whether you would want to use MediSave. For some clinics, when you use MediSave, the cashout can be as low as $0. 
What are some steps that I can take to prepare myself for the extraction procedure?
It is important that you go to a good dentist who is knowledgeable as well as experienced. A doctor who is great at patient reassurance can help you to relax when you are nervous. In fact, this can help to reduce the cost of sedation.
If you have any phobias of dentists or anxiety, do inform your dentist so that they can prepare a more tailored treatment to help you overcome them. I understand that some patients do get scared as it feels as though we dentists are invading your personal space. You can take anti-anxiety pills as a way of temporarily tackling the issue.
I believe that it is important to build a rapport and relationship with all my patients. Especially for patients who are extremely nervous, what I will usually do is prepare the patient as much as I can. Besides that, I will also reassure them by detailing the steps I would take during the procedure. That way, the patient knows exactly what I am doing. This often relaxes the patients, making them more comfortable than before.
What are the steps in getting wisdom tooth extracted?
I usually spend a lot of time on consultation. During the consultation, it is important that I adequately inform the patient, you, what will happen. I also then take data to decide what tests need to be done. This is important as there is a higher risk of radiation when using certain tests, so to ensure patient safety I only use required tests. As always, I will tell you all the possible risks you might face. Consent is very important, so you will have to sign a consent form after being informed.
Next is the procedure. Before undergoing the procedure, I will inform you of what to do after the procedure. This might seem strange, but I have found that after a procedure patients generally feel too tired to take instructions. Therefore it is best to know what to do after the procedure in detail before we begin, with a quick reminder after the procedure is done. This will help to ensure your safety, comfort, and well-being.
Last, there will be 1 or 2 review sessions. You may come back for removal of stitches or if any complications arise.
What do you normally do if a patient is afraid of any form of pain?
Most of the time, patients are more aware of their dental anxiety when they are on the dental chair. As I have mentioned, if you are nervous, I usually let you know:
- The steps I will be taking,
- The amount of pressure you will feel,
- The amount of force I need to use,
- The sounds you can expect to hear, such as the cracking of teeth.
Some dentists may try to relax you with some background music. If music helps you relax better, do inform your dentist if any arrangements can be made. Generally, we would like to keep the surgery short as possible. 
Have you had any interesting cases that we can learn from?
I had an interesting experience with a patient that is an active gym-goer. He had an extraction done and he came back within 3 hours with a lot of blood coming out from his mouth. He had gone to the gym soon after the extraction! This happened because after an extraction procedure you are advised to not do anything that pumps your heart rate too much. For example, going to the gym in this case. To prevent complications, it is important to follow the advice of your dentist, one of which is not to exercise after your extraction!
One common thing I see in my patients is that many are unsure of how to treat their socket. When the tooth is removed, you are actually not supposed to rinse the area much. For the socket to heal, clotting has to occur. However, rinsing will disrupt the clotting process, which results in delayed healing.
Tips for staying comfortable post-extraction
Put your feet up and relax. I always tell my patients to chill out and ensure that they do get some time to rest after the procedure. Besides that, icing is another way to help with your post-extraction. Some patients actually say that having an ice cream after extraction is nice and soothing. Your call!
Feeling pain in your mouth can be scary when it happens. That is a good time to visit your dentist and explore what issues may be causing the pain. It is normal and okay to be scared; many other people as scared as you have managed to tackle their fears and receive treatment with the help of their dentists. You can be sure that you will get through this trying period too!
Dr Jacqueline Feng is a Hong Kong Canadian who graduated from the University of Toronto with a Bachelor of Science Honours degree. She subsequently obtained her second degree from the University of Liverpool with a Bachelor of Dentistry. Having graduated over 10 years ago, Dr Jacqueline has worked in many settings including private and UK government clinics, special needs centers, kids only clinics, dental emergency centers in various UK hospitals plus hospital orthodontics and oral surgery attachments.