Methods of removing wisdom teeth from the lower jaw

The removal of wisdom teeth is a common operation, but it can cause short-and long‐term side effects. People may have their wisdom teeth removed if they are causing pain or infection, or if they are damaging other teeth or not breaking through the gum properly. Surgery has a risk of complications. One of the most common is dry socket. This is when a blood clot fails to form in the socket that the tooth has come out of, or the clot is disturbed before the socket has properly healed. The bones and nerves underlying the socket may be exposed, and it can be a very painful condition.

What was the research?

This research is a systematic review to find out the benefits and harms of different ways of removing wisdom teeth from the lower jaw. We wanted to know how to reduce the risk of complications following surgery. The complications we looked at included: dry socket, infection, excessive bleeding, a broken jaw, and long‐term damage to the nerves supplying sensation to the tongue and skin of the lower lip and chin.

Who conducted the research?

The research was conducted by a team led by Edmund Bailey from Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK, on behalf of Cochrane Oral Health. Wafa Kashbour, Neha Shah, Helen V. Worthington, Tara F. Renton, and Paul Coulthard were also on the team.

What evidence was included in the review?

Data was extracted from 62 randomised controlled trials. A total of 4,643 people participated in the trials. Many studies excluded people who were not in excellent health so the participants in the trials may not be representative of the population.

What did the evidence say?

The available evidence is inconclusive. The studies looked at the position of the cut in the gum, the type of surgical tool used, and the method of stitching the gum after removing the tooth, and the evidence on complications was unclear. Whether adding saltwater to the clean the tooth socket after the tooth has been removed can stop an infection from developing was also unclear. Placing products that are derived from the patient’s own blood into the tooth socket may help to reduce the occurrence of dry socket. These products are known as platelet-rich plasma, or platelet-rich fibrin.

How good was the evidence?

All of the studies were quite small. The quality of the studies varied, with most having flaws that could have biased their results. In addition, some of the results were very unreliable, with differences between them that could not be explained. For these reasons, we consider the available evidence to be uncertain. Future research may be able to provide dental surgeons and patients with clearer conclusions.

What are the implications for oral surgeons and the general public?

This review provides a description and analysis of the evidence from randomised controlled trials, so that oral surgeons can make informed choices about which method to use when removing wisdom teeth from the lower jaw. It is not possible to recommend changes to surgical practice. The evidence is uncertain, though we note that there is some limited evidence that placing blood products in sockets may reduce the incidence of dry socket.

What should researchers look at in the future?

Although there are a large number of studies on this topic, they were small studies of variable quality. New studies should be conducted according to the CONSORT guidance. 


Bailey  E, Kashbour  W, Shah  N, Worthington  HV, Renton  TF, Coulthard  P. Surgical techniques for the removal of mandibular wisdom teeth. Cochrane Database of Systematic Reviews 2020, Issue 7. Art. No.: CD004345. DOI: 10.1002/14651858.CD004345.pub3.

This post is an extended version of the review’s plain language summary, compiled by Anne Littlewood at the Cochrane Oral Health Group Editorial Base.

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