Introduction to wisdom teeth removal
The removal of wisdom teeth is a procedure that involves one or more (there are generally four wisdom teeth, although this is not always the case) being surgically removed. Your wisdom teeth are permanent adult teeth, often referred to as third molars, found at the back of your mouth and are located at the top and bottom corners.
If your wisdom teeth do not have room for growth they may either come in skew or not erupt through the gums like your other adult teeth did, this is known as impaction. Impacted teeth can often be painful or cause dental issues such as infection and the teeth will have to be removed (pulled). A dentist or oral surgeon is likely to perform the surgery.
Oral surgeons and dentists will often recommend that your wisdom teeth are removed even when they are not causing any issues as dental problems arising in the future are often inevitable because of these teeth.
What are my wisdom teeth?
Your wisdom teeth are your third and the last molars located on either side of your lower and upper jaws. These are the final adult teeth to erupt and typically appear when you are in your late teenage years or during your early twenties.
Why do I need wisdom teeth if they have to be removed?
Some anthropologists believe that our wisdom teeth are an evolutionary result of the diet of our early ancestors which consisted of more rough foods like nuts, meats and roots. These foods often required more chewing and therefore resulted in more wear than we experience today. With our more modern diets consisting of softer foods and the aid of eating utensils to help cut our food into bite size portions, the need for these extra teeth has become almost non-existent.
Experts believe that the reason why wisdom teeth result in a number of issues is due to the evolutionary changes humans have undergone. The most significant of which is the expansion of the human brain, as a result, our jaws have had to constrict and become narrower in order to still be able to connect with the lower portion of our skulls. Therefore, we no longer need these teeth.
Some people are, therefore ‘evolving’ to have one or more of their wisdom teeth ‘missing’.
Why are they called wisdom teeth?
These third molars were originally referred to as the ‘teeth of wisdom’ in the 17th century and were referred to as ‘wisdom teeth’ from the beginning of the 19th century onwards.
These teeth usually erupt or appear considerably later than the other teeth (normally when you are somewhere between 17 to 25 years old as opposed to your permanent adult teeth which are usually fully developed by the age of 12 or 13), as such, you are seen as a young adult and ‘wiser’ than you were when your other adult teeth emerged in childhood. It is for this reason that linguists believe that the third molars were termed the ‘teeth of wisdom’ and later ‘wisdom teeth’.
In more recent times, scientists have added some truth to the idea of the third molars appearing when you are indeed ‘wiser’. Recent research shows that our brains continue to develop through adolescence with some experts suggesting that the brain only stops developing after we have turned 25.
With this in mind, it only makes sense that our ancestors thought these teeth were, in fact, our ‘teeth of wisdom’ as they are a sign of the innocence and carefree days of childhood being behind us and therefore welcome maturity and adulthood with their eruption.
How do I know if I have wisdom teeth?
You will know if you have wisdom teeth when you feel them growing or rather, ‘coming’ in. You can often feel these teeth breaking through the surface of your gums which can feel a little painful. You may be able to feel the pressure of them growing which is accompanied by a dull throbbing in your gum. Most people have four wisdom teeth, each one located at a back corner of your mouth, although some people may be ‘missing’ one or more wisdom teeth which are simply non-existent. Genetics often influence whether or not you get these teeth.
If one of your wisdom teeth is impacted under the gingival tissue, you will not be able to feel or see it and may therefore not even know it exists. As impacted teeth are not visible, your dentist will need to verify their presence through a panoramic radiograph which is a form of X-ray that aids in assessing the angle of the tooth’s growth and its current state of development.
**My Med Memo – An impacted tooth is one that is somehow blocked when it tries to push through the gingival tissue (gum tissue) of the mouth. Wisdom teeth are the most commonly impacted teeth. Therefore, the tooth fails to break through the gum and erupt within its expected window of development.
When to see a dentist
It is advised that you see your dentist for a check-up (part of your annual or bi-annual check-up) if you are suffering from any discomfort or severe pain as a result of impacted wisdom teeth. The dentist will examine your teeth and then advise you as to whether or not they should be removed.
Should your dentist think that you need to have your teeth removed, he or she will conduct an X-ray of your mouth to get a clear indication of the position of your wisdom teeth.
What kind of specialist will remove my wisdom teeth?
An oral or maxillofacial surgeon will typically perform the tooth extraction. These types of specialists are orthopaedic facial surgeons and are able to treat a wide range of dental issues, specifically, the removal of impacted teeth.
Why do I need to have my wisdom teeth removed?
The third molars or wisdom teeth do not develop in some people, however, for others, these teeth will erupt normally and not result in any issues. But the majority of people will develop impacted teeth, meaning their wisdom teeth do not have enough space to erupt and develop normally in the mouth. Your wisdom teeth may therefore only erupt partially or they may not erupt at all.
A wisdom tooth that is impacted may cause the following issues:
- Growing towards the second molar causing damage to it
- Growing at a 90-degree angle to your other teeth
- Growing towards the back of your mouth
- Growing straight down or up just like your other teeth, but the wisdom tooth stays trapped under the jawbone
Can wisdom teeth cause other teeth to shift or crowd?
For a rather long time, it has been thought that wisdom teeth are able to ‘push’ the front teeth together and thus cause the teeth to crowd, as a result, a number of oral surgeons, general dentists and orthodontists have recommended that their patients have their wisdom teeth extracted so as to prevent teeth crowding, specifically after corrective orthodontic treatment has been conducted.
Recently, there has been a large amount of well-documented research done that disproves the theory of wisdom teeth exerting the amount of pressure needed to affect the front teeth and move them. This well-validated research consisted of studies tracking patients over a period of 25 years and determined that the teeth will move or drift forward naturally throughout a person’s life, regardless of any orthodontic treatment that has taken place. This natural drift is known as a ‘mesial drift’ and refers to an individual’s lower canine teeth getting narrower or constricting over time, this shift also takes place in those who are missing their back teeth.
It is still not completely understood as to why this shifting takes place, but what is known is that the wisdom teeth do not play a role in this. Therefore, wisdom teeth will only be removed if they are impacted and are currently or could potentially cause issues.
Issues with impacted wisdom teeth
In some cases, it may not be necessary to remove wisdom teeth even if they are impacted, as they may not be causing any issues or pain. Your dentist will decide on what benefit the removal of these teeth will have and evaluate the complications and risks associated with the removal.
In other situations, if wisdom teeth are impacted or haven’t broken through the gum surface fully a number of dental issues can ensue. Bacteria and food can get caught around the edges of your wisdom teeth and result in plaque accumulating. This plaque build-up may lead to one or more of the below issues:
- Dental caries (tooth decay) – Tooth decay will develop as a result of plaque destroying the tooth’s surface. As tooth decay advances, it will leave cavities (holes) in your teeth and this is able to affect the surrounding teeth. Cavities are permanently damaged areas of the teeth that are able to impact other teeth as the bacterial infection which causes cavities is able to spread to adjacent teeth.
- Periodontal disease (gum disease/gingivitis/periodontitis) – Gum disease occurs as a result of plaque build-up releasing toxins that irritate and inflame the gums, resulting in your gums becoming swollen, painful and red. This is known as gingivitis as it only affects the gum tissue which is able to progress and affect the teeth and bone as the gums recede and become further infected, this stage of progression is known as periodontitis and will need to be treated by a dental specialist.
- Pericoronitis – This is an infection that occurs when plaque causes the surrounding soft tissue of a wisdom tooth to become infected. This form of infection is commonly affects impacted wisdom teeth where the gingival tissue overlaps the crown (chewing surface) of the tooth.
- A dental abscess – An abscess is when a collection of pus occurs in the tooth or in the tissue surrounding the tooth. A dental abscess is often the result of an untreated injury or cavity and will need to be drained and treated.
- Cellulitis – This is a common bacterial skin infection that may develop in the tongue, cheek or throat as a result of an impacted tooth. This infection is caused by bacteria entering a crack or cut in the tissue and forming inflammation and redness.
- Benign growths and cysts – In rarer cases, a wisdom tooth may form a cyst when the tooth has not broken through the gum tissue. A cyst is a collection of fluid that results in swelling and pain.
The majority of the issues and infections that are associated with impacted wisdom teeth are easily treated with antiseptic mouthwash or antibiotics, therefore, the removal of your wisdom teeth will only be recommended by some dentists when the other forms of treatment have been deemed ineffective. However, a number of dentists will suggest the removal of your wisdom teeth to prevent further infection.
Preventing future dental issues
Dental specialists will often disagree about whether or not there is always value in removing impacted wisdom teeth if there are no associated issues. Impacted wisdom teeth that do not cause any issues are referred to as asymptomatic (showing no symptoms).
It is difficult for even the most experienced professionals and specialists to predict whether there will be future issues with wisdom teeth that are impacted. However, there is a rationale that is used for removal of asymptomatic wisdom teeth. This rationale is as follows:
- Wisdom teeth that are symptom-free may still be able to harbour disease and infection
- If there is not an adequate amount of space for a tooth to erupt and develop, it may be difficult to clean the tooth properly and this will allow for the accumulation of plaque
- Severe complications regarding wisdom teeth tend to occur less commonly amongst younger adults, when the teeth are removed much later in life the risks are often increased due to advanced age and decreased strength and resilience of the individual (older adults tend to take longer to recover from surgery)
Risks for having wisdom teeth removed
The majority of wisdom teeth removals will not result in any complications long-term. However, the extraction of wisdom teeth will often require a specific surgical approach which involves the specialist cutting through your gum tissue and removing the bone. After the teeth and bone have been removed, there will be a socket left behind, this is known as a surgical wound. Some complications that rarely occur may include:
- Infection forming in the socket as a result of trapped food or bacteria
- Damage done to surrounding teeth, jawbone, sinuses or nerves
- Painful and dry socket, or the bone being exposed when the blood clot (post-surgery) is lost
How do I prepare for my wisdom teeth extraction?
Your dentist can sometimes perform the wisdom teeth removal in his or her office, however, this is not always the preferred choice, particularly if the surgery requires the removal of multiple teeth or a more in-depth approach, in these instances the surgery will be performed by an oral maxillofacial surgeon in hospital. The surgeon will use a local anaesthetic to numb the area as well as a general anaesthetic (in most cases) to allow for you to be comfortable and not feel any pain during the procedure.
The surgery itself is routine and commonly performed worldwide. There is very little that can go wrong and the procedure itself is relatively quick.
There are a few questions you may have for your oral surgeon (to whom you will be referred by your dentist) which might include:
- How many of my wisdom teeth are being removed?
- What kind of anaesthesia will be used? Will I be awake?
- Are there any complications you are expecting to face for this surgery?
- How long will this surgery take?
- Have my impacted wisdom teeth already done any damage to the adjacent teeth? If so, what can be done about this?
- Are there any risks of nerve damage occurring?
- Are there any dental treatments that I might require later on?
- How long will it take for me to heal completely and return to my normal activities?
Wisdom teeth removal surgery
Preparing for surgery
For wisdom tooth/teeth removal, you will be checked into hospital as an outpatient, this means you will be able to go home on the same day as the surgery.
The hospital and your oral surgeon will give you instructions on what you will need to do prior to the surgery and on the day of surgery.
In order for you to be fully prepared, you may ask the below questions:
- Will someone need to drive me home once the surgery is over?
- What time should I arrive at the hospital or dental clinic?
- Should I avoid drinking or eating anything before the surgery and for how long prior to it?
- Am I able to take any prescription medications I have before the procedure?
- Should any nonprescription drugs be avoided before my surgery?
During the procedure
Your oral surgeon or the anaesthetist overseeing your procedure is likely to use one of the three types of anaesthesia below. The type chosen will depend on your medical history, the expected level of complexity of the surgery, your surgeon’s preferences and your level of comfort.
These anaesthetic options include:
- Local anaesthesia – Your oral surgeon will administer a local anaesthesia by injecting the sites of extraction one or more times. Before receiving the injections, your surgeon may apply a topical cream or gel-like substance to the gums to numb the pain. You will be awake during the wisdom tooth extraction and will feel some pressure and movement, but you should not experience any pain.
- Sedation anaesthesia (conscious sedation) – Sedation anaesthesia will be given to you by your oral surgeon intravenously through an IV line put into your arm. This form of anaesthesia will result in your consciousness being suppressed for the procedure. You will not experience any pain during the procedure and will not be able to talk and are likely to fall asleep. Your anaesthetist or oral surgeon will also give you a local anaesthesia to numb the gums.
- General anaesthesia – This form of procedure is often the preferred method of anaesthesia as it will allow you to lose all consciousness. You may have an IV line put into your arm for the anaesthesia to be administered or you will inhale the medication in through a mask that will be placed over your mouth, you may also have both the mask and the IV line. The surgical team will closely regulate and monitor your temperature, breathing, blood pressure and the administration of the medication. You will not remember the procedure at all and will not experience any pain. A local anaesthesia will also be given to aid in any post-surgical pain.
During wisdom tooth extraction, your oral surgeon will:
- Make an incision (cut) in your gum tissue in order for the bone and tooth to be exposed
- Remove any bone that is blocking access to the root of the tooth
- Divide the wisdom tooth into various sections to make it easier to remove the tooth in pieces (this is not always necessary)
- Remove the tooth
- Clean the site from which the tooth was removed and remove any debris from the bone or tooth
- Stitch the wound site closed in order to allow for healing to take place (this is not always necessary; however, your oral surgeon will typically use dissolvable stitches that will dissolve as the wound heals if it is)
- Place gauze on the wound in order for bleeding to be controlled and promote the formation of a blood clot
All of the above is normally done in less than two hours.
After the procedure
If an anaesthetist placed you under general or sedation anaesthesia, you will be taken into a recovery room once the procedure is over, in this room your vitals will be monitored as you will be prompted to slowly wake up. Once a nurse or specialist deems you stable and ready, you will then be taken to a hospital room where your oral surgeon is likely to meet you to discuss how the surgery went. If you were given a local anaesthetic, then your recovery will take place in a dental chair and be brief.
As you begin to heal from the surgery, it is advised that you follow your dentist or oral surgeon’s advice on the following:
- Bleeding – There may be some blood oozing on the first day after your surgery. You will taste this in your mouth and it is advised that you avoid excessively spitting this out so as to not dislodge or prevent a blood clot from forming on the socket. If your surgeon placed gauze over the socket then this will need to be replaced according to his or her instructions.
- Managing pain – Your dentist or oral surgeon may prescribe painkillers, these will be particularly helpful in easing any pain, especially if bone was removed. Your specialist is likely to give you pain medication such as Vicodin (Hydrocodone) and Motrin (Ibuprofen). You may also be able to manage any pain with over-the-counter medications such as Tylenol (acetaminophen) amongst others. You may also be given a cold pack or have one at home, holding this softly against your jaw can help with pain management.
This pain will begin to subside within the recovery period of three to four days. However, this will depend on the extent of the surgery conducted.
- Bruising and swelling – As mentioned, use a cold pack to help with any bruising and swelling. If you suffer from bruising, this will take a number of days to disappear. People often note that they resemble a ‘chipmunk’ because of their swollen cheeks, this swelling will subside within a few days, although it is important to bear in mind that swelling can last for as long as two weeks for some.
- Partaking in activities – It is advised that you plan on resting for the duration of the day after the surgery, . Normal activities such as walking and making yourself food can be resumed the following day. However, you will need to avoid all forms of strenuous activity for a week or more (as per your doctor’s instructions).
- Exercising - A number of dental surgeons will recommend that you hold off on physical exercise (gym and other forms) for as long as ten days after surgery. There are some signs you can look out for to know that it is safe to exercise again such as cessation of bleeding, reduction in swelling and the return of an overall feeling of wellness. However, take note of lightheadedness when exercising as you may have been eating less during your time of healing. If you experience any dizziness or pain when exercising then stop. It is advised that you exercise at a lower intensity until your normal diet of solid foods is in place and your energy levels have returned. A general rule of thumb is to wait until you have finished your prescription pain medications as this will give you some indication regarding your current pain levels which may have previously been masked by the medication.
- Drinking liquids – Your oral surgeon will advise you to drink larger amounts of water than you are used to aid in hydrating you after surgery. Steer clear of any alcoholic, carbonated, caffeinated or hot drinks for the first day (24 hours) after surgery. Speak to your dentist about drinking from a straw as this is sometimes not recommended as the sucking motion associated with straws can dislodge blood clots. You will also need to avoid hot foods and beverages for the first few days as these may be able to contribute to swelling and irritate the surgery site.
- Eating – You will only be allowed to eat soft foods such as custard, yoghurt and jelly for the initial 24 hours after surgery. You can start eating more semi-soft foods once you are able to tolerate these. Eating will be difficult for the first few days and you should stock up on foods you can eat before the procedure. Remember to chew away from the surgical sites. Try to not miss a meal as nourishment is vital for healing. Avoid any spicy or hot foods as these may agitate the wound site. A meal replacement shake may be recommended if you feel that you cannot eat as this can help to provide the calories and nutrients your body requires.
- Cleaning the mouth – Rather than brushing your teeth, you will need to rinse with a mouthwash for the first 24 hours after the surgery. You should not vigorously rinse your mouth in the first 24 hours. The day after surgery you will need to rinse your mouth every time you eat. You can use a teaspoon of salt in a cup of warm water. You will usually be able to return to brushing your teeth the day after surgery, but be mindful to do so gently. You may have to rinse your mouth after meals for the first week if you cannot tolerate brushing.
- Stop using tobacco products – You will not be permitted to smoke for the first 72 hours after the surgery, and it is best if you wait longer. Chewing tobacco will not be allowed for a week or more. Tobacco products will delay healing after surgery and can increase your risks of any complications developing.
- Dealing with the stitches – Your stitches will likely dissolve completely within a week or two. If you have the type of stitches that need to be removed, then your surgeon will schedule an appointment to do so. Some of the dissolvable stitches may come out when you are eating or drinking and you may be able to feel them. This is normal but it is advised that you do not touch the wound or stitches with your hands or tongue as this can agitate the area and slow healing process.
When to call your oral surgeon or dentist
You will need to contact your oral surgeon or dentist if you suffer from one or more of the below symptoms as these may indicate nerve damage, infection or other severe complications:
- Excessive bleeding that persists for longer than 24 hours and cannot be stopped with gauze.
**My Med Memo – Some bleeding after surgery is to be expected. A large amount of bleeding (granted it is not an emergency situation) can be controlled by first rinsing your mouth and then placing a pad of gauze or a damp tea bag on the wound site and biting down on this firmly with a constant pressure for about 30 minutes. A tea bag is beneficial in reducing bleeding as tea contains tannic acid (a type of tannin) which aids in the promotion of a blood clot forming through contracting the blood vessels.
- Difficulty breathing or swallowing
- Swelling that progresses after two or three days
- Severe pain that is not relieved by any of your prescribed medications for pain
- Pus present in and/or being discharged at the surgical site
- Pus or blood in your nasal discharge
- Persistent loss of feeling or numbness
How long does it take to recover from a wisdom teeth extraction?
Healing will take between ten and 14 days, you can return to school or work three or four days after the operation. But it will depend on how you are feeling and your level of pain and swelling. Some people prefer to not return to school or work until the swelling has gone down completely.
The different types of wisdom tooth impactions and what they mean
What are wisdom teeth impactions?
When one of your wisdom teeth cuts through your gum and becomes visible, this is known as an eruption. An impaction is when one of these third molars (wisdom teeth) does not erupt properly.
There are four different kinds of impactions, some of which require the removal of the tooth/teeth concerned and others may be perfectly harmless. These four impactions will be explained in detail in the section that follows.
A number of dentists and patients alike assume that an impacted tooth will need to be extracted, however, removal is not always necessary and each case should be examined thoroughly and a full set of dental X-rays conducted in order for an informed decision to be reached.
The tooth is angled forward towards the front end of your mouth (this is the most common type of impaction).
This impaction refers to when the tooth is faced at an angle towards the front of your mouth. The tooth will push up against the second molar that it is located next to. The tooth’s angle of mesial impaction is what will determine if it is an issue or not.
Most cases of mesial impactions will lead to a partial eruption of the tooth where just the crown of the tooth will erupt through the gums. In a number of instances, the tooth does not have to be removed and over time the tooth might properly erupt. If it is clear that the tooth will never erupt then your dentist may suggest you have it removed to prevent further issues arising in future.
The teeth have an orientation that is relatively normal.
This kind of impaction does not normally require the tooth to be removed. The tooth is very close to having a normal orientation with a high chance of erupting and fitting into your mouth without causing any serious issues.
Should a vertically impacted third molar need to be removed, it will be due to the fact that it is pushing up against the second molar’s underside or against the bones at the back of your mouth. Vertically impacted teeth are sometimes hard to remove and can damage bone areas and surrounding teeth, however, these kinds of complications are rare.
Angulation that is directed towards the back of your mouth.
This kind of tooth impaction is rare and is the opposite of a mesial impaction due to the tooth being angled towards the back of your mouth. The removal of these kinds of impactions will depend on the degree of the angle and any issues it may be causing. In most cases, dentists will wait a year or two before deciding on whether or not the tooth should be removed.
Alignment where the tooth is lying on its side.
This kind of impaction is often seen as the worst type for one to have. The tooth will be angled completely on its side (horizontally) and be positioned towards the second molar. It will also run parallel to your jawbone. This kind of impaction will cause damage to the surrounding teeth and is likely to require removal.
The issues that are presented by this kind of impaction may present a challenge in surgery and it requires a great deal of skill for teeth impacted in this way to be removed. You will generally be placed under general anaesthesia as this kind of extraction will require bone removal.
Further teeth impaction classifications
In combination with the above-mentioned classifications, wisdom teeth are further categorised as bony or soft-tissue impactions. These are described further below:
A hard tissue or bony kind of impaction refers to when the tooth is situated primarily inside of the jawbone. When the tooth is completely covered by bone this is referred to as a full-bony impaction. A partial-bony impaction is when the tooth has erupted slightly.
A soft tissue kind of impaction refers to one that involves the upper part of the wisdom tooth, this is known as the crown of the tooth, penetrating through bone but not having erupted fully through the gingiva (gum tissue).
What happens if I don’t have my wisdom teeth removed?
As previously stated, the reason why impacted wisdom teeth are removed is to treat any current infection that they may be causing and/or to prevent any potential damage to the surrounding teeth. It is often the case that wisdom teeth will erupt and grow perpendicularly to the surrounding teeth, i.e. the second molars. If your wisdom teeth erupt sideways in this way, they can disrupt your bite and form an area for food and bacteria to collect, which may result in inflammation and infection that is often painful.
Some people may never get their wisdom teeth or they may never erupt. If wisdom teeth are left in without being checked by a dentist, there is a chance of them causing infection and issues arising if they damage the other teeth.
It is advised that you make an appointment to see your dentist if your wisdom teeth are causing any pain or discomfort, or if there is visible infection and inflammation of the gums surrounding them (this is usually indicated by pain, swelling and redness of the gums).
How long so I have to wait until I eat after having my wisdom teeth removed?
You should be able to start eating semi-soft foods within a few days after surgery, but if you experience any pain or discomfort, it is advised that you stick with soft foods until you feel you are well enough to move into harder foods. Bear in mind that pain killers can often mask any pain you may experience, so it is suggested that you wait a day or two until you eat semi-soft foods and at least a week until you eat chewy, crunchy or spicy foods. Most people tend to feel better within three days post-surgery, however, healing can take anywhere from a few days to a few weeks.
How do I sleep after having my wisdom teeth removed?
In order for choking to be prevented while you are sleeping, you MUST REMOVE GAUZE when you sleep. When you want to sleep, prop your head and upper body up on a pillow or try sleeping on a reclining chair so as to prevent post-surgery bleeding. It is advised that you keep your head elevated for a day or two after surgery.
You should feel comfortable with lying on your side on the second day after surgery, however, it is best for you to keep your upper body as upright as possible even when sleeping on your side.
What kind of foods can I eat after I have had my wisdom teeth removed?
It is vital that you don’t skip any meals and try to maintain as much of a healthy diet as you can. The following are some soft food options that have some kind of nutrition to them:
- Soft pudding
- Mashed potatoes
- Smoothies (there are a number of different health smoothies you can make with fruits and vegetables)
- Ice cream (this is more of an indulgent food)
Should I take arnica to prevent swelling before my wisdom teeth removal surgery?
Arnica is a herb (used in homeopathic treatments) that is thought to control bruising, reduce pain and swelling in postoperative settings. As such, many people take arnica (or more specifically arnica montana, perioperatively (before, during and after the procedure) when having wisdom teeth surgery.
Pain reduction linked to routine dental extractions has been found in placebo-controlled trials of homeopathic arnica1,2,3, however dual double-blind randomized trials have shown no effect on pain, swelling or bleeding after the removal of impacted wisdom teeth4,5.
- Pinsent RJFH, Baker GPI, Ives G, Davey RW, Jonas S. Does Arnica reduce pain and bleeding after dental extraction? MHRG Newsl 1984;11: 71-2
- Bendre VV, Dharmadhikari SD. Arnica montanaand Hypericum in dental practice. Hahnemannian Gleanings 1980;47: 70-2
- Albertini H, Goldberg W, Sanguy BB, Toulza C. Homeopathic treatment of dental neuralgia using Arnica and Hypericum: a summary of 60 observations. J Am Inst Homeopath 1985;78: 126-8
- Kaziro GSN. Metronidazole (Flagyl) and Arnica montanain the prevention of post-surgical complications, a comparative placebo controlled clinical trial. Br J Oral Maxillofacial Surg 1984;22: 42-9 [PubMed]
- Lökken P, Straumsheim PA, Tveiten D, Skjelbred P, Borchgrevink CF. Effect of homoeopathy on pain and other events after acute trauma: placebo controlled trial with bilateral oral surgery. BMJ1995;310: 1439-42 [PMC free article] [PubMed]