In short
Most oral and maxillofacial procedures are low risk and performed under local anaesthesia as day cases. The main specific risks are temporary nerve numbness, bleeding, infection and swelling. Serious complications are uncommon, and risk depends far more on the individual case and the surgeon than on the specialty.
The short version
- The majority of procedures are day cases under local anaesthesia, not hospital admissions under general anaesthesia.
- Nerve numbness after lower wisdom tooth surgery is usually temporary; permanent change is uncommon and is quantifiable beforehand.
- Your medical history and smoking affect outcomes more than most patients expect — disclose everything.
It is a fair question, and it is asked less often than it should be — usually because patients worry it sounds distrustful. It does not. Asking about risk is the sensible thing to do before any surgical procedure, and a surgeon who is uncomfortable discussing it is telling you something useful.
The honest answer is that most of what this specialty does carries low risk, and that the specific risks which do exist are well characterised and worth knowing in detail.
Most of it is smaller than people imagine
The mental image of maxillofacial surgery tends to be an operating theatre and general anaesthesia. In practice the bulk of the work — impacted wisdom teeth, surgical extractions, biopsies, small cyst removals, implants, apicectomies — is carried out in a dental chair under local anaesthesia, takes under an hour, and you go home afterwards.
You are awake, you feel pressure but not pain, and you drive yourself home unless sedation was used.
General anaesthesia is reserved for the genuinely major work: multiple facial fractures, corrective jaw surgery, large tumour resection, and reconstruction. That is a different conversation with its own pre-operative assessment.
The specific risks, named
Nerve injury. This is the one that matters most in lower jaw surgery. The inferior alveolar nerve supplies sensation to the lower lip and chin; the lingual nerve supplies the tongue. Lower wisdom teeth sometimes sit directly against the former.
Temporary altered sensation is not rare and usually settles within weeks. Permanent change is uncommon. Crucially, the risk is not uniform — it is specific to how your tooth sits, which is exactly what three-dimensional imaging is for. A surgeon who has looked at a CBCT can tell you whether your case is low risk or one of the rarer high-risk ones, rather than quoting a general figure.
Bleeding. Oozing for several hours is normal. Significant bleeding is uncommon in healthy patients but more likely on anticoagulants, which is why your medication list matters. Do not stop blood thinners on your own initiative — that carries its own risk, and the decision belongs with the prescribing doctor.
Infection. Infection after a clean surgical procedure is uncommon. Dry socket after lower extractions is more frequent — intensely painful around day three to five, but readily treated.
Swelling and restricted opening. Expected rather than a complication. Swelling peaks around day two to three and then declines. Jaw stiffness after lower wisdom teeth is normal and eases over a week or two.
Sinus communication. Upper back teeth sit close to the sinus and an opening can occur during extraction. Small ones close on their own; larger ones are repaired at the time.
What raises your risk
Some of this is within your control, which is the useful part.
Smoking is the single largest modifiable factor. It restricts blood supply to healing tissue, substantially raises dry socket rates and is the commonest reason implants and grafts fail. Stopping even for the fortnight around surgery helps measurably.
Uncontrolled diabetes impairs healing and raises infection risk. Controlled diabetes is manageable; uncontrolled is a reason to wait.
Blood thinners, bisphosphonates and immunosuppressants all change the plan. Bone-density medications in particular carry a small risk of impaired jaw healing after extraction, and the surgeon must know about them in advance — including medications stopped a year ago.
Leaving it late. An infection treated on day two is a minor matter. The same infection on day six, having been suppressed with over-the-counter antibiotics, may need drainage and admission.
What reduces it
Proper imaging before surgery rather than estimating from a flat film. A surgeon who performs the procedure often. A full and honest medical history, including things that feel irrelevant. Following aftercare instructions, particularly about not smoking and not disturbing the clot. And attending the review appointment, because most complications are easy to manage when caught early and unpleasant when not.
What recovery actually looks like
Patients tend to fear the procedure and underestimate the few days afterwards, when it is usually the reverse.
For a surgical wisdom tooth extraction, expect the anaesthetic to wear off after two to four hours, with discomfort managed by the medication you are given. Day one is swelling and a soft diet. Day two to three is peak swelling and the stiffest jaw opening, which is the point at which people become convinced something has gone wrong — it has not; that is the normal curve. From day four onward it improves steadily, and most people are comfortable within a week. Sutures, if used, are removed around day seven.
Taking two or three days away from demanding work is sensible for lower wisdom teeth. Most patients overestimate how much time they need for upper teeth and underestimate it for lower ones.
Anaesthesia, and why local is usually better
There is a persistent assumption that being asleep is safer or kinder. For the majority of oral surgery, local anaesthesia is the lower-risk option — it avoids the systemic risks of general anaesthesia entirely, requires no fasting, no recovery ward and no escort home, and the surgical field is identical.
For patients who find dental treatment genuinely distressing, sedation sits between the two: you remain able to respond but are relaxed and typically remember little. That is a reasonable middle path and worth asking about rather than enduring the procedure anxious.
Please do say if you are frightened. It changes how the appointment is run — longer slots, a stop signal agreed in advance, each step explained before it happens — and none of that is unusual to ask for.
Consent should be specific
Being handed a form listing every conceivable complication is not informed consent. What you should receive is the risk for your case: not “nerve damage is possible” but whether your particular root is near the nerve, and what that means for you.
If a surgeon cannot tell you that, they have not looked closely enough yet.
For surgical consultations at our Khurram Nagar or BKT clinics, risks are discussed case by case before anything is scheduled. For urgent problems — spreading swelling, difficulty swallowing, bleeding that will not settle — call rather than book online.
Frequently asked questions
Usually not. Most procedures — including impacted wisdom teeth, biopsies, cyst removal and implants — are done under local anaesthesia while you are awake but numb. Sedation can be added for anxious patients. General anaesthesia is reserved for major trauma reconstruction, corrective jaw surgery and extensive tumour work.
Any altered sensation of the lip, chin or tongue after lower wisdom tooth removal usually resolves within days to a few weeks. A small proportion takes several months. Permanent change is uncommon, and the risk for your particular tooth can be estimated beforehand from imaging showing how close the root lies to the nerve.
Yes, provided blood sugar is reasonably controlled. Uncontrolled diabetes impairs healing and raises infection risk substantially, so surgery is usually best deferred until control improves. Bring your recent HbA1c and your medication list to the consultation.
Bleeding that does not settle with firm pressure after twenty minutes, swelling that increases rather than decreases after day three, fever, difficulty swallowing or breathing, or pain that worsens after day three rather than improving. Any of these means contacting the clinic the same day.
Worried about any of this?
An article cannot examine your mouth. Call and describe the problem — we will tell you honestly whether you need to be seen urgently or whether it can wait.