Wisdom teeth are the last molars at the back of the mouth, and they usually come through between the late teens and mid-twenties. Many people do not have room for them. A wisdom tooth that is stuck against the tooth in front or trapped under the gum is “impacted”, and impacted or partly-erupted wisdom teeth are behind most of the pain, swelling and infection people experience at the back of the jaw.
Not every wisdom tooth needs to come out. Many come through without trouble, and many that are impacted never cause a problem. The ones that cause pain, repeated infection or damage to the tooth in front are the ones we recommend removing.
Why wisdom teeth hurt
- Pericoronitis: the gum flap over a partly-erupted tooth traps food and bacteria and becomes infected. This causes swelling, pain, a bad taste and sometimes difficulty opening the mouth. It is the most common cause of wisdom tooth pain and often comes and goes.
- Pressure as the tooth tries to erupt against the tooth in front.
- Decay in the wisdom tooth, or in the tooth in front of it, because the area is so hard to clean.
- Gum disease around the wisdom tooth.
- Less commonly, a cyst forming around an unerupted tooth.
How we assess it
We will look at the area, check how far the tooth has come through and how the gum around it looks, and take an X-ray to see the position of the tooth, its roots and their relationship to the nerve that runs through the lower jaw. That tells us whether the tooth is likely to settle, whether it needs removing, and how straightforward removal would be.
Treatment options
For a one-off episode of pericoronitis, cleaning under the gum flap, a warm salt-water rinse and sometimes a short course of antibiotics will settle it. If the same tooth keeps flaring up, or it is damaging the tooth in front, removal is the sensible choice.
Most wisdom teeth, including impacted ones, are removed here under local anaesthetic, with IV sedation available if you would prefer to be relaxed for it. Very deeply impacted teeth, or those lying close to the nerve, may be referred to a specialist oral surgeon. Afterwards you can expect some swelling and discomfort for a few days, which painkillers manage well, and we will give you clear instructions for looking after the socket.
Looking after a troublesome wisdom tooth
- Clean the area carefully with a small-headed or single-tufted brush
- Rinse with warm salt water, especially after eating, when the gum is inflamed
- Avoid chewing on that side while it is sore
- Do not ignore repeated flare-ups; each infection is a little harder to clear than the last
