Why do wisdom teeth hurt?
Wisdom teeth are the last teeth to come in, right at the back, and there is often not quite enough room for them. That causes trouble in a few ways:
- Partial eruption. The tooth breaks through the gum only partway, leaving a flap of gum over part of it. Food and bacteria collect under the flap, and the gum becomes infected and swollen. This is called pericoronitis, and it is a common reason a wisdom tooth hurts.
- Crowding. A tooth coming in at an angle, or without room, can press against the tooth in front of it.
- Decay. A wisdom tooth is hard to reach with a brush, so it decays easily, and so can the back of the tooth in front of it, where food packs in between the two.
Relief at home
For a sore, swollen gum around a wisdom tooth, these help while you arrange to be seen:
- Rinse with warm salt water several times a day, especially after eating, to flush out the area under the flap.
- Keep it clean. Brush gently right to the back, even though it is sore, so food does not sit there.
- Take an over-the-counter pain reliever as the label directs.
- Do not hold aspirin or any tablet against the gum. It burns the tissue.
When is wisdom tooth pain urgent?
A sore wisdom tooth can often wait for an ordinary appointment. Some situations cannot. Go to the emergency room now if swelling is closing an eye or spreading down your neck, or if you are having difficulty breathing or swallowing. Those need a hospital first, and we will take care of the tooth afterward.
Call us promptly if the pain comes with any of these, because they mean the infection is spreading beyond the gum flap, and it needs treating as soon as a dental abscess would:
- Swelling of the gum, cheek or jaw.
- Difficulty opening your mouth fully.
- Pain when you swallow.
- A fever, or swollen glands under the jaw.
What we do when you come in
Here in Pearisburg, the first step is an exam of the tooth and the gum around it, and an X-ray. The X-ray sensors are digital, so the exposure is a fraction of what film needed. The X-ray shows what a mirror cannot: the angle of the tooth, how much room it has, whether it is decayed, and whether it is harming the tooth in front of it. It also helps rule out other causes, because pain from grinding or from the jaw joint can feel as if it comes from the back teeth.
If there is an infection, the first job is to calm it. That usually means cleaning out the area under the gum flap, with antibiotics when the dentist judges they are needed.
Then one of two things happens, and we explain which, and why, before you leave. Either it is something we treat here, such as a cavity in the wisdom tooth or the tooth in front of it, which a tooth-colored filling can repair, or a gum flap that settles once it is kept clean. Or we refer you to an oral surgeon, and tell you what they will be looking at and why.
Does every wisdom tooth need to come out?
No. A wisdom tooth that has come in straight, has room, and can be kept clean can often stay. One that keeps getting infected, is decaying, or is damaging the tooth in front of it usually needs something done, and we will explain the options and who should carry them out.
If the pain settles, that is good news, but the cause is usually still there, and an infected gum flap tends to flare up again. It is worth having the tooth looked at even once it has calmed down, so any decision about it is made on a quiet day rather than a painful one.
Looking after wisdom teeth that stay
Wisdom teeth that stay need the same care as the rest, with a little more effort. Angle the brush right to the back, floss behind the last tooth, and keep up with cleanings and exams, where X-rays let us watch how the tooth sits over time and catch decay while it is small.
Questions patients ask
Why does my wisdom tooth hurt?
Usually because the gum over a partly erupted tooth has become infected, the tooth is pushing against the one in front, or there is decay on the wisdom tooth or its neighbor. An exam and an X-ray tell us which. Until then, warm salt water rinses and careful cleaning help.
Can wisdom tooth pain go away on its own?
An irritated gum flap can settle with good cleaning and rinses, and the pain may fade. The cause is usually still there, though, so it tends to come back. It is worth having it examined even after it calms down.
When is wisdom tooth pain an emergency?
Call promptly for swelling, a fever or difficulty opening your mouth. Go to the emergency room if swelling is spreading down your neck or toward your eye, or if you have difficulty breathing or swallowing.
Will I be referred to an oral surgeon?
Sometimes. After the exam and X-ray, we either treat the problem here or refer you to an oral surgeon, and we explain which, and why, before you leave. If there is an infection, calming it comes first.