Oral Surgery
Wisdom Tooth Pain and When It Needs Removing
Wisdom teeth arrive between the late teens and mid twenties, into a jaw that has usually finished growing. When there is room they erupt and cause no trouble at all. When there is not, they come in at an angle, partly through the gum, or stay buried against the tooth in front.
A tooth that is not causing problems and can be kept clean does not need to come out. The decision should rest on what the tooth is actually doing, not on the fact that it exists.
What impaction means
An impacted wisdom tooth is one that cannot fully erupt into position. It may be tilted forwards into the second molar, lying horizontally, or held under bone.
The problem case is partial eruption, where a flap of gum sits over part of the crown. Food and bacteria collect underneath it and cannot be brushed out. That leads to pericoronitis, which is the swollen, painful gum around a partly erupted wisdom tooth that most people arrive complaining about.
An x ray is what settles the question. It shows the angle, the root shape and, importantly, how close the roots sit to the nerve running through the lower jaw.
Reasons to take it out
Repeated episodes of pericoronitis, decay in the wisdom tooth or in the second molar next to it, a cyst forming around the crown, or pressure that is damaging the root of the tooth in front. Pain that returns every few months rather than settling for good is its own answer.
Reasons that are not sufficient on their own include a tooth that is fully erupted, functional and cleanable, or a single episode of soreness that resolved and has not returned.
- Infection around the gum flap that keeps coming back
- Decay in the wisdom tooth or the molar in front of it
- A cyst or damage showing on the x ray
- Pain that recurs rather than resolving
What the procedure involves
A straightforward erupted wisdom tooth comes out much like any other extraction, under local anaesthetic, in a few minutes. An impacted tooth needs a small incision in the gum, sometimes removal of a little bone, and the tooth is often sectioned so it can be lifted out in pieces through a smaller opening. Sectioning sounds worse and is usually gentler on the surrounding tissue.
You are numb throughout. You will feel pressure and hear noise, but not pain. Most single impacted teeth take between twenty and forty minutes.
Recovery, honestly
Swelling peaks around day two or three and then improves. Expect three to five days before you feel normal for a surgical removal, less for a simple one. Ice on the cheek for the first day helps, warm salt water rinses from day two onwards.
Do not rinse hard, spit forcefully or use a straw for the first twenty four hours. All three can dislodge the clot and leave you with a dry socket, which is genuinely painful and easily avoided.
Take the painkillers before the anaesthetic wears off rather than waiting for pain to arrive. Eat soft food on the other side, keep the rest of your mouth clean, and call us if swelling is increasing after day three instead of settling.
In short
- A clean, functional wisdom tooth can usually stay
- Repeat infection or decay in the tooth in front is a clear reason to remove it
- An x ray decides the approach and shows where the nerve runs
- No straws, no forceful rinsing and no spitting for the first day