Wisdom Tooth Pain: How Do I Know If It Needs to Come Out?

Pain at the very back of the mouth is often blamed immediately on a wisdom tooth. That is often exactly where the problem is coming from. But pain alone does not automatically mean the tooth needs to be removed.

At D4 Dentist, we examine whether the tooth is causing a recognised clinical problem such as recurrent infection around the gum, tooth decay, an abscess, damage to the neighbouring tooth or, more rarely, a cyst or other pathology.

If the wisdom tooth is healthy and is not causing an ongoing problem, removal may not be necessary at all.

Why do wisdom teeth cause pain?

Wisdom teeth, or third molars, are the last adult teeth to develop. There is not always enough room for them to come through normally.

A tooth may become impacted, meaning that it is partly or completely prevented from erupting into its normal position.

Partially erupted wisdom teeth can be particularly troublesome because food and plaque can collect around the tooth and beneath the surrounding gum.

This can lead to:

• inflammation or infection of the gum around the tooth, known as pericoronitis

• tooth decay

• gum disease

• food trapping

• an abscess

• damage to the neighbouring second molar

• more rarely, a cyst or other pathology around an unerupted tooth

Your symptoms may include pain or tenderness behind the last molar, swollen gum, difficulty opening your mouth, a bad taste, swelling or discomfort when biting.

Does a painful wisdom tooth always need to come out?

No. - This is an important distinction. Evidence-based guidance does not recommend routinely removing healthy impacted wisdom teeth simply because they are impacted.

A first episode of mild pericoronitis does not necessarily mean the tooth should immediately be extracted either. The area may first be cleaned and treated appropriately, then reviewed.

Removal becomes more likely when there is a clear ongoing problem such as repeated episodes of pericoronitis, significant infection, decay that cannot reasonably be restored, an abscess, disease affecting the surrounding tissues, damage to the tooth beside it or cystic change.

If the tooth is healthy and not causing problems, monitoring may be entirely appropriate.

How do we decide?

We start by listening carefully to what has been happening.

Is this the first episode? Has the gum become swollen several times? Is food continually catching around the tooth? Is there pain from the wisdom tooth itself or from the tooth immediately in front of it?

We then examine the area and will use an X-ray where removal is being considered. This allows us to assess the position of the tooth and the shape and position of its roots.

With lower wisdom teeth, their relationship to nearby nerves is also important when planning treatment.

The decision to remove a wisdom tooth should therefore be based on the individual tooth and the problems it is causing, rather than on the fact that it is a wisdom tooth.

What happens if it does need to be removed?

Some wisdom teeth are relatively straightforward to extract. Others are partly or completely beneath the gum or bone and need a surgical extraction.

The area is normally numbed thoroughly with local anaesthetic. You should not feel pain during the procedure, although pressure and movement are normal.

If the tooth is impacted, the dentist or oral surgeon may make a small incision in the gum. A small amount of surrounding bone may need to be removed, and the tooth may be divided into smaller sections so that it can be removed safely.

The area is cleaned afterwards and stitches may be placed. These are often dissolvable.

Sedation may be considered for particularly anxious patients or more difficult procedures. Some complex wisdom teeth may be referred for specialist oral surgery treatment.

What should I expect afterwards?

Recovery varies considerably according to how difficult the extraction was.

A straightforward extraction may cause relatively little disruption. Surgical removal of an impacted tooth generally produces more swelling, stiffness and discomfort.

Pain after the procedure is expected and is usually managed with the pain relief recommended for you by your dentist.

It is also normal for your jaw to feel stiff and for chewing to be uncomfortable for a few days.

How much swelling is normal?

Some swelling of the cheek and the tissues inside the mouth is normal after surgical wisdom tooth removal.

It does not necessarily appear immediately. Swelling commonly becomes more noticeable during the first two to three days after surgery before gradually settling. Bruising can also occur.

Most of the discomfort and swelling improves steadily afterwards, although it can take up to a couple of weeks for everything to feel completely normal following a more involved extraction.

What concerns us more is swelling that becomes increasingly severe rather than beginning to settle, particularly when accompanied by fever, discharge, worsening pain or feeling generally unwell.

Can I go back to work after wisdom tooth removal?

For many patients, yes, but it is sensible to plan around the type of extraction you are having. At D4 Dentist, we will normally recommend taking a day off work or planning your extraction in the afternoon so that you can go home afterwards.

After a relatively straightforward removal under local anaesthetic, some people feel well enough to return to normal activities the following day. However, a complicated procedure may need rest and a little more recovery from moving the jaw.

The HSE advises that your dentist may recommend taking one or two days off work. More difficult surgical extractions can require a little longer.

Your type of work also matters. Someone working at a desk may return sooner than somebody whose job involves heavy physical activity.

We generally advise avoiding strenuous exercise and high-effort physical activity for the first few days because this can encourage bleeding and interfere with early healing.

If you have sedation or a general anaesthetic, there are also specific restrictions around driving and returning to normal activities.

What should I do during the first 24 hours?

One of the most important parts of early healing is allowing a stable blood clot to form in the socket where the tooth was removed.

For that reason, you will normally be advised during the first 24 hours to avoid:

• vigorous rinsing

• spitting repeatedly

• smoking

• alcohol

• very hot drinks

• strenuous exercise

Choose soft foods and follow the individual instructions your dentist gives you.

Gentle rinsing with warm salt water or an appropriate mouthwash is generally started after the first 24 hours rather than immediately after the extraction.

What is dry socket?

Dry socket, or alveolar osteitis, is one of the complications patients often worry about following a wisdom tooth extraction.

When a tooth is removed, a blood clot normally forms inside the socket. This protects the underlying tissues while healing begins.

In dry socket, that clot either does not form properly or is lost before the socket has healed sufficiently.

The result can be quite intense aching or throbbing pain that develops or becomes significantly worse a few days after the extraction. The pain may extend into the jaw and sometimes towards the ear or temple. An unpleasant taste or smell can also occur.

Dry socket is different from a normal level of post-operative soreness.

If your pain had been manageable and then becomes markedly worse after a few days, contact your dentist.

How is dry socket treated?

Dry socket needs dental treatment, but it does not automatically mean you have an infection. The socket can be gently irrigated to remove debris and, where appropriate, a soothing medicated dressing can be placed.

Pain relief is also important. Antibiotics are not routinely required for dry socket unless there are separate signs of spreading or systemic infection.

Smoking increases the risk of developing dry socket, which is another important reason to avoid smoking during healing.

When should I contact my dentist urgently?

Contact your dentist if you have severe or worsening pain, heavy or persistent bleeding, increasing swelling, discharge, a high temperature or a bad taste accompanied by worsening symptoms.

Significant facial or neck swelling associated with difficulty breathing or swallowing requires emergency medical assessment.

The main thing to remember

Wisdom tooth pain does not automatically mean extraction. Sometimes an inflamed area can settle and the tooth can be monitored. In other situations, repeated infections, decay or damage to surrounding structures make removal the more predictable long-term option.

The important part is establishing which situation you are dealing with.

At D4 Dentist, we assess the tooth itself, the surrounding gum, the tooth beside it and its position on X-ray before recommending removal.

If extraction is appropriate, we will also explain what the procedure involves, what recovery is likely to look like and any individual risks before treatment goes ahead.

Book your next appointment with D4Dentist today.