Wisdom Teeth

Wisdom teeth can hurt because of decay in the tooth itself progressing into the nerve of the leading to persistent sensitivity. Furthermore, Impacted wisdom teeth can also cause decay in the adjacent teeth. Improper oral hygiene can also cause gum disease and inflammation around the wisdom tooth.

This can quite often be due to difficulty in accessing this area as it is right at the back of the mouth. If the inflammation persists, this can cause the gums to swell up and lead to discomfort. If the opposing wisdom tooth compresses these inflamed gums, it can further worsen the pain and swelling.

They should only be removed when necessary. Guidelines created by the national institute of clinical excellence (NICE) have provided certain situations where they should be removed, which is based on the most relevant and up to date clinical research. Situations where there is decay in the wisdom tooth, decay in the tooth adjacent, several infections requiring 3 or more courses of antibiotics, or one severe infection are just some of the indications for removal of wisdom teeth.Ultimately, removing them must provide some benefit to you, but this should be weighed up against the risks.

Whenever we treat patients, there must be a benefit, which must outweigh the risks. The main risks are pain, swelling, bleeding, infection, stitches, damage to adjacent teeth and retained roots. There is also a nerve in very close proximity to lower wisdom teeth which can be susceptible to damage. This risk can vary from person to person and often depends on how close the nerve actually is to the wisdom tooth. This must be imaged with a special form of imaging known as OPG (orthopantomogram) / DPT (dental panoramic tomogram) and nowadays 3D scanning with a CBCT (cone beam computerised tomography) is also common practice.

Whilst the risk of nerve damage is quite low in general, if nerve damage does occur, there can be persistent numbness, pain or altered sensation of the lip, chin and tongue which may or may not recover. This is why it is important to be seen and treated by a suitably trained clinician to assess, diagnose and treat you accordingly.

Nowadays with the advent of good local anaesthesia and intravenous sedation availability the removal of wisdom teeth is uncomfortable at worst. However, wisdom teeth that are deeply imbedded within the bone may require a surgical approach with bone removal. If this is the case it is generally the post operative swelling which causes pain afterwards. If this is controlled with local measures such as ice packs and regular anti-inflammatory drugs, the pain can be well tolerated. If you are unlucky to suffer with an infection, this can cause pain which can be remedied by seeing the relevant clinician and treat it accordingly.

Not necessarily, there are alternative less invasive options which may be more suitable.

Deep cleaning – this can be done with a hygienist or dentist who can then provide some oral hygiene instructions to ensure the area is kept as clean as possible.

Smoothing the opposing wisdom tooth – The pain from wisdom teeth can often come from the gums around them being inflammed. On biting, if the opposing wisdom tooth compresses these inflamed tissues it can result in worsening pain and inflammation. By smoothing this opposing wisdom tooth, it can often alleviate the symptoms without having to remove the wisdom tooth with inflamed gums.

Remove the opposing wisdom tooth – Quite similar to the example above, the removal of the opposing wisdom tooth can be considered if smoothing it doesn’t help.

This is usually reserved for situations where the lower wisdom tooth is quite close the nerve (mentioned above) and is at risk of being damaged. This prevents running the risk of damaging the nerve and removes the problem of the opposing wisdom tooth crushing and compressing the inflamed gums.

As long as there is no dental disease in the wisdom tooth, adjacent teeth or surrounding region, there is no adverse risks in leaving them as they are as long as good oral hygiene is maintained. It is therefore important to regularly visit the dentist to ensure that the wisdom teeth are in good health in addition to the rest of the mouth.

Wisdom teeth erupt between the ages of 18-25 on average but can occur earlier and even later.

To avoid swelling up, we advise that you take the relevant anti-inflammatory medications as prescribed by your dentist, use local measures such as ice packs and sleep slightly upright.

The cost can vary depending on the extent, severity and procedure involved. But is charged between £350-£450

It is firstly most important to identify the cause of the wisdom tooth pain which will then help manage it appropriately. By seeking a dentists opinion they will be able to provide the best way to manage the pain. In the interim warm salty mouth rinses are good in addition to chlorhexidine based mouthwashes which are routinely available from your local pharmacy. Routine pain killers as best advised by your GP or pharmacist are also recommended whilst you are waiting for your dental appointment.