Wisdom teeth pain - or as it's properly called pericoronitis.

(or, teething!)

This page about wisdom tooth infections was originally created as a response to my daughter and her friends - it's amazing how many students have wisdom tooth or teeth pain, particularly at exam time.

Pericoronitis tends to happen over and over again, so understanding why you get wisdom teeth pain in the first place is important. Learn a little and prevent that next attack of pericoronitis.

Why do I get wisdom tooth pain?

When teeth grow, they start life as a bud. The bud is basically a sphere of jelly at first. The tooth bud has two layers - an outer one that forms a bag that the tooth grows inside (the follicle) and a second layer of cells called odontoblasts that grow downwards and away from the follicle. As it grows, it fills in with hard tissue and creates the tooth. For a permanent tooth, this takes 6 years to form the crown, plus another 3 years to grow the root.

So, when you're born, your first permanent teeth which usually come through (we say erupt) when you're six years old, are just starting to form. Eventually, the tooth erupts and the follicle opens up and blends into the gum. But for a time, the follicle part covers the tooth and is partly open into the mouth - we call this partially-erupted.

It can get sore as bacteria get into the remains of the follicle and can multiply where it's impossible to brush. Most of our teeth erupt with little trouble, but if a tooth is wedged in some way so that it can't fight its way through naturally, we can get a situation where the the follicle is chronically inflamed. If it gets inflamed, it will swell. If it swells, it will collect more bacteria and other debris and a vicious circle can be set up. Often we're just aware of a little soreness. But, add a little trauma, for instance if another tooth bites on the gum over the tooth. Or, if we don't keep the area clean. Then the area will flare up and become acute pericoronitis.

wisdom tooth, wisdom teeth, operculum, skin flapPericoronitis causes pain and swelling behind the last tooth in the arch of teeth and can cause restriction in the amount you can open your mouth. We call this limitation of opening trismus. Pericoronitis is common in lower wisdom teeth, but less common when upper wisdom teeth come through. It's simply because lower wisdom teeth are wedged in the concave corner of our lower jaws, but upper wisdom teeth erupt out of the convex rear end of our upper jaw.

How do I get rid of my wisdom tooth pain? 

  • Keep it clean! The natural thing to do is to back off, but if you leave bacteria and debris around the partially erupted tooth, then the population of bugs will simply explode. Because the follicle is mostly tucked away below the top of the gum, there's not a great deal of oxygen getting in there. So the environment will favour bacteria that live without air. We call these anaerobes. Anaerobic infection of wisdom teeth is caused by bacteria called spirochaetes, which are spiral shaped (as opposed to round or rod shaped). For bacteria to live without air is difficult metabolically and results in the production of chemicals which can make a very unpleasant odour. So keep the area free of bugs and you reduce the inflammation and the nasty taste and smell.
  • Use chlorhexidine gel - the big brand in the UK is known as Corsodyl gel. It doesn't taste very nice but it kills bugs magnificently. Chlorhexidine is available as a mouthwash, but it can stain your teeth, so the gel has the advantage of targetting the actual spot that you want to hit. 
  • So, get the area as clean as you can and then massage Corsodyl Gel into the area. If there's a flap of skin hanging over the tooth (we call this an operculum), massage a pea size of the gel under the flap of skin as best you can. wisdom tooth, wisdom teeth, operculum, skin flapDo this for a minute and repeat it according to the instructions on the tube.
  • If the area is sore to the point that you need painkillers, if you can take them, anti-inflammatory drugs such as ibuprofen should be the first stop. 

If things really aren't settling down, you need to see a dentist (not your GP). Dentists have a number of tricks. First thing is to wash out the follicle, if we can get at it. Simple really. We fill a BLUNT (!) ended syringe with chlorhexidine mouthwash and gently slide it under the flap of skin. Give it a squirt and it's amazing how much debris will flush out. Don't forget the chlorhexidine also kills bugs, so it disinfects the area as well. Sometimes, you'll be provided with syringes to take home if we think it'll be possible for you to do the same.

If it looks like the infection needs more, if your medical history allows it, then the treatment of choice is a course of metronidazole tablets which will usually calm things very quickly - anaerobic bacteria are very sensitive to metronidazole. Metronidazole has the disadvantages of reacting with alcohol, it can make you feel nauseous and you mustn't take it if pregnant.

If the tooth very nearly made it all the way through, but not quite, there's sometimes an annoying, small flap of skin hanging over the back of the tooth, the remains of the operculum. Sometimes, we'll just trim it off with electrosurgery (very easy, and surprisingly not sore).

Ultimately, if you just keep getting wisdom tooth pain, we'll consider removing your wisdom teeth but we'll make sure that you know the risks first, because it can be a traumatic experience (speaking from experience here - been on the wrong end of it!)

 

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© Hesslewood Lodge Dental Practice, 16 November 2015