Wisdom teeth can be very troublesome and commonly cause episodes of pain and infection.
Many people incorrectly assume the cause of wisdom tooth pain is the wisdom tooth erupting or growing. There is a common misconception that wisdom teeth cause so-called “over-crowding” of teeth.
Around 8% of people have no wisdom teeth, and not everyone with wisdom teeth will have problems.
Eruption timing of wisdom teeth
Wisdom teeth normally start to erupt at around age 18-25 but can erupt any time after this. They normally take a few months to a few years to fully erupt.
Impacted wisdom teeth
Wisdom teeth often get stuck bumping into the tooth in front. Sometimes they get stuck bumping into the gum or bone at the side or behind. When teeth are stuck and cannot fully erupt they are described as impacted.
Wisdom tooth pain
Most people tend to incorrectly attribute the cause of any wisdom tooth pain to the tooth erupting or growing. Instead the pain is usually caused by food and bacteria being left around the tooth or under the flap of gum that might cover some of the tooth. The bacteria then cause swelling and soreness of the gum around the tooth. Sometimes the bacteria can produce pus and this might cause more swelling and pain. The condition of swelling and soreness of the gum around a partially erupted tooth is called pericoronitis.
Treatment for pericoronitis at home
The first line of treatment for a sore wisdom tooth should always be to improve your oral hygiene and to use an antibacterial mouthwash. This means:
- Ideally use an electric toothbrush to reach and massage the gum as well as cleaning the tooth.
- Use dental floss to clean between all of your teeth.
- Use a chlorhexidine mouthwash like Corsodyl.
- Very hard-to-reach wisdom teeth which are only partially erupted can often be cleaned better with a single tufted toothbrush.
Treating pericoronitis with mouthwash
Chlorhexidine mouthwashes like Corsodyl are antibacterial, and should be used as a first line treatment for a sore wisdom tooth.
Usually the pain will improve over 2-3 days and resolve in 5-7 days. If the pain is getting better, you can continue to manage your wisdom tooth pain at home. If there is no improvement after 5 days then you should seek advice from a dentist.
- Brush your teeth at least twice daily, but wait around 45 minutes after brushing before you rinse with Corsodyl.
- Rinse with Corsodyl at least 4 times daily, ideally after eating.
- Time your rinsing for 60 seconds using a clock or timer.
- Stop using a chlorhexidine mouthwash when your pain and swelling have resolved.
Alternatives to Corsodyl
- Corsodyl is a popular brand of chlorhexidine mouthwash, but other brands are available.
- An alternative to a chlorhexidine mouthwash is a peroxide mouthwash like Peroxyl, which can be used in the same way.
- A warm salty mouthwash may be of some benefit until you can obtain some chorlexidine or peroxide mouthwash to use. You should make the warm salty mouthwash using a teaspoon of salt in small a cup of warm water.
Antibiotics for treatment of pericoronitis
Antibiotics are for treatment of whole-body, spreading and blood infections. Wisdom tooth pain is usually caused by bacteria located directly around the tooth. Antibiotics are therefore usually not appropriate for the treatment of wisdom tooth pain.
Misuse of antibiotics in humans is partly contributing to the global threat of antibiotic resistance. Antibiotics should not be used when they wont help or there is a more appropriate alternative.
If caught early enough, most episodes of wisdom tooth pain can be easily and successfully treated at home. The best treatment is to simply improve your oral hygiene and use an antibacterial mouthwash.
If left too long before starting treatment at home, or in circumstances where there are complicating factors (such as tooth decay or extremely difficult to clean impactions), then the bacteria around the tooth and gum can spread into your blood and around your body. At this point, antibiotic treatment may be advised by your dentist.
Pain control for pericoronitis
If you are unsure if it is safe for you take ibuprofen or paracetamol (e.g. if you have an allergy, asthma sensitive to NSAIDs, stomach ulcers, gastrointestinal bleeding, heart failure, or you are pregnant) or you already know you are unable to use them, then ask your pharmacist for advice or visit the NHS 111 website.
- Paracetamol is available to buy over the counter in supermarkets and pharmacies. Shop own brands are usually the best value. You can also buy paracetamol online from a pharmacist (or from Amazon: Panadol tablets).
- Ibuprofen is available to buy over the counter in supermarkets and pharmacies. Shop own brands are usually the best value. You can also buy ibuprofen online from a pharmacist (or from Amazon: Nurofen tablets).
When to get emergency or urgent advice from a dentist for wisdom tooth pain
You should seek advice from a dentist as soon as possible if you:
- have severe facial or oral swelling
- cannot open your mouth fully or your tongue is swelling
- have swelling which is rapidly getting bigger
- feel unwell, excessively tired, or have a fever
- feel your glands (lymph nodes) in your neck are sore or swollen
- have been using an antibacterial mouthwash strictly (as detailed above) for 5 days with no improvement
Wisdom tooth extractions
Lower wisdom teeth are not preventatively extracted in the UK.
This is because of the risk of damage to a nerve in your lower jaw bone during the extraction procedure. Nerve damage is thankfully a rare complication of lower wisdom tooth extraction, but can leave some patients feeling tingly or numb. Sometimes the numbness is temporary but it can be permanent.
All dentists in the UK (NHS and private) have to follow UK guidelines set by the National Institute for Health and Care Excellence (NICE). The guidelines state that your lower wisdom teeth should only usually be extracted if they are decayed, causing decay in the next tooth, or if you have been to your dentist with several episodes of wisdom tooth infection that were severe enough to need treatment with antibiotics.
Unfortunately, the guidelines have resulted in many patients having to suffer with their wisdom teeth problems for a few years before they meet the criteria for extraction. During the delay, the next tooth often starts to decay and then requires a filling, root canal treatment and a crown, or extraction.
The guidelines may be preventing a few cases of nerve damage, but in doing so, causing many more episodes of pain and suffering, and causing lots of tooth decay.
After much criticism by dentists and oral surgeons, the guidelines are currently under review and hopefully will be updated soon.
What to expect after a wisdom tooth extraction and aftercare at home
The Royal College of Surgeons have produced an excellent Get Well Soon guide to help you make a speedy recovery after wisdom teeth extractions.
Wisdom teeth and crowding
It used to be believed that wisdom teeth might cause “over-crowding” of teeth by pushing forwards from the back of the mouth. However the gradual crowding of teeth can be seen equally in people with no wisdom teeth. It is now understood to be a normal part of the ageing process. It is caused by a tendency for teeth to drift forwards toward the front of the mouth. Extraction of wisdom teeth unfortunately does not prevent tooth crowding.