The third molars are often called the wisdom teeth and are the last permanent teeth to erupt in the mouth. Usually, they bring with them pain, swelling, and other problems. Most of the time the ultimate treatment of impacted wisdom teeth is extraction.
We will read about the symptoms of impacted wisdom teeth which include severe pain, referred pain, swelling, and gingival problems.
Why are the wisdom teeth called so?
The third molars erupt between the ages of 18 to 25, sometimes even later than that. Since they erupt at an older age, they were called wisdom teeth as it was that age when people were wiser than children.
Impacted third molars
When the third molar erupts in the upper or lower arch, all other teeth are already present in the mouth. Naturally, there is a lack of space for the last molars to erupt.
In this hustle for space, they grow in an angulated fashion. They are tilted, or inclined and may even be completely horizontal. These are known as impacted teeth and need treatment.
Problems faced due to impaction
Impacted symptomatic third molars give us many dental problems, most of which need immediate treatment. If the teeth are unerupted, or even wholly erupted but asymptomatic, they can be left as it is.
The wisdom teeth are at the end of each, after the second molar. When they are impacted, they are tilted, and some of their surfaces remain unexposed.
As a consequence, it is difficult to brush or clean the area because of overlapping. Using floss or other interdental cleaning is also nearly impossible.
As the wisdom teeth begin to erupt, there is accompanied pain even if a single cusp is erupting. This is because the tooth has to push through the gingiva to appear in the mouth. It also exerts pressure on the adjacent tooth.
The pain is severe if the third molar is impinging on the nerve fibers. You may also experience radiating pain to the ear on that side or even a headache.
As discussed earlier, the wisdom tooth exerts pressure to push through the gingiva. In this process, there is trauma to the gums around the tooth. This means your gums may be red, inflamed and painful. They may also bleed. (1)
Accumulation of plaque and food debris is another common problem because of which the periodontium gets inflamed. This secondarily causes the issue of a foul smell from the mouth.
If the third molar is carious and the infection reaches the pulp, there may also be a cyst or abscess formed in the vicinity of the roots. (2) This will cause pus discharge, pain, and bleeding, accompanied by halitosis.
Caries in the adjacent tooth
An impacted third molar may tilt in the direction of the adjacent second molar. This means it may overlap or be crowding around that tooth.
Consequentially you are unable to keep that area lean. The risk of developing decay in the second molar increases. (3) It also becomes difficult to spot and restore the tooth and sometimes it is not possible until wisdom tooth extraction.
Diagnosis & Treatment
A dentist takes an x-ray of the area or the whole mouth to know the exact position of an impacted wisdom tooth. The radiograph gives a clear picture about the angulation of the tooth and its relationship with the other surrounding tissues. (4)
Cone beam computed tomography (CBCT) is also another investigation that can help with the diagnosis.
The only treatment for a painful third molar is extraction. The extraction of impacted teeth is a more complicated procedure than conventional removal.
An oral and maxillofacial surgeon is a specialist who performs this extraction. Commonly it is carried out under local anesthesia.
However, if you have a medical history or any other condition that warrants the need for general anesthesia, it may be done. If you have any medical history, particularly hypertension and diabetes, you must be sure to get your physician’s consent before the procedure.
The procedure involves cutting to drill out the bone after giving anesthesia. This helps to expose the impacted tooth and remove the gums and bone over and around it.
The tooth may be broken into several fragments to facilitate easier removal. Once the extraction is complete, the socket is cleaned, and if there is any sharp bony fragment, it is filed and smoothened.
Special instruments like a chisel and mallet may be used for extraction of impacted third molars.
The dentist will give you some instructions to follow after extraction. These are important to promote healing of the area. The healing and post-operative pain vary from patient to patient. (5)
Complications of third molar extraction are those that accompany any surgical procedure.
Mild complications are pain and swelling, whereas the major ones are nerve damage, loss of sensation, difficulty in mouth opening, hemorrhage, etc.
You can avoid these complications with appropriate aftercare and correct surgical technique.
Some home remedies for wisdom teeth pain
- Saltwater gargles – Add a teaspoon or two of salt in slightly warm water, and rinse your mouth with this solution. This disinfects the mouth and destroys bacteria around the wisdom tooth, which reduces pain and inflammation.
- Ice pack – Ice, when applied from the outside, can relieve swelling and provide a numbing sensation. Use it intermittently until the pain lessens.
- Clove – Clove oil has a numbing effect and analgesic effect. Alternatively, you can place a whole clove in the mouth, over the affected tooth. Similarly, clove oil, soaked in cotton is an appropriate remedy.
- Onion – Keeping a cut onion piece on the side of the tooth pain is an effective remedy since it also exhibits antibacterial and anti-inflammatory properties.
- Peppermint – in addition to its analgesic and anti-inflammatory properties, peppermint is aromatic, giving a soothing effect.
- Painkillers – Painkillers are the quickest remedy for an aching tooth until you get to a dentist. Ibuprofen is an analgesic and anti-inflammatory medicine that is often used.
It is known now that wisdom teeth give us more problems than all our other teeth. But with timely dental intervention and removal, this can be managed.