Why my wisdom tooth hurts?


Wisdom tooth is the last molar tooth present. With evolution, wisdom tooth’s eruption has been affected very significantly due to various factors. Diet is one of them. Abnormal eruption has been observed in patients with pain in their last molar. The average age for completion of eruption of third molar is 20-22 years.

Following are some causes of wisdom tooth pain.

1. Partial eruption:

One of the most common cause of painful tooth is partial eruption of teeth. Complete eruption is seen at 20-22 years of age mostly but in some patients tooth erupts in different angulations. These angulations can cause impaction of tooth.

During normal pattern, tooth erupts first in horizontal angulation. Jaw growth happens lately which causes rotation of teeth from mesioangular to vertical. Failure of this rotation can cause partial or complete impaction of the tooth.

There is another reason why tooth is not fully erupt. In some people who had short mandible, there is little space available for eruption of the molar into oral cavity. Tight space could lead to painful and mal-eruption of the wisdom tooth.

Partial eruption of the teeth can cause some serious pain in patients because of large amount of soft tissues over the occlusal and axial plane. This condition of partially impacted wisdom tooth is known as pericoronitis. The major reason is normal oral flora which leads to pericoronitis.

Treatment:

Treatment options includes surgical removal of soft tissues over the wisdom tooth. The procedure is known as operculectomy. Prognosis for this one is poor as flap regrow over the tooth. Patient who has been suffering from high fever should be administered IV antibiotics and surgical extraction of teeth in hospital immediately.

2. Improper positioning:

The most used classification system with respect to treatment planning used a determination of the angulation of long axis of the impacted third molar to long axis of the second molar. There are different angulations that could cause impaction of the tooth.

Mesioangular angled teeth are far common and easiest to extract. Horizontal angled tooth are uncommon and more difficult. Vertically impaction has also been seen which is second most common. Disto angulation, the most difficult angled teeth to extract. In Disto angulation, tooth are embedded inside the bone.

These angulation can affect second molar. Periodontal diseases are seen around second molar more often due to forces applied from angled, impacted wisdom tooth. Forces applied from wisdom tooth towards normal oriented second molar create spacing and periodontal widening which might cause pain.

Treatment plan:

If there is swelling present, ice packs compression can be effective. NSAIDs such as Aspirin and ibuprofen can be given depending upon systemic health of the patient. Extraction of the angled wisdom tooth is the ultimate step to go to avoid furthur complications in future.

3. Abscess:

One painful, emergency found in dental region is abscess. This painful condition is caused by pus transfer from different spaces. Once, it spreads, it can cause some serious life threatening conditions known as Ludwig’s angina.

During abscess formation there is spreading of infection throughout the facial structures. When infection falls down into submandibular and sublingual spaces, it causes Ludwig’s angina. This can cause swelling around the neck and floor of mouth.

Treatment:

For simple, abscess, antibiotics such as penicillin, clindamycin and amoxicillin are prescribed according to the doctor’s recommendation. If there is spread of infection, incision and drainage is done immediately. Hydration of patient is maintained.

4.Cyst and tumour:

There are different cysts and tumour that has been reported in clinics associated with impacted third molar. Ameloblastoma, dentigerous cyst and OKC have been found around third molar. Although cyst around impacted teeth aren’t dangerous but they can be quite painful.

Swelling occurs around the impacted third molar can be infectious. Cyst can also cause weakening of bone around the third molar. A little blow can be painful, injurious to the bone and teeth. Tumour can be cancerous around third molar.

Treatment:

Surgical excision of the cyst by enucleation or marsupilization is done for cyst. Firstly, biopsy is done to confirm the diagnosis. Malignant, spreading tumour will require surgical excision of some part of mandibular bone with wisdom tooth as well.

5. Vitamin deficiency:

Vitamin B deficiency can cause toothache in some patients. Vitamin B helps in gums normal growth and control overall sensitivity. Vitamin C deficiency has also been seen in some patients who came with pain in their molar teeth.

Diet should be optimised in these patients. Eat fruits and vegetables regularly. Take calcium and vitamin B rich food daily. Avoid drugs and food that aggravate the pain. Avoid spicy and junk food.

6. Periodontal disease:

Gingivitis is the simple inflammation of gums without tooth movement. Untreated gingivitis can lead to periodontitis which involves periodontal widening, tooth movement, receding gums and bony abnormalities. Different angulation of wisdom tooth increases chances of periodontal disease.

Treatment:

If PDL diseases have been seen around impacted wisdom tooth, extraction should be done. Periodontal surgeries is not recommended around third molars due to less access and visibility. Also masticatory function is rarely done by third molar. To avoid, PDL abnormalities around adjacent teeth, extraction is the ultimate step to go for.

How to relieve pain at home?

Saltwater rinse:

Saltwater rinse is the most popular home remedy for toothache. This helps in normal growth of gums and killing some of the bacterias that have been found the leading cause of infection around the third molar. Anti inflammatory effect has also been seen in patients who have undergone periodontal diseases.

Peppermint and oil clove:

Peppermint leaves and clove oil can also be used as tooth relievers as home remedy between pain and appointment time.

Notes:

Tooth is one of the most sensitive part of the tooth. Home remedies should not be done on regular basis. These aren’t effective every-time. There might be different causes of toothache which should first be examined by dentist.

Treatment plan changes accordingly. Home remedies sometimes can cause adverse effect. Wisdom tooth removal isn’t a big of deal right now. But impacted tooth should be removed as it might lead to dental caries, pain and periodontal diseases.

Dentist should be well aware of patient’s systemic health as well. Bleeding time and prothrombin time should be known by blood reports before starting the extraction procedures. Give proper post operative instructions after surgical extraction of impacted last molar.

Always consult your physician before starting antibiotic therapy. Do not overdose yourself. Contact your dentist immediately if there is fever and malaise associated with wisdom tooth. Maintain oral hygiene by brushing and flossing regularly.

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