What helps wisdom tooth pain, and does the tooth need to come out?

Wisdom tooth pain usually happens when the tooth does not have enough room to come through properly, so it becomes impacted or only partly breaks through the gum, letting food and bacteria collect around it. A warm salt water rinse, pain relief and a cold compress can ease the discomfort while you wait to be seen, but only a dentist can examine the tooth and X-ray it to say whether it needs to come out.

In short

• Wisdom tooth pain often means the tooth does not have enough space to come through properly and has become impacted.
• Trapped food and bacteria around a partly emerged wisdom tooth can lead to infection, decay or gum disease.
• A warm salt water rinse, over-the-counter pain relief and a cold compress can ease pain while you wait to be seen.
• Not every wisdom tooth needs to be removed. A dentist examines the tooth and usually takes an X-ray before deciding.
• Facial swelling, a high temperature or difficulty opening your mouth are signs to be seen the same day.

This article is part of the extractions and wisdom teeth information on this site for patients in Cape Town.

Why do wisdom teeth cause pain?

Wisdom teeth, also called third molars, are usually the last teeth to come through, generally between the ages of 17 and 21. By that age there is often not quite enough room at the back of the jaw for them to come through straight, so a wisdom tooth can become impacted, meaning it is stuck against the jawbone or the tooth next to it, or it may only partly break through the gum. A flap of gum over a partly emerged tooth traps food and bacteria underneath it, which is difficult to clean and can lead to infection, decay, or damage to the tooth next to it. This is what usually causes the pain, swelling and jaw stiffness associated with wisdom teeth, rather than the tooth itself being unhealthy.

What can I do about the pain while I wait to be seen?

Rinsing gently with warm water, or a warm salt water rinse, can help keep the area clean and ease discomfort for some people. Over-the-counter pain relief such as paracetamol or ibuprofen can also help. Always follow the instructions on the packet, and ask a pharmacist if you are unsure what is right for you. A cold compress held against the outside of your face can help with swelling, and it helps to avoid chewing on that side in the meantime. This is general pain relief, and the same steps covered in What can I do about severe toothache at night? also apply to wisdom tooth pain.

Does the tooth always need to come out?

No. A wisdom tooth that has come through properly, sits in a good position and is not causing any problems does not necessarily need to be removed, and it can simply be monitored at your regular check-ups. Removal is generally considered when the tooth is causing pain, infection, decay, gum disease or damage to the tooth next to it, or when it cannot come through properly at all. A dentist examines the tooth and usually takes an X-ray to see its position and roots before advising whether it should be removed. Dr Davies normally assesses wisdom teeth between the ages of 18 and 21, and When should wisdom teeth be checked, and do they need to come out? explains why. The extractions and wisdom teeth service page has more on what this involves.

What happens if it needs to be removed?

The area is numbed with local anaesthetic before the tooth is taken out. A straightforward extraction is often finished within a few minutes. Simple extractions, including wisdom teeth, are done at the practice under local anaesthetic, and a wisdom tooth that is impacted or awkwardly placed is referred to a maxillofacial and oral surgeon after Dr Davies has assessed it. Who removes wisdom teeth, a dentist or an oral surgeon? explains the difference. See What should I do after a tooth extraction? for how to look after the area afterward and how to lower the risk of a painful complication called dry socket.

When is it urgent?

Contact a dentist the same day if the pain is severe, keeps you awake, or comes with swelling, a high temperature, a bad taste, or difficulty opening your mouth. If the swelling is spreading towards your eye or neck, or you are struggling to breathe, swallow or speak, this is covered in the dental emergency guidance on this site, and in My face is swollen from a tooth. When is that urgent? These signs need same-day attention rather than waiting to see if they settle.

How do I reach Dr Davies?

To have a painful wisdom tooth examined, call Dr Davies directly on her own mobile, which is shown on this page. Emergency appointments are available at weekends and on public holidays. Dr Davies treats adults and children at BRS Dental on Strand Street, in Cape Town City Centre. This page gives general information and cannot tell you whether your own wisdom tooth needs to come out. Only an examination and an X-ray can answer that.