What Causes Wisdom Tooth Pain?

What Causes Wisdom Tooth Pain?

In Part One of a two-part series on wisdom teeth, Dr. Mark Hochberg looks at the signs that indicate you may need to have your wisdom teeth extracted.

As we head into summer, most oral surgeons become increasingly busy with the removal of 3rd molars (commonly referred to as wisdom teeth). Why? Probably because the vast majority of patients having their wisdom teeth evaluated and removed are in high school or college – typically, people under the age of 25 – and just getting out of school.

Some of the patients referred to us for evaluation by general dentists may not be experiencing pain or showing obvious symptoms. So, why even be evaluated? Quite simply, to avoid problems before they develop, especially if those problems seem likely to occur.

While some patients may not be experiencing noticeable signs, many who are referred to us are actually experiencing pain and discomfort. Here are some telltale signs your child is ready to have his or her wisdom teeth removed:

  1. Headaches or pain

As any tooth develops in the upper or lower jaw, the development of the roots of the tooth is what forces the tooth through the gums – also called eruption – and into the mouth. If there is inadequate room for this to occur, or if the tooth is malposed (positioned sideways or tilted forward or backwards), patients may experience pressure, headaches or outright pain from the affected area.

Determining whether a wisdom tooth is in a position to erupt is not always possible by looking in the mouth. This is usually quite evident with a panoramic x-ray that is part of the wisdom tooth evaluation process by an oral surgeon.

  1. Dental caries

Dental caries, commonly referred to as cavities, can occur with any tooth in the mouth. Because wisdom teeth are positioned in the back of the jaws, they cannot always be completely seen.  Predictably, this makes practicing hygiene in these areas more difficult than anywhere else in the mouth.

If wisdom teeth cannot be adequately cleaned with brushing and flossing, they will begin to develop cavities and these cavities will get bigger, eventually encroaching upon the pulp (what the patient would refer to as the “nerve”) and cause the patient to experience pain in the form of a toothache!

  1. Cysts

While wisdom teeth are developing in the upper and lower jaws, there is a “sac” of tissue that surrounds the crown of each developing tooth called the follicle. If a tooth stays impacted, or stuck in the jaw bone and doesn’t erupt into the mouth, some of the cells that make up the follicle can begin to produce fluid that will fill up the space between the crown of the tooth and the follicle itself, forming what is called a “cyst.” Although a cyst is a benign entity, it will expand or enlarge, resorbing or destroying what is in its path. Although this is not usually a painful process, eventually the cyst will expand into the oral cavity (mouth) and allow for bacteria to enter. The cyst will eventually become infected, causing redness, swelling and pain. The development of a cyst is also something that can be observed on a routine panoramic x-ray.

  1. Pericoronitis

If there is not enough room for a wisdom tooth to erupt completely into the oral cavity (mouth), leaving it partially exposed, it is impossible to adequately clean the tooth and oftentimes leads to a painful problem called “pericoronitis”. This is a soft tissue infection around a partially exposed wisdom tooth and will manifest itself as red, tender and swollen gum tissue around the tooth.  To prevent recurrent episodes of pericoronitis and the pain and inconvenience associated with it, the treatment is to remove the affected tooth.

If you are experiencing any of these problems or would like to prevent going through any of the aforementioned problems, an evaluation of your wisdom teeth to determine if you would benefit from wisdom tooth removal is likely in order.

In Part Two of this series, Dr. Hochberg explains the potential complications from having your wisdom teeth removed.


Dr Mark HochbergDr. Mark Hochberg is a Diplomate of the American Board of Oral and Maxillofacial Surgery. He has also earned Fellowship status from the American Association of Oral and Maxillofacial Surgeons, the American Dental Society of Anesthesiology and the International Congress of Oral Implantologists.