Additional reasons to remove wisdom teeth.

- Pain, pressure, headaches, cysts, tumors, soft tissue trauma, 2nd molar root resorption.

This page explains the following reasons why your dentist might determine that your wisdom teeth need to be removed.

These issues are a subset of our master list of (valid) indications to remove third molars.

After you've finished reading this page, you may find its companion titled "Is it always necessary to remove impacted wisdom teeth?" of interest.


Reasons to extract third molars -

A) Wisdom teeth that cause pain.

  • The most common reason why people seek an evaluation of their wisdom teeth is because they've recently experienced a painful episode.
  • Having pain is the most common third molar symptom, with 33% of patients reporting problems stating it. (Pogrel)
The discomfort may be nebulous in nature.

The type of pain or sense of pressure that the patient reports is often vague or indistinct.

  • The discomfort is sometimes described as a radiating pain stemming from the region of the wisdom tooth (Koerner).
  • In other cases the tooth is suspected as the cause of headaches or neuralgia (intense intermittent pain associated with the path of a nerve). (Fragiskos)

Causes of 3rd molar related pain, pressure and headaches.

Especially in the case where the symptoms experienced are vague, indistinct or distant, it will be the dentist's goal to discover a direct relationship between the discomfort and events taking place with the person's wisdom teeth. Possible circumstances include:

1) The tooth's eruption process.

The pain that a person has noticed with their wisdom tooth may be associated with the process of it coming in (its "eruption").

The discomfort may be intermittent or constant. Patients sometimes describe what they feel as a vague sense of pressure.

2) Pressure on adjacent nerves.

In rare cases, an impacted lower wisdom tooth may place pressure on the nearby inferior alveolar nerve (the major nerve of the lower jaw).

This may cause intermittent pain, a general sense of pressure, neuralgia or headaches. (Fragiskos, Haq)

 
3) Pain of unknown origin.

There can be situations where the pain or pressure felt by the patient certainly seems to be centered on the region where an impacted wisdom tooth lies. But due to the absence of obvious pathology, the dentist can't be certain that the tooth itself lies at fault.

  • If there are no absolute contraindications for removal, these teeth are sometimes extracted. If so, the patient must understand that pain relief may not be achieved and ultimately the procedure they endured unnecessary.
  • In other cases the patient and dentist may determine that the best plan of action involves the implementation of palliative treatment (possibly including the use of a prescription pain reliever) and then further monitoring until a diagnosis can finally be made.

Non-odontogenic conditions.

This second approach can be a good one. Indistinct symptoms involving pain, pressure sensation or headaches are sometimes ultimately attributed to non-tooth conditions.

One common one is tempromandibular joint (jaw joint, TMJ) dysfunction or the spasm of its associated muscles. This scenario is especially likely if the person has a habit of clenching or grinding their teeth. It's also possible that a medical condition (migraine, cardiac, vascular or neuropathic pain) is the underlying problem.

 Reference: 

Koerner KR. - linked above.

4) Common pathologies.

Once investigated, what a person has experienced can often be directly attributed to common wisdom tooth-related issues and pathologies. This could include most any of the conditions or situations discussed further below on this page, or the following items that we discuss elsewhere.


B) Poorly positioned wisdom teeth.

Some wisdom teeth manage to erupt but nevertheless have a positioning that causes, or has the potential to cause, problems. For example:

Tissue trauma and associated wisdom tooth.

Trauma to both flap and cheek tissue in the area of a 3rd molar.

a) Crooked teeth.

Teeth whose final positioning is tilted or angled may poke, scrape, crush (bite) or otherwise irritate adjacent cheek or gum tissue. For the most part, the only solution that exists is to extract the offending tooth.

Chronic tissue trauma may cause hyper-keratinization (like the line of dense tissue that makes up the white streak on the inside of the cheek in our picture).

b) High gums or gum flaps.

Gum tissue that creates a tall collar around a third molar, or lies as a flap over its chewing surface, may constantly be traumatized by hard foods or opposing teeth.

This may cause the tissue to become chronically inflamed (reddened, sore and swollen, like the "flap" tissue in our picture).

In some cases, the excess tissue can be successfully trimmed away. In others, it may tend to grow back over time. (It depends on the tooth to jawbone relationship that exists.) If your dentist determines that the latter is the likely outcome for your situation, then the tooth will need to be extracted.

c) Supererupted third molars.

Wisdom teeth that don't have an opposing tooth to bite against often supererupt (poke through the gum tissue further than normal).

These teeth may cause tissue irritation or trauma. Their abnormal positioning may interfere with jaw movements, or create traps between teeth where food and debris tend to accumulate. Teeth having this problem should be extracted.

d) Teeth that are hard to clean.

Some wisdom teeth occupy a position that makes them very difficult to brush and floss. If so, both they and their neighboring tooth are placed at increased risk for complications with tooth decay and gum disease. And for that reason, they should be removed before problems develop.

C) Cysts and tumors.

While not an especially common occurrence, cysts or tumors can arise from the retained developmental tissues associated with an impacted wisdom tooth.

A dental cyst associated with an impacted wisdom tooth.

It is the size of the tissues that surround this tooth that suggest cyst formation.

As an example, during cyst formation these tissues can grow in size significantly and as a result displace the wisdom tooth, cause bone destruction, damage nearby structures (including adjacent teeth), and/or cause distortion of the jawbone.

Identification and treatment.

A tooth's associated pathology is most often discovered via the use of x-ray examination. Once identified, the associated tooth should be removed and its cyst or tumor evaluated histologically (microscopic evaluation) by a pathologist for identification.

Monitoring impacted wisdom teeth.

In cases where a decision has been made not to remove an impacted wisdom tooth, it should be periodically evaluated via x-ray examination. Doing so allows the dentist to compare current and previous pictures, in search of changes that may indicate that a cyst or tumor is forming.


Impacted wisdom teeth can cause root resorption on neighboring teeth.

Misdirected eruption can trigger resorption of adjacent teeth.

D) Root resorption of neighboring teeth.

It's possible that the attempted eruption of a misdirected impacted wisdom tooth (a third molar) can cause damage to the person's 2nd molar (the next tooth forward).

This process, which is termed "root resorption," is somewhat similar to what happens with baby teeth.

When they fall out, they look as though they don't have a root. That's because as the permanent tooth underneath erupted, its presence caused the baby tooth's root to resorb (dissolve away).

In similar fashion, when a misdirected wisdom tooth attempts to erupt, its pressure can cause resorption of the rear root of the 2nd molar. The worst case scenario in this type of situation is one where the offending wisdom tooth and the damaged 2nd molar will both have to be extracted.

 Reference: 

Hupp J, et al. - linked above.

Last revision/review: 02/11/2019 - Major revision. Reference links added.

 
search

Comments

Sched for extraction tomorw

2 wisdom tooth to pull by tomorow.. is it safe to pull a tooth while im suffering severe pain on all left side jaw,ears and head?

Jam

Possibly. In some cases having the extraction might be the solution. In other circumstances, like when a tooth has an associated infection, the extraction process may need to wait until the secondary issue is brought under control.

You should touch base with your dentist's office and let them know what's going on. They can then quiz you and decide what's needed, and what the timing of your extractions should be.

As a courtesy, you should contact them as much ahead of time as possible. They have set aside appointment time for you and now if you don't need it (or just less of it) they should know so they can see other patients that require attention.

Rotten wisdom tooth and 2nd molar decaying

Over the last 6 weeks i have experienced increasing aches around the left of my jaw and cheek. 2 weeks ago it began to become even more painful in waves whenever i ate or drank something cold or hot and has become somewhat more painfull and now its a constant pain. Last night i felt more pain than i have ever felt in my life and nearly passed out. I felt aches extending from my neck on the left all the way up past my jaw, ear and head giving me a migraine. I used clove oil - 5x the recommended amount which has left lacerations in my inner mouth and took pain killers and used an ice pack but with very short periods of relief(10min) and not a wink of sleep, i was in tears most of the night and know that tonight wont be much better due to the cold temperature. I contacted the dentist they think its a rotten wisdom tooth and got an xray . The dentist prescribed me antibiotics which i have begun taking. Im booked in two days time to have the tooth extracted whilst being sedated and given valium and happy gas. Im so anxious and scared about the procedure and worry if i have been given the correct advice?
Have i been given the right advice or should i

Kelly b

We're not entirely sure what your question is in regard to "advice."

Per your comment's title "Rotten wisdom tooth and 2nd molar decaying," a treatment plan of having one or more extractions seems as though it would be appropriate for that type of situation. But only a dentist who has actually evaluated you could decide that.

In regard to your the use of clove oil (eugenol), about all we can say is that there can be some dental conditions where its use might be beneficial. But generally speaking it is not a bio-friendly material and non-dentists should be discouraged from using it in its pure form, like when trying to alleviate toothaches. When in contact with oral tissues, it can cause irritation and even be toxic to living cells. Allergic reactions are sometimes a problem with its use.

There can be instances where applying ice to a tooth whose pulp tissue has died can relieve pain. But that's a relatively unique situation and evidently doesn't characterize yours.

It's common that patients with your situation are managed via the use of antibiotics and narcotic pain relievers until that point in time when treatment can be rendered.

You have an actual relationship with a dentist (they've evaluated you and made plans for treatment).
They also must have a filled out medical history for you (after all, treatment has been planned).
Those two points are usually the only requirements needed for a dentist to be able to phone in a prescription into a pharmacy. In your situation, one for a stronger pain reliever.

Dentists expect patients with problems to call. Especially ones, like you, who actually are a current patient.

In regard to the use of oral antibiotics, it usually takes 24 hours or so before they can be expected to even begun to have an effect that you notice.


Add new comment

Excessively long submissions may be edited for brevity and clarity. Comments that don't relate to the content of the page they are posted on especially well will be moved to a more appropriate one, or deleted, after a few days.

Plain text

  • No HTML tags allowed.
  • Lines and paragraphs break automatically.
Please answer the question so we know you're a human.
Feedback