Additional reasons to remove wisdom teeth.

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

This page outlines additional reasons why your dentist might determine that your wisdom tooth needs to be removed. This includes:

If you don't see the specific topic you're seeking listed above, this menu leads to additional pages explaining other reasons why third molars are extracted.

Or after you've finished reading this page, you may find our related one 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. 33% of patients who experience problems report having it. Pogrel (2007) [page references]
The discomfort may be nebulous in nature.

It's not uncommon for a patient's symptoms to be vague or indistinct. The pain or sense of pressure noticed may be generally associated with the region of a third molar but not centered directly on it.

Sources of 3rd molar pain / pressure / headaches.

Obviously it's the dentist's goal to be able to directly attribute their patient's discomfort to events taking place with their wisdom teeth. Some likely circumstances include:

a) The tooth's eruption process.

It's possible that the discomfort a person notices with a wisdom tooth is associated with the process of it coming in (its "eruption"). If so, what's experienced may either be intermittent or of constant duration. Patients sometimes describe what they feel as a vague sense of pressure.

b) Additional causes.

It's more likely that a person's discomfort is due to some other type of wisdom tooth-related issue. This could include most any of the conditions or situations discussed either below or on our previous page.

c) 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 or even headaches. (Haq 2002)

d) 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.

 

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 they're not an especially common occurrence, cysts and tumors can develop in the tissues around an impacted wisdom teeth.

A dental cyst associated with an impacted wisdom tooth.

They're frequently associated with the developmental tissues that have formed the tooth. And as they grow in size, they may cause damage to surrounding bone, nearby structures such as adjacent teeth or cause a distortion of the jawbone.

If pathology is observed (in early stages, this is frequently via the use of x-ray examination), the associated tooth should be removed and its cyst or tumor evaluated by a pathologist.

Monitoring impacted wisdom teeth.

In cases where a decision has been made not to remove a person's impacted wisdom tooth, it should be evaluated periodically via x-ray examination. Doing so allows the dentist to compare current and previous films, 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.

The attempted eruption of a misdirected impacted wisdom tooth can cause damage (root resorption) to a person's 2nd molar. Fortunately, this is an uncommon occurrence.

This event 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 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.


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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.


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