Wisdom tooth pain: when is it time to see an oral surgeon?
Pain at the back of the jaw in your late teens or twenties is most often a wisdom tooth trying to erupt. Sometimes it settles on its own. Sometimes it’s the start of a cycle of infection that only ends when the tooth is removed. Here’s how to tell the difference.
The usual suspect: pericoronitis
When a wisdom tooth is partially through the gum, a flap of gum tissue covers part of the tooth. Food and bacteria collect under this flap, and the result is pericoronitis — a painful, swollen gum over the tooth, sometimes with difficulty opening the mouth or swallowing.
A first, mild episode can be managed with professional cleaning under the flap, warm salt-water rinses, and sometimes a short course of antibiotics. But here’s the honest part: once a tooth has caused pericoronitis twice, it will almost certainly keep doing so. Removal is usually the definitive answer.
Signs you should be seen promptly
- Swelling of the face or under the jaw (not just the gum)
- Difficulty or pain on swallowing
- Mouth opening becoming progressively restricted
- Fever along with tooth pain
These suggest infection spreading beyond the tooth and warrant a same-day assessment.
”But it doesn’t hurt — should I still remove it?”
Not necessarily. A fully erupted, upright wisdom tooth you can keep clean can stay. The teeth we advise removing even when painless are the ones causing silent damage: impacted teeth decaying the healthy tooth in front of them, or teeth associated with cysts visible on X-ray. That’s why an OPG (panoramic X-ray) is worth doing — it shows what’s happening below the gumline.
The bottom line
One painful episode? Get it assessed, treat the infection, and make a plan. Recurrent pain, swelling, or damage to the neighbouring tooth? Removal by a specialist is a 30-minute procedure with a few days of recovery — far better than years of intermittent misery.