Wisdom Tooth Pain -
Causes and Treatments

By dentist Dr. Richard Mitchell

Wisdom tooth pain can be caused by a couple of things. I will list the most common problems first! Probably the most common wisdom tooth problem I see is where a wisdom tooth has started to come through the gum on the lower jaw.

The gum is red and sore around the new tooth, and even a little swollen. Sometimes you cannot open your mouth very wide. You feel like your jaw is stiff, and you just can't open your mouth like normal.

There are 2 problems causing this wisdom tooth pain.

1. First problem, the tooth is irritating the gum as it grows.


As long as the tooth has enough room to grow, and is pointing straight up, it will eventually come through the gum properly, like any other tooth.

wisdom tooth painswollen gum over a wisdom tooth as it comes through

But while it's growing, it can be quite sore. The best remedy at this time is rinsing around the gum with hot salty water, and taking some ibuprofen ("Nurofen"), or paracetamol.

Wisdom Tooth Pain

For the hot salt water mouthwash, just pour out about half a cup of hot water, and add half a teaspoon of normal table salt. Stir it up and wait for it to cool a tad - you don't want to burn your mouth!

Next, take a small mouthful of the hot salt water to check the temperature. If it's OK (it should be quite hot), then swish it around the painful wisdom tooth for 20 seconds, (You should try to swish it around quite forcefully.) and then spit out.  Do it again a second time. And then finally do it again a third time.

So now the gum over the wisdom tooth has had a full 60 seconds of hot salt water over it. What does this do?  It does 2 things!

First, the salt will inhibit the bacteria around the wisdom tooth. This effect lasts an hour or so, enough time to kill the bacteria and give the gum a much-needed break from the irritation and inflammation.

Second, the heat opens up all the tiny blood capillaries in the area, allowing your own immune system a better shot at coping with the inflammation.

For this to be really effective, though, you need to do it 3 times a day, morning, afternoon and evening. It's not the most pleasant thing to do, but it's better than wisdom tooth pain!

At other times through the day, you might want to try another trick; Get a cucumber and cut off several slices about 2mm thick. Then put them in the refrigerator. After a few hours, they should be quite cold. Then you can take out a slice, cut it in half, and put the half slice over the sore wisdom tooth.

The coldness of the cucumber is very soothing on the gum, and there is something in the cucumber itself that takes down the inflammation too! The first half slice will take some of the heat out of the gum, and after a minute you should take it out and replace it with the other half. That way the effects last longer. The second half of the slice can be left in place for around 5 minutes before it warms up.

If you want you can repeat this cucumber application another 1 or 2 times with fresh slices from the refridgerator.

Wisdom Tooth Pain

2. The second problem arises if the tooth does NOT have enough room to grow through, and gets jammed against the next-door tooth. Any wisdom tooth that cannot come through straight is called "impacted".

Now it is stuck halfway in and halfway out. The gum is sore and swollen. And plaque starts to collect around the tooth, because it's difficult to get a brush back there. So now there is infection, too! This is when it can get difficult to open your mouth wide.

wisdom tooth painimpacted wisdom tooth

In the image above, the wisdom tooth on the right is lying on it's side, jammed up against the next tooth, and it has caused a cavity in the side of the neighboring tooth.

At this stage, hot salt water will help, but you probably need some antibiotics as well to help settle things down. After that, you might need to see about getting the tooth removed.

If the tooth is lying on its side, under the gum, it will probably never come through the gum. But it can grow against the next tooth. This pressure can cause a dull ache which may become quite intense.

The wisdom tooth will not be able to move, and the roots will continue to form. This continuous pressure may cause part of the next tooth to erode, leading to a cavity. Unfortunately, this can lead to both teeth having to be removed.

The next most common cause of wisdom tooth pain I see is an UPPER wisdom tooth that has grown through as normal, but then starts hitting on something.

Sometimes it comes through at an angle, pointing out towards the cheek. Of course, in this position, the tooth irritates the inside of your cheek. It can even cause a semi-permanent ulcer.

If it is pointing in the right direction, (straight down), and the lower wisdom tooth is not there, then the top one can start to hit the lower gum when you chew. Ouch! Below is an X-ray showing this situation.

wisdom tooth painThe wisdom tooth at the top right of this picture has nothing to bite on but gum. The lower wisdom tooth is impacted under the gum. Image courtesy Dr. Howard Farran DDS

Quite often, the upper tooth is hitting on the gum of the lower jaw, and the lower wisdom tooth is half-way through, but jammed on the next one along. Double trouble!

The solution? In this situation, the lower jaw is painful, but the quickest and easiest treatment is to take out the TOP tooth. This stops the biting on the lower gum, and makes things more comfortable very quickly.

In due course, the lower tooth will have to be removed too.

More rarely, an impacted wisdom tooth can get a cavity. In this case, you get a normal toothache. Again, the solution is usually to have the tooth removed!

Wisdom tooth pain can have one of several causes. As long as the tooth has enough room to come through, it will usually settle down on its own.

Frequently, however, the tooth does NOT have enough room to come through, and it will need to be removed.

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