Wisdom tooth pain: causes, relief and when to get it checked

What’s probably going on

Wisdom teeth are the third molars, the last teeth at the very back. They usually come in between ages 17 and 21, and many jaws don’t have room for them. When one hurts, the most common causes are:

• An infected gum flap (pericoronitis). When a wisdom tooth is only partway through, a flap of gum can cover part of it. Food and bacteria get trapped underneath, and the gum turns red, swollen and sore. It often comes with bad breath, a bad taste, or pain when you bite on that side. It’s most common on the lower teeth.
• A tooth that’s stuck (impacted). A wisdom tooth can be trapped under the gum or in the jawbone, or come in tilted. A fully buried tooth may cause no pain at all. One that’s partly through can make your jaw ache and make it hard to open wide.
• A tooth that’s still coming in. The gum over an erupting tooth can be tender for a while, a bit like teething.
• A cavity in the wisdom tooth, or the tooth in front of it. Wisdom teeth are hard to reach with a brush or floss, so food collects and decay follows. A tilted wisdom tooth can also trap food against the molar in front and damage it.
• Gum disease at the back of the mouth, for the same reason: it’s hard to keep clean.
• Less often, a cyst. A sac of fluid can form around a buried tooth and damage the roots or bone nearby. It needs an X-ray to find.

Pain at the very back isn’t always the wisdom tooth itself. The molar in front of it can be the problem, which is one reason a dentist usually takes an X-ray. If the pain pounds, see throbbing tooth pain.

What to do tonight

These steps often calm a sore wisdom tooth enough to get through the night. They don’t fix the cause.

1. Rinse with warm salt water. About half a teaspoon of salt in a cup of warm water. Swish it around the back of your mouth and spit. Cleveland Clinic suggests doing this three or four times a day for an infected gum flap.
2. Clean gently around the tooth. Brush the area softly and floss the tooth in front of it. Rinsing out trapped food can ease the pressure under the flap.
3. Try an alcohol-free antibacterial mouthwash twice a day, as Cleveland Clinic suggests for an infected gum flap.
4. Take an over-the-counter pain reliever as the label directs. For adults and teens 12 and up, the American Dental Association’s toothache guideline puts ibuprofen or naproxen first, alone or with acetaminophen. Ask a pharmacist first if you take other medicines, are pregnant, or have stomach, kidney or bleeding problems.
5. Hold a cold pack on your cheek for short stretches if the jaw is sore or puffy.
6. Chew on the other side, and stick to soft food until you’re seen.

For more ways to get some sleep, see what to do for a toothache right now.

What not to do

• Don’t put aspirin on the gum. It burns the tissue.
• Don’t use heat on a swollen jaw or face.
• Don’t poke at the gum flap or try to cut or drain it yourself.
• Don’t take leftover antibiotics. Only a dentist or doctor can decide whether you need them, and they don’t fix the tooth.
• Don’t ignore it because it settles down. An infected gum flap often calms and then flares again while the tooth is still trapped.

When it can’t wait

Left alone, an infected gum flap can turn into an abscess, and the infection can spread. Go to the ER if swelling spreads into your face or neck, or if you have trouble swallowing, breathing or opening your mouth. Call a dentist today if you have a fever or pus around the tooth.

How a dentist fixes it, and what it costs

A dentist will look at the area and usually take an X-ray to see where the tooth sits and whether it’s damaging anything nearby. The fix depends on what they find:

• A mild gum flap infection often gets a thorough cleaning under the flap and home rinses. Antibiotics or a prescription mouthwash may be added if the infection is spreading.
• A flap that keeps getting infected may be trimmed away in a small gum surgery.
• An impacted or decayed wisdom tooth is usually taken out. Cleveland Clinic says removal is usually recommended when an impacted tooth causes pain, infection or damage. Recovery often takes one to two weeks.

The price depends on whether the tooth is through the gum or buried in bone, who does it (a general dentist or an oral surgeon), the type of anesthesia, and where you live. See wisdom teeth removal cost for ranges. Ask for a written estimate first. Without insurance, a dental savings plan (a discount membership, not insurance) can lower the price at participating dentists.

How to keep it from coming back

If your wisdom teeth stay in, they need extra care, because problems can start years later.

• Brush all the way to the back, twice a day, with a fluoride toothpaste. Angle the brush behind the last molar.
• Floss or clean between the back teeth once a day, including behind the tooth in front of the wisdom tooth.
• Rinse after meals if food tends to pack in around the back teeth.
• Keep up with checkups. The ADA’s MouthHealthy site says retained wisdom teeth should be watched, since problems can still develop later.

A good electric toothbrush can make reaching the back teeth easier. See the best electric toothbrush.