The third molars, commonly known as wisdom teeth, are the last set of teeth to emerge, typically appearing between the ages of 17 and 25. Many people experience discomfort as these teeth try to break through the jawbone and gum tissue. Wisdom tooth pain is often intermittent, meaning it flares up and then subsides, rather than being a constant ache. This fluctuation results from the complex, start-and-stop processes involved in the tooth’s eruption or impaction.
Underlying Reasons Pain is Intermittent
The most frequent cause of fluctuating pain is an inflammatory condition called pericoronitis, which affects the gum tissue surrounding a partially erupted wisdom tooth. When the tooth only breaks through the gum partway, it leaves a flap of tissue, known as an operculum, over the tooth surface. This flap easily traps food debris and oral bacteria, leading to localized inflammation and a flare-up of pain.
The pain subsides when debris is flushed out, temporarily reducing inflammation. However, since the gum flap remains, the area is susceptible to re-infection, leading to a cycle where pain returns after relief. Intermittent pain is also caused by the stop-and-start nature of tooth movement; wisdom teeth push for a period, causing pressure, and then pause, allowing discomfort to ease until the next growth spurt.
Pain can also be exacerbated or relieved by changes in mechanical pressure. Chewing hard foods or involuntary teeth grinding temporarily increases pressure on the adjacent jawbone or molar, causing a spike in pain. Avoiding tough foods allows the area to rest, easing symptoms. Stress and immune system changes can also influence the body’s inflammatory response, making a low-grade issue more noticeable during periods of sickness or fatigue.
Warning Signs Requiring Immediate Dental Attention
While intermittent pain is common, a sudden escalation of symptoms suggests a serious infection or complication. Severe, persistent pain that no longer responds to over-the-counter medication is a red flag, indicating the inflammation has likely become a substantial infection requiring professional intervention.
Any noticeable swelling of the face or jaw spreading beyond the immediate tooth area needs immediate attention. Trismus, the difficulty or inability to open the mouth fully due to muscle stiffness, is another serious warning sign caused by spreading infection. A persistent fever or pus draining from the gum tissue are clear signs of a systemic infection. Difficulty swallowing or breathing signals a potentially life-threatening spread of infection into the neck or throat area.
Short-Term Strategies for Managing Pain
For temporary relief during a flare-up, over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can be effective. These medications work by reducing the inflammation that is a primary cause of the pain, rather than simply masking the sensation. Applying a cold compress or ice pack to the outside of the cheek over the affected area can also help reduce localized swelling and numb the pain.
Rinsing the mouth several times a day with a warm saltwater solution helps cleanse the area and soothe inflamed gum tissue. The saline solution acts as a mild disinfectant, removing trapped food particles and bacteria. It is also important to maintain gentle but thorough cleaning around the wisdom tooth using a soft toothbrush. These measures manage the pain episode but are not a substitute for a dental examination.
Determining the Need for Removal
The decision to remove a wisdom tooth shifts the focus from temporary management to a long-term resolution of the problem. Dentists often recommend extraction when the intermittent pain is caused by recurrent episodes of pericoronitis that cycle repeatedly. If the gum flap becomes inflamed multiple times, it signals that the area cannot be kept clean enough to prevent chronic infection.
Removal is also necessary if the tooth is impacted and causing irreversible damage to adjacent structures. This damage includes deep decay that cannot be filled, or pressure causing root resorption or bone loss on the neighboring second molar. In rare cases, an impacted tooth can lead to the formation of a fluid-filled sac, or cyst, in the jawbone, requiring surgical removal to prevent extensive bone damage. Consistent, recurring pain and the risk of damage to other teeth are the primary indicators that removal is the best path.