Feeling pressure or pain at the back of the jaw after wisdom tooth removal can be alarming, often making it seem as if the tooth is growing back. However, once a wisdom tooth is completely extracted, it cannot regenerate. This sensation is a misinterpretation of anatomical and neurological changes that occur long after the surgical site has healed. The pain is real, but it signals a different underlying issue. This article explores the specific reasons behind this confusing sensation.
Understanding Post-Extraction Sensations
The area where the wisdom tooth was removed undergoes significant remodeling, and this healing process can cause strange feelings at the surgical site. A common cause of sharp pressure is the presence of bone sequestra, which are small, sharp fragments of jawbone left over from the extraction. These bone splinters, or spurs, work their way to the surface of the gum tissue as the socket heals and reshapes over time.
These fragments can feel like the sharp edge of an erupting tooth pressing against the gum, causing irritation and discomfort. While they are a normal part of the healing response, they may occasionally require a simple in-office procedure for removal if they do not resolve naturally. Scar tissue formation is another post-surgical change that can cause tightness or localized pressure months or years later. Excess or dense scar tissue can create persistent discomfort or a feeling of fullness in the jaw.
Another explanation for a lingering or phantom sensation is nerve healing or dysfunction. The extraction procedure can sometimes irritate or damage the trigeminal nerve branches that supply sensation to the jaw and gums. This can lead to neuropathic pain, or phantom tooth pain, which is similar to phantom limb syndrome. The brain interprets these damaged or regenerating nerve signals as persistent tingling, pressure, or chronic pain in the area where the tooth was removed.
Issues Affecting Adjacent Molars
Sensations that feel like a wisdom tooth is returning often originate from the second molar, the tooth immediately in front of the extraction site. This adjacent tooth may develop new problems that radiate pain backward into the empty socket. Deep decay, a new fracture, or periodontal disease affecting the second molar’s root can produce pain easily mistaken for a problem at the surgical site.
The extraction process can sometimes stress the adjacent second molar, leading to temporary soreness or revealing a pre-existing weakness. Removing the wisdom tooth eliminates physical support, allowing for minor orthodontic shifting over time. This subtle movement or resulting change in bite alignment places new pressure on the surrounding bone and ligaments, which patients perceive as a dull ache or growth sensation.
In rare instances, the original wisdom tooth may have been incompletely removed, leaving behind a small root tip or a portion of the tooth. If this remnant was asymptomatic for a long time, it might eventually become inflamed or infected. While the remnant was always present, its delayed symptoms can certainly feel like a re-emergence of the original problem.
Referred Pain from Non-Dental Sources
Not all pain felt in the back of the jaw originates from the teeth or gums; the sensation can be referred from nearby structures. The Temporomandibular Joint (TMJ) connects the lower jaw to the skull, and dysfunction in this joint is a frequent cause of pain that radiates to the molar area. Issues like joint inflammation or misalignment can cause a deep, aching pressure that feels like it is coming from the wisdom tooth region.
Muscle spasms are another common source of referred pain, especially for individuals who clench or grind their teeth (bruxism). The masseter and temporalis muscles, used for chewing, can become fatigued and tense. The resulting muscle pain is often felt deep in the cheek and jaw, which can be incorrectly localized to the area of the missing wisdom tooth.
For upper jaw extractions, the close proximity of the maxillary sinuses means that sinus issues can mimic dental pain. Sinusitis or pressure from allergies or a cold can cause a heavy, dull ache and pressure in the cheek and upper jaw. Since this pain is concentrated near the back teeth, it is often confused with a dental problem or a sensation of something pushing in the area.
Steps for Professional Diagnosis
Because the underlying cause of the perceived regrowth can range from a tiny bone fragment to a distant joint problem, a professional diagnosis is necessary. The first step for a dentist is to obtain current imaging, typically a panoramic X-ray or a periapical film of the area. These images definitively rule out retained root fragments, hidden decay in the second molar, or a large bone sequestrum requiring removal.
The clinical examination involves a thorough inspection of the extraction site to check for signs of inflammation or exposed bone. The dentist will also palpate the surrounding soft tissues, including the chewing muscles and the TMJ, to assess for tenderness, clicking, or limited movement. Providing a detailed history of your symptoms—including the pain’s onset, intensity, and triggers—is helpful for pinpointing the source.