Deal with an Infected Wisdom Tooth

Wisdom teeth (third molars) get their name because they’re usually the last teeth that come in, often when people are in their late adolescence. (A few people do not have wisdom teeth at all.) Having an infected wisdom tooth can be very unpleasant and will usually require immediate action. You can take a few steps to relieve the pain until you are able to see your dentist.

Steps

Caring At Home

1. Identify the signs. Pericoronitis (the infection around the wisdom tooth) occurs when the tissue surrounding a wisdom tooth becomes inflamed and infected. It can be caused when only part of the tooth has “erupted” into the mouth, or if crowding near the wisdom teeth has made flossing and proper cleaning difficult. To figure out whether your wisdom tooth is infected, it is important to be able to identify the tell-tale signs and symptoms. Look for the following:
   • Bright red gums or red with white spots on your gums. The gums will be inflamed around the particular tooth.
   • Moderate to severe pain in your jaw and difficulty chewing. You may notice swelling that looks like a small lump in your cheek. The swollen area may also feel hot to the touch.
   • An unpleasant, metallic taste in your mouth. This is caused by the blood and pus at the site of the infection. You may also experience bad breath as a result.
   • Difficulty opening your mouth or swallowing. This may mean that the infection has spread from the gums to the surrounding muscles.
   • Fever. A temperature above 100 degrees F (37.8 degrees C) indicates that you have a fever, which means that your body is fighting off an infection. In severe cases, the infection may be accompanied by muscle weakness. If this is the case, you should contact a dentist or doctor immediately.
   • In some cases, the root may also be infected. If this is the case, your dentist will likely extract the tooth.
2. Rinse your mouth with saltwater. Salt is naturally antiseptic. Using a saltwater rinse can help kill bacteria in your mouth. Add ½ to 1 teaspoon of salt to 8 ounces of lukewarm water. Mix well to combine.
   • Take a mouthful of the rinse and swirl it around your mouth for 30 seconds, concentrating on the infected area to kill the bacteria.
   • Spit out the salt water after 30 seconds — do not swallow. Repeat this process 3 to 4 times per day.
   • You can use this treatment in combination with any antibiotics your dentist prescribes.
3. Use a dental gel to relieve pain and inflammation. Depending where you live, it might possible to buy antibacterial dental gels at your local drugstore. These gels help to control the infection and alleviate any pain or inflammation.
   • To apply the gel, rinse your mouth thoroughly and apply one or two drops of the gel directly onto the infected area using a cotton applicator tip.
   • Don't use your fingers to apply the gel as you risk introducing more bacteria.
   • Apply the dental gel 3 to 4 times per day for best results.
4. Relieve the pain. If you are experiencing severe discomfort as a result of the wisdom tooth infection, you can take a pain reliever that also relieves inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually available over the counter at pharmacies and drug stores.
   • Ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin are the most common NSAIDs. Do not give aspirin to children under age 18, as it has been linked to the development of Reye’s Syndrome, which causes brain and liver damage.
   • Acetaminophen (paracetamol) is not an NSAID and does not reduce inflammation, but it can help relieve pain.
   • Follow the dosing instructions on the packaging, or as instructed by your doctor, and do not exceed the maximum dosage.
   • Keep in mind that each drug has its own list of side effects, so read the product advice information on the packaging before taking any medication. Talk to your pharmacist or doctor if needed.
5. Use an ice pack. If you don’t want or can’t take medication, apply an ice pack to the infected area. It will relieve pain and reduce the inflammation until you can seek treatment. If the swelling is severe, seek emergency medical treatment.
   • Pour ice cubes in a plastic bag or in a towel. Press the bag against the painful area for at least ten minutes.
   • You can also use a bag of frozen vegetables, such as peas or corn. (Don’t eat bagged veggies that have been thawed and refrozen.)
6. Call your dentist. It is very important that you schedule an appointment with your dentist as soon as possible. If you do not get adequate medical treatment for your infection, it could spread to other parts of your mouth and body.
   • Pericoronitis may also lead to other complications such as gum disease, tooth decay and the development of cysts. More severe complications include swollen lymph nodes, sepsis, systemic infection, and possibly even death.
   • If your dentist is too busy to see you immediately, visit an urgent care clinic or go to the hospital. Many have emergency dentists.

Seeing Your Dentist

1. Discuss the treatment with your dentist. S/he will examine the infected area and take an x-ray. to determine the severity of the situation and identify the best treatment.
   • S/he will examine the position of the tooth to see whether it has fully or partially emerged from the gums. Your dentist will also take note of the condition of the surrounding gums.
   • If the wisdom tooth has not yet emerged, the dentist may need to perform an x-ray to locate the tooth and identify its position. These factors will influence whether or not the tooth will need to be removed.
   • Don’t forget your medical history. Your dentist will want to know if you’re allergic to any medication.
2. Ask about costs, risks, and benefits of treatment. Consult with your dentist about how much the procedure will cost. You should also ask about all the risks and benefits of the treatment, as well as any alternative treatments that may be an option.
   • Don’t be afraid to ask questions. You have the right to understand your medical care.
3. Let your dentist clean the infected area. If the wisdom tooth is about to emerge from the gums without any problems and the infection is not too severe, the dentist may be able to clear the infection by simply cleaning the area with an antiseptic solution.
   • The dentist will remove any infected tissue, pus, food debris or plaque from around the area. If there is an abscess on the gums, sometimes a small incision will be made to drain the pus.
   • After the cleaning, your dentist will recommend home care for you to follow over the next few days. This might include mouth gels to bring down inflammation, antibiotics to fully clear the infection, and painkillers to relieve any pain. Commonly prescribed antibiotics include Amoxicillin, Clindamycin, and Penicillin.
4. Prepare yourself for minor surgery. One of the main causes of wisdom tooth infection is when a section of gum covering the wisdom tooth — known as the gum flap —becomes infected due to bacteria, plaque and food debris becoming trapped underneath it. If the tooth is still buried within the gums (but is positioned to emerge from the gums correctly) it is often easier to remove the infected gum flap than the tooth itself.
   • Your dentist might schedule a minor surgical procedure called an ‘operculectomy’, in which the soft gum tissue covering the wisdom tooth is removed.
   • Once removed, the area will be a lot easier to keep clean and free of plaque and bacteria, which greatly reduces the chances of the wisdom tooth becoming reinfected.
   • Before the procedure, your dentist will numb the area with a local anesthetic. S/he will then remove the infected tissue flap using surgical scalpel blades, lasers or electrocautery methods.
5. Consider a tooth extraction. If you have suffered from multiple infections and your wisdom tooth shows no sign of emerging on its own, it may be necessary to have the tooth removed. Extraction may also be necessary if the infection is very severe.
   • Depending on the position of the tooth, the extraction will be conducted by your dentist or by an oral surgeon.
   • The dentist will give you a local anaesthetic and will remove the tooth.
   • You may be prescribed antibiotics and painkillers to prevent further infection and relieve any pain. It is essential that you follow your dentist's advice regarding good oral hygiene practices.
   • You will need to schedule a follow-up appointment with your dentist to inspect the gums to ensure they are healing properly. The dentist will check the positioning of the opposite wisdom tooth, in case it need to be removed also.

Maintaining Good Oral Hygiene

1. Brush your teeth twice a day. In order to avoid future infections, it is essential to maintain good oral hygiene. The first step to good oral hygiene is to brush your teeth twice a day using a soft-bristled toothbrush. Hard-bristled toothbrushes are too harsh and can wear away delicate tooth enamel.
   • Hold your toothbrush at 45-degree angle to your gumline.
   • Brush your teeth using small circular motions, rather than brushing back and forth (as this can damage tooth enamel).
   • You should brush your teeth twice a day, for at least two minutes at a time. Make sure to brush down to the gum line and don't forget the teeth at the back.
2. Floss daily. Flossing is just as important as brushing, as it removes built-up plaque and bacteria from between the teeth that the toothbrush cannot reach. If this plaque isn't removed, it can lead to tooth decay, infection and gum disease. Floss at least once a day.
   • Hold the floss firmly between both hands and work it gently down between the teeth using a gentle back and forth movement. Try not to "ping" it down onto the gums, as this is irritating to the gums and can cause bleeding.
   • Curve the floss into a “C” shape against one tooth. Slide the floss gently between your tooth and your gum.
   • Holding the floss tightly, rub the tooth with gentle back and forth motions.
   • Make sure to floss between every tooth and at the backs of your rear molar. You should always rinse your mouth after flossing to remove the dislodged plaque and bacteria.
3. Use an antiseptic mouthwash to kill bacteria. Using an antiseptic mouthwash helps to control the level of bacteria inside the mouth, while also keeping your breath nice and fresh. Look for one that has the ADA Seal of Acceptance; these have been approved by the American Dental Association as effective for your teeth.
   • You can use mouthwash before or after brushing. Pour a small cap-full of the mouthwash into your mouth and swish it between the teeth for approximately 30 seconds before spitting out.
   • You can use a commercial brand antiseptic mouthwash, or simply rinse your mouth with undiluted chlorhexidine, which is available at most pharmacies.
   • If you find the “burn” of mouthwash too strong, look for an alcohol-free version.
4. Schedule a dental check-up. Scheduling regular check-ups with your dentist is the best preventative measure you can take to avoid wisdom tooth infection and other dental issues.
   • You should see your dentist every six months, particularly if your wisdom teeth have not yet emerged. Your dentist may recommend that you visit more frequently if you have certain health issues.
5. Don't smoke. Avoid smoking or using tobacco products when suffering from an infected wisdom tooth, as these activities irritate the gums and can make the infection worse.
   • Cigarette smoking is bad for your health in general, and your oral health is no different. Talk to your doctor about ways to quit as soon as you can.
   • Smoking can also stain your teeth and tongue, slow your body’s ability to heal, and cause gum disease and oral cancer.

Tips

• Not all wisdom teeth need to be extracted if they aren’t causing problems. Your dentist can help you decide whether extraction is right for you. Most people who have trouble with their wisdom teeth are between age 15-25.

Warnings

• Home remedies and self-care will likely not cure an infection. Any infection should be examined by your dentist as soon as possible and the management/treatment should be done immediately

Sources and Citations

See also

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• Reverse Dental Bone Loss
• Choose Dental Loupes
• Get Rid of Tooth Pain

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