Wisdom tooth pain usually comes from inflamed gum around a tooth that is only partly through (pericoronitis), a tooth that is stuck against bone or the tooth in front (impaction), or decay in a tooth that is hard to reach with a toothbrush. Mild soreness often settles with careful cleaning and pain relief, but swelling, trouble opening your mouth or pain that keeps coming back should be checked by a dentist.
If the pain is severe or your face is swollen, read our dental emergency guide alongside this article. Below we cover the likely causes, what you can do at home tonight and when removal may be recommended.
Get help urgently if you notice these signs
Infection around a lower wisdom tooth can spread into the tissues of the jaw and neck. Call 000 or go to your nearest hospital emergency department if you have:
- difficulty breathing or swallowing, or you can’t swallow your own saliva
- swelling spreading to the eye, neck or floor of the mouth (under the tongue)
- a fever with facial swelling, or you feel very unwell
- bleeding that won’t stop after 15–20 minutes of firm pressure, for example after an extraction
- a possible broken jaw, or a knock to the head with loss of consciousness, vomiting or confusion
Out of hours, if you’re unsure how urgent it is, call healthdirect on 1800 022 222 for 24/7 nurse advice.
What causes wisdom tooth pain?
Wisdom teeth (third molars) usually come through between the late teens and mid-twenties. Many people have no trouble with them, but there often isn’t enough room at the back of the jaw, and that’s when problems start.
Pericoronitis
This is the most common cause. When a wisdom tooth is only partly through, a flap of gum can sit over it. Food and bacteria get trapped underneath, and the gum becomes red, swollen and tender. You may notice a bad taste, bad breath, pain when swallowing, stiffness when opening your mouth or a sore gland under the jaw. Biting on the swollen flap with the opposite tooth often makes it worse.
Impaction
An impacted wisdom tooth is blocked from coming through fully, often because it is angled into the tooth in front or sits deep in the bone. It may cause pressure or a dull ache. It can also leave a hard-to-clean pocket where the gum and the neighbouring molar are prone to decay and gum disease. Less commonly, a fluid-filled sac (cyst) can form around a buried tooth.
Decay and gum disease
Wisdom teeth sit so far back that they’re easy to miss when brushing and flossing. Decay in the wisdom tooth, or in the back of the molar in front of it, can cause sensitivity to cold and sweet foods, then throbbing pain if it reaches the nerve.
Other causes to rule out
Pain at the back of the mouth isn’t always the wisdom tooth. Jaw joint and muscle problems from clenching, a cracked molar, an ulcer or sinus congestion can feel similar. An examination and X-ray help your dentist work out where the pain is coming from.
How to ease the pain at home
These steps can help while you wait for an appointment. They manage symptoms but won’t fix the cause.
- Rinse gently with warm salty water (about half a teaspoon of salt in a glass of warm water) after meals and before bed.
- Brush the area carefully with a soft toothbrush, including the gum flap, to clear trapped food. A small single-tuft brush can reach further back.
- Hold a cold pack wrapped in a cloth against the outside of your cheek for 10–15 minutes at a time.
- Take over-the-counter pain relief such as paracetamol or ibuprofen, taken as directed on the pack, if it’s safe for you.
- Chew on the other side and choose soft foods for a few days.
- Ask your pharmacist whether an antiseptic mouthwash is suitable for you.
Don’t put aspirin on the gum, don’t hold heat against your face, and don’t take leftover or borrowed antibiotics. Antibiotics should only be used when a dentist or doctor prescribes them, and they don’t remove the underlying cause.
When to see a dentist
Book an appointment within a day or two if you have:
- pain that lasts more than a couple of days or keeps coming back
- swollen or bleeding gum around a wisdom tooth
- a bad taste or pus near the back tooth
- difficulty opening your mouth fully
- pain that wakes you at night or doesn’t settle with pain relief
We aim to see urgent problems as soon as possible, often on the same day. Our emergency dentist in North Sydney can assess the tooth, clean under the gum flap and relieve pain, so you can think about next steps without rushing.
Will my wisdom tooth need to come out?
Not always. A wisdom tooth that is healthy, fully through and easy to clean may never need treatment. Your dentist will usually take an X-ray, often a panoramic image of the whole jaw, to see the tooth’s position, its roots and how close it sits to the nerve.
Wisdom tooth removal may be recommended if you have:
- repeated flare-ups of pericoronitis
- decay in the wisdom tooth that can’t reasonably be repaired
- decay, damage or gum disease affecting the tooth in front
- a cyst or other change around the tooth seen on an X-ray
- an upper wisdom tooth that bites into the gum or cheek
At our North Sydney practice, many wisdom teeth can be removed in the chair under local anaesthetic, and happy gas is available if you feel nervous. If a tooth is deeply impacted or very close to the nerve, your dentist may refer you to an oral and maxillofacial surgeon, who may arrange a 3D scan and treatment under sedation or general anaesthetic.
Like any surgery, removal carries risks, such as swelling, a dry socket or, rarely, numbness from irritation of a nerve. Your dentist will explain the benefits, risks, recovery and costs before anything is done. See our price guide or ask about payment plans.
Frequently asked questions
Can a sore wisdom tooth settle on its own?
Mild pain from a tooth coming through, or a minor flare of gum inflammation, often settles within a few days with careful cleaning and salt water rinses. If the pain keeps returning, the underlying cause is still there and a dentist should check it.
How long does pericoronitis last?
A mild flare often settles within a few days to a week once the area is kept clean. It tends to come back while the gum flap remains, so repeated flares are a common reason to consider removal.
Is wisdom tooth pain an emergency?
It is urgent if you have swelling, fever, trouble opening your mouth or pain that won’t settle, so see a dentist promptly. Call 000 or go to hospital if you have difficulty breathing or swallowing, or swelling spreading to your eye or neck.
Do all wisdom teeth need to be removed?
No. Healthy wisdom teeth that are fully through and easy to clean can often stay. Your dentist will advise you based on an examination and X-ray.
Need help now?
North Sydney Dentistry is at Level 1, Suite 102/71 Walker St, North Sydney, a two-minute walk from North Sydney station. We’re open Monday to Friday, 9am to 6pm, and keep time aside for urgent problems where we can. Call (02) 8090 1108 or book online.
This article is general information only and is not a substitute for advice from your own dentist or doctor. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.
