Wisdom Teeth Pain: Pericoronitis and More

Wisdom teeth are a common source of pain for many people. In fact, most adults will experience some degree of wisdom tooth discomfort during their lifetime, and studies suggest that around one-third to one-half of adults eventually need at least one wisdom tooth removed due to pain, infection, or crowding (Hill et al., 2020).

But why do wisdom teeth cause pain and how can you tell what’s happening? Let’s look at the most common causes.

Pericoronitis – Infection Around a Partially Erupted Tooth

Pericoronitis is the most frequent causes of wisdom tooth pain. It occurs when a wisdom tooth doesn't fully erupt, creating an uncleanable void or 'pocket' around the tooth that occasionally traps food and gets infected, causing pain and/or swelling. The infection, pain and swelling can range from mild to very severe. In rare circumstances, the swelling can be so severe that it can be life threatening as it can block the airway.

The area becomes red, swollen, and tender — and you might notice:

• Pain and swelling around the gum at the back of the mouth

• A swollen face

• A bad taste or smell

• Difficulty opening your mouth (trismus)

• Swollen glands or fever in severe cases

In many cases the bodies immune system will eventually clear the infection and the pain and/or swelling spontaneously subsides. Sometimes a doctor or dentist may prescribe antibiotics or clean the pocket. But if the wisdom tooth remains and the pocket persists, usually the infection returns weeks or months later as food repeatedly gets stuck in the void or 'pocket'. Many patients experience multiple repeated bouts of pain and/or swelling.

If a wisdom tooth is causing pain and or swelling (especially if it's causing repeated bouts) then it needs to be removed.

If a wisdom tooth that is causing repeated infections is left in place, then over a lifetime it will invaribly cause many bouts of pain and swelling.

Tooth Decay

Because wisdom teeth sit so far back in the mouth, they’re often difficult to clean properly. Food and plaque often collect around them, increasing the risk of decay. Decay in wisdom teeth can cause a typical 'toothache':

• Dull or throbbing pain

• Pain can range from mild to incredibly severe

• Sensitivity to hot, cold, or sweet foods

• Pain that radiates to nearby teeth

Damage to Adjacent Teeth

When a wisdom tooth pushes sideways against the molar in front, it creates an area that traps food and it almost impossible to clean properly. This greatly increases the risk of developing a cavity in the wisdom tooth and on the back of the molar in front of the wisdom tooth. See image below.

A cavity on the tooth in front of the wisdom tooth is a difficult area to have a filling (even after the offending wisdom teeth is removed). So even a small cavit on the back of the molar in front of the wisdom tooth can often lead to loss of both teeth (the wisdom tooth and the tooth in front).

Early diagnosis with X-rays or CBCT imaging is essential. If caught early, the affected molar can sometimes be saved, but often the wisdom tooth must be removed to prevent further damage.

Over-Eruption and Traumatic Bite

If an upper wisdom tooth has no opposing lower tooth, it can “over-erupt” and continuing to grow downwards gum until it starts biting on the soft tissues below. This can cause:

• Sharp pain when biting down

• Ulceration of the gum or cheek

• Irritation of the jaw joint from an uneven bite

• Swelling of the traumatized soft tissues

Cheek Ulcers and Soft-Tissue Irritation

Sometimes upper wisdom teeth erupt at an awkward angle toward the cheek. As you chew, the tooth may repeatedly rub or bite into the inside of your mouth, leading to a painful ulcer or swelling. These ulcers can make eating or speaking uncomfortable, and the constant trauma may trigger chronic inflammation or infection.

Odontogenic Cysts and Tumours (Rare)

Although uncommon wisdom teeth can be the source of odontogenic cysts or tumours can. These form when the tissue that normally surrounds a wisdom tooth or is involved in the embryonic tooth development behaves abnormally and develops into a pathological cyst or tumor. Most cases are painless initially but can cause:

• Swelling in the jaw

• Bone loss around nearby teeth

• Shifting of teeth or facial asymmetry

The majority of these are benign and not dangerous, but in rare circumstances they can be very large (predisposing to jaw bone fractures), locally aggressive and destructive, and even develop into malignant cancer.

Such conditions are typically detected on dental X-rays or CBCT scans and are treated by surgical removal of both the cyst and the associated tooth.

Conditions That Can Be Mistaken for Wisdom Pain

Not all pain at the back of the mouth is caused by wisdom teeth. In fact, several other conditions can mimic or overlap with the symptoms of erupting or infected wisdom teeth:

1. Clenching and Bruxism (Teeth Grinding)

Pain around back teeth can come from chronic clenching or grinding. The pain often radiates to the jaw joint and may be worst first thing in the morning and / or worse during times of increased stress.

Clues that may indicate pain is from clenching and grinding rather than wisdom teeth include:

• Pain occurs simultaneously on the the left and right side. Pain from infections or decay is rarely experienced on the left and right at the same time

• Pain is worse in the mornings. Clenching and grinding most often occurs whilst people are asleep.

• Periodic bouts of pain are experienced during times of increased stress. Increased stress if often a trigger for nocturnal clenching and grinding.

2. Sinusitis (Sinus Inflammation or Infection)

The roots of the upper molars sit close to the maxillary sinus. The maxillary sinus is a chamber of air that lives above the teeth in the top jaw, it is connected to the nasal cavity and can get infected.

When a maxillary sinus becomes congested or infected, it can create a dull, pressure-like pain in the upper back teeth that feels very similar to dental pain even though the teeth are healthy.

Some clues that pain is from sinusitis rather than wisdom tooth pain are:

• A recent cough, cold, ear infection or runny nose. Especially if the congestion or runny nose is one-sided.

• A feeling of 'heaviness' or tenderness around the sinuses, typically felt under the eyes

• A post nasal drip (mucous dripping down the back of the throat.

• Pain that changes with head position. For example if the pain is better or worse when you lie down or bend over to tie your shoelaces.

• A known history of sinusitis.

3. Ear Pain or Jaw Joint Disorders (TMJ Dysfunction) Because the jaw joint sits right beside the ear canal, inflammation or muscle tension around the temporomandibular joint can cause earache or a feeling of fullness in the ear. Many patients mistake this for pain from an upper wisdom tooth.

4. Pain from Other Teeth

Deep decay, cracks, or nerve inflammation in adjacent molars can radiate pain backward toward the wisdom tooth area. This “referred pain” can make it difficult to pinpoint which tooth is responsible without a thorough dental exam.

5. Headaches and Migraines

Migraines and headaches can occasionally be confused with wisdom teeth pain.

6. Neck or Muscle Pain

Tight muscles in the neck and shoulders can occasionally radiate pain to the jaw and lower face. This muscular referral pattern can create tenderness that feels similar to dental or jaw pain.

Key Takeaway

Wisdom teeth can cause pain for many different reasons from infection (pericoronitis) to decay, or cyst formation. And there are conditions that can mimic or be confused with wisdom teeth pain. Early assessment helps prevent serious complications, protect nearby teeth, and relieve pain quickly.

If you’re concerned you're experiencing wisdom tooth pain in Adelaide, contact Adelaide Tooth Removals & Dental Implants for an assessment and personalised treatment plan. We are experts in assessing and managing wisdom teeth pain.

References

• Hill et al., 2020, Australian Dental Journal – notes that approximately 60–70 % of adults have at least one impacted third molar and that around 30–40 % ultimately undergo removal due to pain, infection, decay, or orthodontic reasons. Hill CM, McAndrew R. "Management of the third molar: a clinical update." Aust Dent J. 2020;65(S1):S30–S37. https://doi.org/10.1111/adj.12759

• National Institute for Health and Care Excellence (NICE, UK Guideline CG1) reports that roughly one-third of adults experience at least one episode of wisdom-tooth–related pain or infection significant enough to require professional treatment.