Wisdom Tooth Pain? When You Should Remove It

If you are experiencing pain from your third or “wisdom” teeth in Bryn Mawr, PA., there is a good chance the tooth may require removal due to either an impacted tooth, infected tooth or a crowded tooth that will not heal without surgical intervention. At Dillon Family Dentistry, located in the Main Line section of Philadelphia, Dr David Dillon takes X-rays of the impacted teeth and provides surgical extraction of those teeth if they are determined clinically necessary. The extraction can occur on the same day or through regular emergency services to the Bryn Mawr area, as well as those in Haverford, Ardmore, and Wayne.

If you’re reading this at midnight because you’re in pain from the back of your mouth, I want to put your mind at ease and give you an honest answer without dancing around the issue. A reason many patients call my Bryn Mawr office is that they are in pain from wisdom teeth, but for whatever reason, there seems to be some confusion about it. Some people will wait for months on end to see if their pain goes away, but it seldom does. Others will assume that since their wisdom tooth hurts, they need surgery, but that is not necessarily true either.

I am Dr. David Dillon from Dillon Family Dentistry, located on the Mainline and have evaluated and removed many wisdom teeth from the patients that I treat in Bryn Mawr, Haverford, Ardmore, Wynnewood, Wayne, and Villanova. It is my goal at this time to give you an accurate, evidence-based response regarding what is occurring within your mouth and what can or needs to be done about it.

Wisdom tooth pain that is persistent, worsening, or accompanied by swelling, infection, or difficulty opening your jaw almost always requires professional evaluation and, in most cases, removal. Pain that comes and goes temporarily during eruption may not. The only way to know for certain is with an X-ray and clinical exam. At Dillon Family Dentistry in Bryn Mawr, we offer same-day and emergency appointments for patients who can’t wait.

What Is Wisdom Tooth Pain and Why Does It Happen?

Third molars are called wisdom teeth, but they are the last teeth to come in. They usually grow in between the ages of 17 and 25; however, I see a lot of patients in my practice who are dealing with their wisdom teeth when they are in their 30s. The main reason why wisdom teeth create problems like impaction is simple: there isn’t enough room in the modern human mouth for third molars to develop correctly because of changes in the size of human mouths over time.

When there’s not enough space, a wisdom tooth can become impacted. That means it’s blocked from fully erupting and ends up stuck in one of several positions:

1. Partially erupted through the gum but unable to fully emerge, creating a flap of gum tissue where food and bacteria collect
2. Angled toward the adjacent second molar, pressing directly against it
3. Growing horizontally, completely sideways, trapped under the gum and against bone
4. Fully impacted, buried entirely beneath the gum and bone with no exit route

Each of these scenarios creates a different pattern of pain and risk. The common thread is that impacted wisdom teeth don’t clean properly, don’t sit correctly, and over time they cause problems, whether that’s infection, pressure, crowding, or cyst formation.

Understanding what’s happening with your wisdom teeth starts with a proper dental evaluation. Our family dental services in Bryn Mawr include panoramic X-rays and a thorough clinical assessment so we know exactly what we’re dealing with before recommending anything.

Signs You Need Wisdom Tooth Removal: What to Watch For

This is the part most patients get wrong. Not every wisdom tooth needs to come out, and not every twinge of discomfort means you’re headed for surgery. But there are clear signs that tell me removal is the right call. If you’re dealing with any of the following, don’t wait it out.

1. Persistent Pain or Pressure at the Back of Your Mouth

If you have a persistent dull pain in your mouth that occurs primarily when you chew or open your jaw wide, this is not typical. Eruption pain from growing teeth as a teenager may be mild and short-lived. If you’re experiencing continual pain for weeks or even months, something isn’t right. Impacted teeth won’t get better by themselves, and the pain will become cyclical, with each bout being more severe until the tooth has been treated.

2. Swollen, Red, or Bleeding Gums Behind Your Last Molar

The first thing to appear that usually indicates pericoronitis (a condition affecting the soft tissue around the partially erupted wisdom tooth) is that the flap surrounding the partially erupted tooth through the gum, called pericoronitis, will trap food debris and bacteria. The flap and surrounding area will swell and become red, and you may experience a bad taste and/or discharge. Short-term treatment for pericoronitis consists of antibiotics and surgical cleansing of the tissue; however, in most cases, pericoronitis continues to return until the offending tooth is extracted. I have repeatedly seen this pattern develop during my years working with patients who delay their wisdom tooth extractions.

3. Difficulty Opening Your Jaw or Chewing

When an infected molar or the inflammation connected to an infected molar spreads to the muscles near the jaw, trismus (or “jaw stiffness”) can develop. Are you having difficulty fully opening your mouth? Do you avoid eating certain foods because of pain when you bite them? If so, your wisdom teeth may be contributing to this problem. Lower wisdom teeth are the most common culprits of trismus, meaning that severe irritation has occurred as a result of the situation worsening beyond mild irritation.

4. Headaches and Earaches That Don’t Have a Clear Cause

Many people are shocked to learn that their impacted wisdom teeth may also be contributing to the source of their headaches or earaches. The nerves used by the impacted wisdom teeth also travel to the jaw joint, ears and temples. When an impacted wisdom tooth applies pressure and/or causes inflammation on those areas, it may result in a radiating pain directed towards the head and/or ears as if it were a tension headache or sinus issue. If you’ve tried treating what you think were tension headaches or sinus issues with no relief, consider having your dentist rule out any possible relationship between your impacted wisdom teeth and your headaches or earaches.

5. Bad Breath or a Persistent Bad Taste

Sulfur compounds are produced by bacteria trapped around a partially erupted wisdom tooth, producing chronic bad breath that is not relieved by brushing, flossing or mouthwash. Pus or discharge from the back of your mouth indicates an active infection that needs treatment immediately, not next month.

6. Visible Shifting or Crowding of Your Other Teeth

A wisdom tooth can push on a second molar, creating a domino effect. Patients may feel like their front teeth have become tighter and are now overlapping where they were not before, or that their bite feels different. People who have completed orthodontic work before getting their wisdom teeth removed are often bothered by this. Removing the wisdom teeth will not always eliminate the crowding that exists; however, they will cease adding additional pressure to the area and can help to prevent the crowding from getting worse.

When You Don’t Need Wisdom Tooth Removal

I’ll be direct here: not every wisdom tooth needs to come out. I’m not in the business of recommending procedures patients don’t need. If your wisdom teeth are:

1. Fully erupted with a normal upright position
2. Accessible and easy to clean with a toothbrush and floss
3. Not causing pain, infection, or pressure on adjacent teeth
4. Not showing cysts or bone changes on X-ray

…from there, the wait-and-see approach is very reasonable. You will be checked each appointment and have periodic X-rays taken to monitor any changes. Once there is a significant change, we will talk about it at that time.

One item I want to make you aware of is that there have been many studies done which state that as you get older, the more complicated the surgical procedure will be to remove wisdom teeth. Typically, by the time you are in your mid-late 20’s, your roots are fully developed, and your bone density increases. This does not mean that one should not wait; however, if there is a chance that you will need to have them removed, you should do this sooner rather than later in most cases, so that you will heal faster and have less risk involved.

Emergency Wisdom Tooth Removal in Bryn Mawr: When It Can’t Wait

Some wisdom tooth situations are urgent. If you’re experiencing any of the following, call our Bryn Mawr office the same day rather than trying to manage it at home:

1. Severe, unrelenting pain that over-the-counter medications are not controlling
2. Visible swelling in your jaw, cheek, or neck (which can indicate a spreading infection)
3. Fever combined with tooth or jaw pain is a classic sign of bacterial infection
4. Difficulty swallowing or breathing, which may indicate the infection is spreading into the throat. This is a medical emergency.
5. Pus or significant discharge around the wisdom tooth

If you have a dental infection, it can easily spread. An untreated infection with your wisdom tooth could spread to your jaw, neck, or even your airway. You shouldn’t try to manage the situation with ibuprofen and hope things get better. If you have bad pain, a swollen face, or a fever with dental pain, you need to get a dental evaluation today. 

At Dillon Family Dentistry, we try to get emergency patients in on the same day when possible, and we will do our best to get you seen as quickly as possible if you tell us you have terrible pain due to a wisdom tooth when you call.

What Happens During Wisdom Tooth Removal at Our Bryn Mawr Office

A lot of the anxiety around wisdom tooth extraction comes from not knowing what the process actually looks like. Let me walk you through it.

Step 1: Evaluation and X-Rays

We begin by taking x-rays, typically a panoramic x-ray, which will show us all four wisdom teeth, their root structure, angle and relationship to neighbouring teeth and nerves. This allows me to see exactly what type of extraction we’re going to do and the safest and most efficient way to do it.

Step 2: Anaesthesia

The local anaesthetic is administered to completely numb the area, which is why this step is done slowly. The goal of a properly numbed extraction is for it to be a comfortable experience. Additional sedation options can be discussed during your consultation if you desire.

Step 3: The Extraction

The ex