Wisdom Tooth Pain Relief at Home, and When the Tooth Should Come Out

Why do wisdom teeth hurt?

Wisdom teeth are the last molars, usually coming through in the late teens or twenties, often into a jaw that has little space left. That lack of space explains most of the pain. The common causes are:

• An inflamed gum flap. When a wisdom tooth is only partly through, a flap of gum covers part of it. Food and bacteria collect underneath and the gum becomes sore, swollen and sometimes infected. This is called pericoronitis, and it is the most frequent reason for wisdom tooth pain; our page on pericoronitis covers it in detail.
• Decay. Wisdom teeth are hard to clean, so they and the molar in front of them decay easily. Decay that reaches the nerve causes a deeper, throbbing ache.
• Pressure on the neighbouring tooth. A tooth growing sideways can push against the second molar, trapping food and causing decay or damage to its root.
• Biting on the gum. An upper wisdom tooth that comes down too far can bite into the gum around the lower one, keeping it sore.
• Rarely, a cyst around an impacted tooth, usually found on an X-ray rather than felt.

Is the pain from the tooth or the gum flap?

How can I ease wisdom tooth pain tonight?

The NHS advises these steps for toothache until you can see a dentist: painkillers such as those sold at pharmacies, taken as directed on the label (a pharmacist can advise what suits you, and children under 16 should not take aspirin), rinsing with warm salt water (not for children), soft food, and avoiding sweet, very hot or very cold food and smoking. For a wisdom tooth, a few extras help:

• Clean the area gently but thoroughly. Use a soft or small-headed brush on the wisdom tooth and the gum behind it, then rinse after every meal to wash trapped food from under the flap.
• Chew on the other side and cut food small, so the sore gum is not squeezed.
• Use a cold pack on the cheek for short periods if the area is swollen, wrapped in a cloth.
• Sleep with your head raised on an extra pillow, which reduces throbbing for many people.
• Avoid smoking, shisha and alcohol, which slow healing and irritate the gum.

Do not take leftover antibiotics or someone else's. Antibiotics are sometimes needed when infection spreads, but they are prescribed after an examination, and they do not remove the cause. Our guide on antibiotics for tooth infection explains why.

Why does wisdom tooth pain come and go?

Pericoronitis tends to flare and settle. A flap that has calmed down is still a pocket where food collects, and the next flare is often set off by a cold, tiredness, exams, travel, a busy period at work or a piece of food stuck underneath. Each time, the gum swells, the upper tooth bites on it, and the swelling makes it easier to bite again, until the cycle eases.

Pain that disappears is therefore not proof that the problem has gone. The pattern matters more than any single episode. UK NICE guidance states that a first episode of pericoronitis, unless it is particularly severe, is not by itself a reason for surgery, but that second or later episodes are. That is why dentists ask how many times the pain has come back.

Can wisdom tooth pain cause headache or ear pain?

Yes. The nerves that supply the lower back teeth share pathways with the ear, jaw joint and temple, so pain from a wisdom tooth is often felt as earache, a one-sided headache or a sore jaw. Swelling around the tooth can also tighten the chewing muscles, making it hard to open wide. The reverse also happens: jaw joint and muscle problems can feel like a wisdom tooth.

If ear pain or headache comes with a sore wisdom tooth area, bad taste or swelling at the back of the mouth, the tooth is a likely source. If you have ear discharge, hearing changes or a fever without mouth symptoms, see a doctor. Our guide to toothache that spreads to the ear and head explains how to tell them apart, and the guide on difficulty opening the mouth covers a stiff jaw.

Does wisdom tooth pain mean it must come out?

Not always. The NHS explains that wisdom teeth are removed when they cause problems such as pericoronitis, decay, cysts or abscesses, while teeth causing no problems are usually left and monitored. A single mild flare-up that settles with cleaning may simply need watching and better access for the toothbrush. Removal is usually discussed when:

• pericoronitis has come back more than once, or one episode was severe;
• the wisdom tooth, or the molar in front of it, has decay that cannot sensibly be restored;
• there is an abscess, a cyst or damage to the neighbouring tooth's root;
• the tooth has no chance of coming through into a useful, cleanable position.

The decision is made after an examination and an X-ray. When the roots of a lower wisdom tooth sit close to the nerve, a 3D CBCT scan helps plan the safest approach; our guide to coronectomy explains one option that is sometimes considered in that situation. For the wider question of when removal is worthwhile, see do wisdom teeth need removing.

At Creative Arts, wisdom tooth surgery is planned by Dr. Firas Osman, Oral & Maxillofacial Surgeon & Implantologist, with Dr. Khalid Saeed and Dr. Somar Dahdal, in operating rooms equipped for dental surgery. Local anaesthesia, sedation or general anaesthesia is chosen after a review of your medical history. If more than one tooth needs to come out, our guide on removing all wisdom teeth at once compares the options.