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Valerie from Singapore asked a question

Is wisdom tooth removal absolutely necessary if my jaw has started to hurt? (photo)

I'm a 25 year old female and my jaw has been starting to hurt as my bottom left wisdom tooth is growing out. My dentist recommended an extraction, but also said that I would not be able to claim the full amount with Medisave as the tooth is growing upright. I would like an opinion on whether extraction is necessary in this situation. When is wisdom tooth removal absolutely necessary? Thanks!

DOCTOR’S ANSWER (2)
Dr Gerald Tan
Dentist
Singapore
(18 Ratings)
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Dr Gerald Tan
Dentist
Singapore
(18 Ratings)
Answered on Mon Jul 09 2018 16:00:02 GMT+0000 (UTC)

Dear Valerie,

No one likes to have their wisdom tooth removed and I don't blame you for wanting to avoid it unless absolutely necessary!

According to your X-ray, your bottom left wisdom tooth has erupted in a upright, non-impacted position and it seems to be in good function with the opposing upper left 2nd molar ( although this can only be confirmed clinically).

In my opinion, if a wisdom tooth is not impacted and in function, my first thoughts would be to try to keep it instead of extract it, since it is a useful tooth for chewing.

I would try to find out the root cause of your discomfort ( likely to be pericoronitis: An infection of the gum around the erupting wisdom tooth) and treat the condition and monitor.

If the problem goes away and does not come back, I would then say that you might be better off keeping the tooth instead of extracting it at first instance!

I would recommend my patients to consider to remove their wisdom tooth in the following scenarios ( in no particular order of importance)

1. When it is badly decayed.

2. When it is partially erupted, impacted, non-functional and has alot of food trapped in the area ( inability to keep good hygiene in the area)

3. As part of an orthodontic treatment plan

4. When there is evidence of cystic formation or bone pathology around the wisdom tooth.

5. When the benefits of extracting the wisdom tooth outweigh any potential risks of the procedure.

6. When the roots of the wisdom tooth are not twisted around the mandibular nerve in the jaw bone ( if it is, the removal process would be complicated, with a high risk of injury to the nerve)

7. When there are repeated bouts of pericoronitis around the wisdom tooth.

I hope you find my answer useful and now armed with this advice, I hope you can now make a more informed decision about whether or not you would like to keep or extract your wisdom tooth.

I wish you a speedy recovery from your dental discomfort and that you find a experienced and reputable dentist that you can trust and build rapport with.

Kind Regards,

Dr Gerald Tan

0 476 views 0 Doctors agree Mon Jul 09 2018 16:00:02 GMT+0000 (UTC)
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Dr Beth Seow
Dentist
Singapore
(3 Ratings)
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Dr Beth Seow
Dentist
Singapore
(3 Ratings)
Answered on Thu Jul 12 2018 04:48:49 GMT+0000 (UTC)

Hey Valerie, 

 

Thank you for the enquiry. It seems likely to me based on your description that there is pain due to the biting trauma from the upper tooth that is biting on the lower gum partially covering the lower left wisdom tooth

Dr Gerald has given a thorough description of what should be done and I agree with all that he has said. 

An alternative solution to relieve the pain would be to do something called crown lengthening. Crown lengthening is as follows: 

 

Basically its to uncover the gum over the tooth that is causing pain and this procedure is medisave claimable. I do feel that you should consider this rather than extraction since you do have a fully functional wisdom tooth that is upright tooth. 

Hope this helps and all the best! 

Warm regards, 

Dr Beth Seow 

0 168 views 0 Doctors agree Thu Jul 12 2018 04:48:49 GMT+0000 (UTC)
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