Removing the wisdom tooth opposite the problem?

September 12, 2008 10:53 AM

WisdomToothFilter. My previous dentist told me I had impacted wisdom teeth, which might need future attention. I now have toothache in the bottom-right of my jaw. New dentist says I have an infection there and has prescribed me antibiotics. However, he says the problem is the top-right tooth which is pressing down in the wrong place, and it's the top one that needs to be extracted. Is it valid to remove the tooth that's not giving me a problem?

I've made an appointment for him to remove it next week, but I can cancel if necessary.

More info. I've been pretty slack and haven't had a checkup in a couple of years. I've never used this dentist before: got a slightly lukewarm recommendation from someone.

posted by TheophileEscargot to health & fitness (22 comments total)

Is it not possible that these are two separate issues?

Top-right is impacted and causing (or will cause) a problem.

Bottom-right is infected.
posted by dirtynumbangelboy at 11:04 AM on September 12, 2008

Wisdom teeth are annoying at the best of times (God is a bad designer, qv appendix), and yes they can put pressure on other teeth, which push other teeth, which can cause pressure and pain very far away from where it starts.

While having one problematic wisdom tooth removed, I opted to have all four pulled. It cost almost the same, and one week of soreness meant there'd be no later issues or return trips to the House of Pain.

That was 10 years ago. No regrets.
posted by rokusan at 11:04 AM on September 12, 2008

Mr. Adams once had a situation similar to yours...woke up one morning in pain and with a swelling on one side of his jaw. Went to dentist, was told he had an infection in one wisdom tooth, but that another wisdom tooth was the main cause of the problem. Sorry for being vague, but this was some 10 years ago. I just remember being confounded by the "logic" at the time; nevertheless we went to an oral surgeon and had all four wisdom teeth removed. He was incapacitated for a few days (but at least he had me to make his Jell-O and change his gauze), and once he healed he never had any tooth trouble other than the occasional cavity.
posted by Oriole Adams at 11:09 AM on September 12, 2008

But it is giving you problems. If you have a callus on a toe that is giving you a blister on another toe, and the blister hurts and the callus doesn't, it's still the callus that is the problem (or at least an equal offender). In this case I would guess (without being a dentist or having a clue about what's going on in your mouth) that the top right tooth is easier to pull than the bottom tooth (which might be impacted further), so it's better to take that one out. Wisdom teeth that are causing problems anywhere should be pulled.
posted by dness2 at 11:10 AM on September 12, 2008

dirtynumbangelboy: Well, he definitely told me that it was the upper tooth causing the problem (infection) with the lower, because of the place it's pressing down on.

He did do an X-ray, and pointed authoritatively at various tooth-liked blobs on the screen while explaining, but I couldn't quite follow it.

dness2: He did say that the upper tooth extraction was the simplest kind.
posted by TheophileEscargot at 11:14 AM on September 12, 2008

Yeah, I've had exactly this problem. What happens is that your gum gets swollen from impact and then every time you close your jaw the upper tooth beats up the infected area more and pushes nasty stuff down between the tooth and the gum. In my case, the dentist remove the top wisdom tooth to relieve the pressure on the bottom gum while he waited for antibiotics to clear the infection so he could remove my bottom wisdom tooth on that side. It's possible, though, that just by removing the offending tooth the dentist or oral surgeon can remove the pressure on your lower teeth sufficiently to allow it to heal, whether or not it ultimately needs to be removed for other reasons (e.g., that tooth itself is impacted).

The extraction will probably be easy. I couldn't have the full sedation for mine but the liquid Valium and some local was more than enough to keep me from feeling anything. What happened to me is roughly this: administration of anesthesia, use of a laser to cauterize the infected area where it has swollen over the rear top of the molar, removal of upper tooth and packing the wound with gauze, general cleanup. 45 minutes with an ice pack and monitored intermittently for excessive bleeding, and after that I went home.
posted by Inspector.Gadget at 11:19 AM on September 12, 2008

I had this exact situation. I'd get an abscess in the impacted lower one maybe once a year. It hurt, a lot, especially once the tissue swelled and the top tooth was literally biting a swollen infected gum. I got all four removed and never had a problem. It didn't even hurt.
posted by sanka at 11:20 AM on September 12, 2008

jeez, just have them removed and be done with it already. i had an infected wisdom tooth removed earlier this year and it took the dentist longer to anesthetize me than it did to get the tooth out—she pulled it so quickly i didn't even realized it was done and asked her when she was going to do it. turns out she was already stitching my gum up! as they say on ebay: A+++ WOULD DO AGAIN.
posted by lia at 11:29 AM on September 12, 2008

My recommendation would be to talk to your dentist and ask about the option of getting them ALL out. It sounds like these two teeth will have to be removed eventually anyway, might as well get it all overwith.

I had all of mine out when I was 17 because my mom had horrible wisdom teeth problems and decided that I needed to pre-empt any badness and just get it overwith. It was a bad week, but that was it. Just one week of Vicodin and applesauce.

I lived with my ex while he had two wisdom teeth out on two different occasions. Each time it was hell. First time, he got a dry socket and was out of commission for almost 3 weeks. Second time was slightly better, but still, two surgeries, two healing periods, two hurting teeth.

From my (limited) experience, it's best to just "git 'er done." Talk to your dentist and see if that's an option.
posted by grapefruitmoon at 11:40 AM on September 12, 2008

This is really just me, but I wouldn't trust a dentist to remove an impacted wisdom tooth (and I love my dentist). I would certainly NEVER trust a dentist that took X-rays and then didn't give me a full and clear explanation of exactly what was going on. Don't see a doctor you don't feel comfortable with!

I think the best course of action here is to see an oral and maxillofacial surgeon, get one of those neat panoramic X-rays and ask his/her opinion. These doctors remove wisdom teeth and deal with jaw problems for a living.

I had four horribly impacted wisdom teeth removed a few weeks ago and it still kinda sucks, but not nearly as bad as the jaw pain and headaches I was having (and I didn't have anything infected!). If you don't have the room for them in your jaw, and you have some way of paying for it, just go for it. Go to an oral surgeon, get knocked out, try to not drool blood while picking up your Vicodin prescription at the pharmacy and then eat some mashed potatoes while watching daytime TV.

(If anyone needs a recommendation for a dentist or oral surgeon in the Boston area, just let me know)
posted by giraffe at 11:41 AM on September 12, 2008

IANADentist but the explanation sounds plausible because I had upper (nonimpacted) wisdom teeth removed to prevent the issue you have.

The gist was that the teeth of the upper and lower jaws should be in alignment and so 'press' evenly against each other. I had impacted bottom wisdoms and nonimpacted uppers, however the upper wisdom teeth were growing out of alignment and would be longer than the rest of my upper teeth, ultimately putting extra pressure on my bottom jaw. If I removed impacted bottom wisdoms only, the upper ones would grown down and rub against gum rather than teeth (ouch).

So I think there are several answers to your question:
1. Yes an ache in the lower right jaw can be caused by a misaligned tooth in the upper right jaw.
2. Removing the impacted lower tooth, will not remove the source of pain (a misaligned, albeit unimpacted, upper tooth). Therefore one should remove the upper tooth.
3. Even if you remove the upper tooth, your dentist will probably eventually recommend removal of the bottom teeth as well since the bottom wisdoms are actually impacted.

I had all 4 teeth pulled last year, no regrets.
posted by kitkatcathy at 11:41 AM on September 12, 2008

I'm surprised you weren't told to get them all out, which is what I did despite having one impacted wisdom tooth.
posted by O9scar at 12:17 PM on September 12, 2008 [1 favorite has favorites]

When I had an infection in one wisdom tooth, I had been urged by my oral surgeon to have at least both the upper and lower teeth on that side removed (if not all 4 at once). In my case, though, as I recall, the reason he gave was that the remaining tooth would continue to grow if there wasn't another tooth for it to press up against. Icky as that sounded, at the time I did opt to just have the one tooth removed. For me, this was my first invasive dental procedure after having recovered from a broken jaw from the year before, so I had wanted to have as little dental work done as possible..! By the next year, though, I had a similar infection in one of the other teeth on the other side, and so at that point opted to have all remaining three yanked at once. I would nth the suggestion to just get knocked out, have all four pulled at once, and deal with just one recovery period.
posted by lgandme0717 at 12:18 PM on September 12, 2008

I've had something similar, after getting an onlay filling in an upper molar - the exterior surface wasn't shaped quite right so it was putting pressure on the tooth below it. It felt like something was wrong with the lower tooth, but it was caused by the upper not contacting it correctly. As soon as I got the filling ground down correctly, the pain disappeared fairly quickly.
posted by chundo at 12:25 PM on September 12, 2008

I had a very bad infection in an upper wisdom tooth (that spread to my sinuses, I was told), and for the days/weeks leading up to the extraction (when I assumed it was just pain of teeth moving around) sometimes the top hurt and sometimes the bottom did. I was told this was not unusual for a variety of reasons that I have since forgotten.

My dentist had told me months previously that eventually they'd all have to come out as they were already crowding my previously straight teeth. So I went in to an oral surgeon asking to have them all out, was told the problem was an infection and not the teeth so much, but opted for 4 removals anyway. Went 100% perfectly, no regrets--and now that I watch a close friend dealing with his (pain once a month or so due to having only had one removed that had been giving him problems) I'm very glad I had them all out at once then.
posted by Martin E. at 12:59 PM on September 12, 2008

I had exactly the same thing happen. Except I waited through four months of excruciating pain before I got the mal-aligned tooth removed. It's not just an infection, it's an infection that your top tooth will keep pressing on and making worse (i.e. it won't heal on its own, it will just keep going). The removal was quick and easy, and totally worth it. I'd trust your dentist on this one.
posted by Paragon at 1:47 PM on September 12, 2008

Get 'em all done if you can. You don't need them, and if you're going in there anyway, better to have one operation than two or three.
posted by o2b at 2:35 PM on September 12, 2008

I have the occasional problem with canker sores, especially where I accidently bite the inside of my cheek, or scratch my gums with an errant swipe of the toothbrush.

I also would get them in large numbers when I had my wisdom teeth, as they were coming in at odd angles and were impacting the gums around that area.

I was reluctant to do the removal because of the sedation and recovery time.

But the sores are bacterial infections from repetitive mouth injuries, and the constant pressure did not allow the gums the opportunity to heal. I had the wisdom teeth removed and my canker sores have since largely disappeared.

If your insurance makes it reasonable, I'd get them all removed. Your quality of life will probably improve, all else the same.
posted by Blazecock Pileon at 2:37 PM on September 12, 2008

In my experience, my dentist has always referred our family to an oral surgeon for a tooth extraction, if was not done by the dentist.
posted by metahawk at 10:37 PM on September 12, 2008

Thanks for your help guys! It definitely sounds like this is legit, so I'll go ahead with the extraction.
posted by TheophileEscargot at 11:18 PM on September 12, 2008

FWIW a few months ago I decided to get all my wisdom teeth out due to several problems.

For one many people don't know how badly your wisdom teeth can affect the rest of your body. I was getting bad neck pain and sinus problems from mine and occasionally some sore cases of a sore jaw.

Wednesday morning I had the op to take all 4 wisdom teeth out...slept the afternoon and by night was eating soup.

Thursday morning was eating solid food (carefully) and Thursday night was out living again (not drinking though...or smoking which I don't anyway)

Friday was fine apart from some tenderness.

Monday back at work...but really I could have handled work on Saturday apart from some tenderness and a headache.

People react differently to getting their teeth out...I heard many a war story before I did mine.

All in all...I felt a whole lot of weight taken from my jaw and so much more relief.

Plus the operation only took an hour and isn't that expensive. Do it before more damage happens.
posted by thelloydshow at 6:39 AM on September 13, 2008

Short, and unequivocal -- yes, the way the nerves work do allow an infection in one jaw to manifest as pain in the other.

Been there, done that, almost passed out on the tube when the CLANG biting-on-foil pains started coming in ever larger orders of magnitude in waves of 5 minutes or less.

I'd sort out the infection before getting the op, though.
posted by genghis at 10:18 AM on September 13, 2008