I think I have an operculum, a partially erupted wisdom tooth. Is this okay?

November 19, 2007 2:17 PM

I've got a wisdom tooth partly in. While it's not causing me discomfort, it smells weird and I think I've found the medical name for it: operculum. Suggestions? Experiences? More inside.

I've never had a problem with my wisdom teeth. My dentist has said that it looks like they should come in fine. Over the last couple of years there's been some mild discomfort but nothing severe. None of teeth are all the way in yet, but last week my lower right wisdom tooth starting making a go for it. After a few days of general soreness I was left with a tooth maybe halfway out, horizontally. The other part of the tooth is still under the gum.

Wikipedia lends this: "Sometimes the wisdom tooth fails to erupt completely through the gum bed and the gum at the back of the wisdom tooth extends over the biting surface, forming a soft tissue flap or lid around the tooth called an operculum. Teeth covered by an operculum can be difficult to clean with a toothbrush. Additional cleaning techniques can include using a needle-less plastic syringe to vigorously wash the tooth with moderately pressured water or to softly wash it with hydrogen peroxide.

However, debris and bacteria can easily accumulate under an operculum, which may cause pericoronitis, a common infection problem in young adults "

That sounds an awful lot like my case. If I rub my finger on the area and sniff my finger (That sounds gross.) it smells a lot like a tonsil stone; That is, decay and general bad odor. As a result I've taken to becoming a maniac brusher and a mouthwash swiller, as well a twice daily salt water swisher. Is this enough? For what it's worth, the odor subsides for a few hours after, uh, sanitizing. The tooth and the gum area around it are fine. There's no redness, soreness or any sign than anything is up other than that gross smell.

Also, this one is a bit out there, but I caught a nasty cold just after. Are the two related?

My Q: Any Mefi-ites had this problem? Is it enough to just wait for the tooth to come through? I have no insurance, so even if I could afford the visit, extraction would very likely be outside my means. Stories, references and suggestions are much appreciated!

posted by GilloD to Health & Fitness (22 answers total)

I don't have any advice, but I can say that I've had this issue for 2-3 years now (smells like rot) with one of my bottom wisdom teeth and it doesn't look like it's gonna be growing out on it's own. I suggest getting it pulled; call around and see if you can find a dentist who would do it for a reduced price or possibly put you on a payment plan (if dentist's do that sort of thing).
posted by Sufi at 2:39 PM on November 19, 2007

Response by poster: My real plan- And I had a friend who did this- is to try and hold out until I get deployed with the Peace Corps. She had it covered under their insurance, although I'm sure MMMV on that plan.
posted by GilloD at 2:44 PM on November 19, 2007

Even if you don't get it pulled, perhaps they can remove the "flap" of gum there to fully expose the tooth.

It's probably worth it to get it looked at. I've had tonsil stones before and I practically gag just thinking about the smell.
posted by eldiem at 2:51 PM on November 19, 2007

I would have thought that getting the flap trimmed off would probably be both less traumatic and far cheaper than having the tooth pulled, if the tooth is not otherwise causing trouble. Dentist is first port of call in any case.
posted by flabdablet at 2:52 PM on November 19, 2007

I had the same thing, the gross smell, and eventually the infection as well. It was extremely painful, but (being a poor student at the time) I tried to tough it out. It did not go away on its own, and I endured several months of come-and-go agony. Eventually had it pulled (although I cannot speak for the US, it was not too expensive), and I wish now that I had done so much earlier.
posted by Paragon at 2:54 PM on November 19, 2007

swishing your finger around in your mouth without washing it could give you a cold.

then again, judging from your post you sound like the kind of person who cleans hands vigorously.

bravo for the tonsil stone mention!

some small help: When I had my wisdom teeth removed one of the pouches got infected soon after, and the maxillofacial surgeon packed it with gauze soaked in clove oil. If you're really going to do the insurance hold-out thing, clove oil might help ward off infection. Also, it's a way better smell than tonsilloliths. Bleugh.
posted by laconic titan at 2:58 PM on November 19, 2007

Response by poster: I actually became a habitual hand washer after some time in food service. And my mother was a nurse, so while I'm not a germ freak, I wash my hand before I jam it in my mouth. Tee-hee.

Anyway, I may be eligible to join my fiancee's insurance plan after we get married. I was just wanted to see if there were any "I HAD THAT AND NOW I'M BLIND AND CANT WALK" stories.
posted by GilloD at 3:05 PM on November 19, 2007

oh, i think this is worth some credit card debt to get it fixed. if there is a dental school in your area, they may offer reduced-cost exams and procedures from supervised students.
posted by thinkingwoman at 3:17 PM on November 19, 2007

I had this exact same problem some years ago, and trimming away the gum flap is a short-term fix, as it will creep back over the partially-emerged tooth, exactly as my dentist predicted it would. Fortunately, by the time the hideous inflammation flared up again, I had insurance and had the wretched thing pulled.

I do know that some dentists will agree to payment plans; it might be that you'd want/need a reference from a friend who patronizes the particular dentist. A year ago, my wife went to her boss' dentist and got them to agree to a plan, as her insurance had not kicked in at that point.
posted by Skot at 3:18 PM on November 19, 2007

Being too aggressive with mouthwash or other mouth-sterilizing stuff can cause its own set of problems, FYI. You have a normal bacterial population in your mouth and if you manage to suppress the usual flora then other, less happy, stuff will grow. I don't know how to balance this against trying to keep the tooth clean, though.

(I also agree with eldiem, it seems like simply removing the flap of skin should solve the immediate problem, which I'd hope would be a pretty quick procedure and maybe affordable without health insurance.)
posted by hattifattener at 3:23 PM on November 19, 2007

You could do a wisdom tooth extraction study if you have any places like Pharmaco or Scirex in your area. You either get experimental pain meds or pain meds that they already use. You hurt, they give you the good stuff. You get your teeth out for free, too. I haven't done this, but people I know said it was fine.

And tonsil stones- gag! Thank god for tonsillectomies.
posted by fructose at 3:23 PM on November 19, 2007

flabdablet: "I would have thought that getting the flap trimmed off would probably be both less traumatic and far cheaper than having the tooth pulled, if the tooth is not otherwise causing trouble. Dentist is first port of call in any case."

I had this exact thing done -- the dentist removed the offending gum for a nominal fee and gave me this neato syringe-y thing (free of charge) that I was to use with warm salt water to flush out the area after meals and when brushing. Then when I had insurance I was able to get the sumbitches removed.
posted by macadamiaranch at 3:39 PM on November 19, 2007

My dentist trimmed the bit of gum after a cleaning - I hadn't had any issues with it, other than the compulsion to constantly poke at it with my tongue. No big deal.
posted by restless_nomad at 3:58 PM on November 19, 2007

i ended up with an abcess and had to have it pulled.
posted by elle.jeezy at 4:04 PM on November 19, 2007

If I were guessing, I'd guess you probably have a 'cavity', not an 'operculum'. For treatment of a 'cavity' I'd recommend a 'dentist'.
posted by ikkyu2 at 4:12 PM on November 19, 2007

Heh, I wrote large parts of that wikipedia passage you're quoting when this happened to me.

In 2005, my dentist mentioned an operculectomy as a possible treatment if pericoronitis developed, but said that he would leave it alone otherwise. My operculum is still there, but it has slowly but progressively reduced in size, nothing has become infected, operculectomy or tooth removal is now off the table - the dentist says it should just slowly go away on its own.

I've learned to remove large bits of food that get stuck with my tongue without thinking about it. I have found that using an electric toothbrush that rotates (I have an Oral-B) makes cleaning much easier, as I can just push the flap up with the brush and leave it there to rotate and clean the tooth. The syringe thing, which my dentist recommended, should help you keep things clean back there. Make sure you get peroxide that is OK for oral usage.

You'll know it's pericoronitis if you develop it. Opening and closing your mouth will be painful, touching the operculum will be even more painful. If it doesn't hurt, doesn't become infected and you can keep it clean, it's something you can safely live with, IANADentist.

I'll check for replies, but email is in my profile if you want.
posted by stereo at 4:47 PM on November 19, 2007

I think even low levels of infection can contribute to diabetes and heart disease. I really think it did in my case. But that's just a guess. I finally made the money to get them out. Now I feel 100% better. My neck pain even went away. (That I thought was caused by a car accident. Guess not.)

In the meantime get one of those syringes from an oral surgeon's office and use it to clean around the tooth. And the electric toothbrush with the small head is indespensible. Especially after you get wisdom teeth out (To brush the very back of the last tooth in the row.)

Another thing is that I am pretty sure that my wisdom tooth pushed so hard on another tooth that the tooth fractured causing it to abscess. I couldn't get the gums back there to heal until I got the wisdom tooth out. And I had to get a crown on the fractured tooth.

And another thing. If your body has low level infection and it is giving you heart disease, surgery - even oral surgery will be more difficult and dangerous. So in my opinion you shouldn't wait.
posted by cda at 5:43 PM on November 19, 2007

Response by poster: Stereo- You seem to indicate that flap is movable. Mine isn't. It's just solid gum over where, I suppose, the rest of the tooth is. It's less a flap and more an enclosure.
posted by GilloD at 6:03 PM on November 19, 2007

I got an operculectomy last Christmas (you can read about it), and I ended up trading a food-trapping flap for a food-trapping gap between gum and wisdom tooth, so I'll be getting my wisdoms out anyway, schedule allowing.
posted by brownpau at 6:19 PM on November 19, 2007

I have exactly the same thing. I'm signed up to a dental plan where I see a hygienist every few months for a thorough clean. I asked my dentist about the operculum who said that it could be cut out, but will just grow back again. He said mouthwash is the best defence...
posted by DZ-015 at 4:39 AM on November 20, 2007

I had an operculectomy more than 10 years ago. Didn't leave a flap or a gap. In fact, this is probably the first time I've thought about it in 10 years. It's just a quick slice and a stitch or two.
posted by kamikazegopher at 10:28 AM on November 20, 2007

GilloD — mine didn't move at first, but started to when they recesed. If it moves enough you'll be able to clean it with a syringe, if it doesn't move enough food won't get trapped under it.
posted by stereo at 7:04 PM on November 20, 2007