Patient Problem
A young adult woman came to our clinic complaining of pain on the left side of her mouth, around her lower wisdom tooth. She said this had happened before on the right side, but at the time of her visit, the pain was mostly on the left. She was otherwise healthy, with no swelling or problems on the outside of her face.
Inside her mouth, we saw that both of her lower wisdom teeth (teeth #38 and #48) were only partly erupted. This means they had not fully come through the gum. The gum around the lower left wisdom tooth was red and sore, a condition known as pericoronitis, which is caused by food or bacteria getting trapped under the gum.
On the upper left side, we found her second molar (tooth #18) had some decay, and her upper left wisdom tooth (tooth #28) was pushing against the gum, causing irritation.
Proposed Diagnosis & Treatment Plan
We diagnosed the patient with:
- Tooth #28: Gum irritation due to how it had erupted
- Tooth #38: Pericoronitis (gum infection around a partly erupted tooth)
After reviewing her x-ray (an OPG), we saw that:
- Her upper wisdom teeth were fully erupted
- Her lower wisdom teeth were still developing and were close to an important nerve in the jaw (the inferior alveolar nerve)
We discussed all available treatment options with her:
- Remove all four wisdom teeth with a specialist oral surgeon
- Remove the two upper wisdom teeth in the dental chair and refer the lower two to a specialist
- Do nothing for now and monitor
After talking through the risks, benefits, and costs, the patient agreed to have the upper wisdom teeth removed in our clinic and to see a specialist for the lower wisdom teeth.
Treatment Procedure
We performed the upper wisdom tooth extractions (teeth #18 and #28) under local anaesthesia. Each area was numbed using 2% lignocaine with adrenaline to make sure the procedure was comfortable.
The teeth were gently loosened and removed with forceps using a simple extraction method. The sockets (where the teeth had been) were cleaned with saline, and a small hemostatic sponge was placed to help control bleeding. Gauze pressure was applied to help with clotting.
The patient was given both written and verbal post-operative instructions, including what to eat, how to clean the area, and what symptoms to look out for.
Post-Operative Care
The following medications were prescribed to support healing and manage discomfort:
- Antibiotics: Amoxicillin with clavulanic acid, taken twice daily for 5 days
- Pain relief: Panadeine Forte, with instructions to also take Nurofen (1–2 tablets) if needed for stronger pain relief
We advised the patient to:
- Rest for the remainder of the day
- Avoid hard or spicy food for a few days
- Rinse gently with salt water from the next day
- Avoid smoking or drinking alcohol while healing
Outcome and Follow-Up
The extractions were completed without any complications. The patient tolerated the procedure well and had no issues during her visit. She was advised to follow through with her referral for the removal of the lower wisdom teeth by a specialist oral surgeon.
No follow-up appointment was required for the upper wisdom teeth, as the procedure was straightforward and healing instructions were clearly provided.
Clinical Discussion
Wisdom teeth often cause problems in young adults, especially when they do not erupt properly. In this case, the patient’s lower left wisdom tooth was infected due to partial eruption, and her upper wisdom teeth were also causing irritation or crowding nearby teeth.
Removing the upper wisdom teeth in the clinic provided immediate relief from pain and inflammation, while the lower wisdom teeth, due to their position near the jaw nerve, were referred to a specialist for safe removal. This approach helped reduce the risk of complications and ensured the patient received the most appropriate care at each stage.
Disclaimer: The information provided on this website is for general educational purposes only and is not intended as a substitute for professional medical or dental advice, diagnosis, or treatment. Always seek the advice of your dentist or other qualified health provider with any questions you may have regarding a medical condition.
Important Note on Surgical Procedures: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.