Symptoms of a Wisdom Tooth Infection
A wisdom tooth infection typically starts with dull, aching pain in the back of the jaw near where your wisdom teeth sit. As the infection progresses, the pain becomes sharper and may throb constantly. You may notice that the pain gets worse when chewing or when you press on the area with your tongue.
The gum tissue around the affected wisdom tooth will usually appear red, swollen, and tender. In many cases, you can see a flap of swollen gum partially covering the tooth. Pus may drain from under this flap, leaving a bad taste in your mouth.
Common Symptoms to Watch For
- Pain or throbbing in the back of the jaw on one side
- Swollen, red, or bleeding gum tissue around the wisdom tooth
- Bad taste in your mouth or persistent bad breath
- Difficulty opening your mouth fully (trismus)
- Pain that radiates to your ear, temple, or throat on the same side
- Swollen lymph nodes under your jaw
- Low-grade fever
Severe Symptoms That Need Immediate Attention
Some symptoms signal that the infection may be spreading beyond the wisdom tooth area. These require urgent or emergency care, not just a routine dental appointment.
- Fever above 101 F (38.3 C)
- Swelling that has spread to your cheek, eye area, or neck
- Difficulty swallowing or breathing
- Inability to open your mouth more than a finger-width
- Feeling generally unwell, with chills or fatigue
What Causes a Wisdom Tooth Infection
Wisdom teeth are the last teeth to come in, usually between ages 17 and 25. Many people do not have enough room in their jaw for these teeth to fully erupt. When a wisdom tooth only partially breaks through the gum, it creates an opening where bacteria can enter but are difficult to clean out.
Pericoronitis: The Most Common Cause
Pericoronitis is the medical term for infection of the gum tissue surrounding a partially erupted tooth, and it is the most frequent cause of wisdom tooth infections. A flap of gum tissue, called an operculum, partially covers the tooth and creates a pocket where food particles and bacteria accumulate. Normal brushing and flossing cannot adequately clean this area.
Pericoronitis can be acute (sudden and severe) or chronic (recurring mild episodes). Chronic pericoronitis causes occasional soreness and a bad taste that comes and goes. Acute pericoronitis involves significant pain, swelling, and sometimes pus drainage.
Impaction and Tooth Decay
An impacted wisdom tooth is one that is stuck beneath the gum or bone and cannot fully emerge. Impacted teeth can press against the neighboring molar, creating hard-to-clean areas that are prone to decay and infection. Decay in the wisdom tooth itself or in the adjacent second molar can also lead to infection.
Wisdom teeth that are tilted sideways or angled toward the cheek are especially difficult to keep clean, even if they have fully erupted. Food and bacteria collect in the spaces around these misaligned teeth.
Home Care Before Your Appointment
Home remedies can help manage the pain and swelling from a wisdom tooth infection, but they cannot eliminate the infection. Think of these as temporary measures to keep you comfortable until you can see an oral surgeon or dentist.
Salt Water Rinses
Dissolve half a teaspoon of salt in a cup of warm water. Gently swish the solution around the affected area for 30 seconds, then spit it out. Repeat this 3 to 4 times per day. Salt water helps reduce bacteria in the area and can draw out some of the swelling.
Over-the-Counter Pain Relief
Ibuprofen (Advil, Motrin) is particularly effective for dental infections because it reduces both pain and inflammation. Follow the dosing instructions on the package. Acetaminophen (Tylenol) can be taken in addition to ibuprofen for more severe pain. Do not exceed the recommended dose of either medication.
Applying a cold compress or ice pack to the outside of your cheek for 15 to 20 minutes at a time can also help reduce swelling and numb the area.
What to Avoid
- Do not apply aspirin directly to the gums. This is an old home remedy that causes chemical burns to the tissue.
- Avoid very hot or cold foods and drinks, which can increase pain.
- Do not try to pry up or cut the gum flap with any instrument.
- Avoid alcohol-based mouthwashes, which can irritate the inflamed tissue.
How a Wisdom Tooth Infection Is Treated
Treatment for a wisdom tooth infection typically happens in two stages: controlling the active infection first, then addressing the underlying cause to prevent it from coming back.
Antibiotics for Infection Control
If the infection is moderate to severe, your dentist or oral surgeon will prescribe antibiotics, most commonly amoxicillin or amoxicillin with clavulanate (Augmentin). For patients with a penicillin allergy, clindamycin or azithromycin are common alternatives. The typical course is 7 to 10 days.
Antibiotics alone will not cure the problem. They reduce the bacteria and calm the infection, but as long as the wisdom tooth remains, the infection is likely to return. Antibiotics are a bridge to definitive treatment, not a final solution.
Wisdom Tooth Extraction
Extraction is the definitive treatment for a wisdom tooth that has become infected. Once the acute infection is under control (usually after a few days of antibiotics), the oral surgeon will remove the tooth. For impacted wisdom teeth, this is a surgical procedure performed under local anesthesia, IV sedation, or general anesthesia depending on the complexity and your preference.
Recovery from wisdom tooth extraction typically takes 5 to 7 days for the initial healing, with complete soft tissue healing over 3 to 4 weeks. Your surgeon will give you specific aftercare instructions including pain management, diet, and activity restrictions.
Other Treatment Options
In some cases, the dentist may irrigate (flush out) the area under the gum flap with an antiseptic solution to reduce bacteria. An operculectomy, or surgical removal of the gum flap covering the tooth, is sometimes performed if the tooth has enough room to fully erupt and the patient wants to keep it. However, extraction remains the most reliable long-term solution for recurring infections.
Complications of an Untreated Wisdom Tooth Infection
Most wisdom tooth infections are manageable when treated promptly. However, an infection that is ignored or treated only with home remedies can spread to surrounding tissues and become dangerous.
The infection can extend from the gum tissue into the jawbone (osteomyelitis), the floor of the mouth, or the tissue spaces in the neck. Ludwig's angina is a serious deep neck infection that can develop from a dental infection and may compromise the airway. While rare, these complications do occur and can be life-threatening.
Infection can also spread to the adjacent second molar, potentially causing decay or damage to a tooth that would otherwise be healthy. This is one reason many oral surgeons recommend removing problematic wisdom teeth before an infection develops.
When to Go to the Emergency Room
Most wisdom tooth infections can be treated at a dental office or oral surgery practice during normal business hours. However, certain signs indicate the infection may have spread and requires emergency care.
Go to the ER If You Experience
In the emergency room, doctors can administer IV antibiotics and assess whether the infection needs to be drained surgically. They will typically refer you to an oral surgeon for follow-up care and definitive treatment.
- Difficulty breathing or a feeling that your throat is closing
- Difficulty swallowing your own saliva
- Swelling under the tongue, in the floor of the mouth, or extending down the neck
- Fever above 101 F (38.3 C) that does not respond to over-the-counter medication
- Rapid swelling that has worsened significantly over a few hours
- Feeling confused, lightheaded, or severely unwell
When to See an Oral Surgeon
An oral and maxillofacial surgeon is a dental specialist with 4 to 6 years of hospital-based surgical residency training beyond dental school. While a general dentist can prescribe antibiotics and perform simple extractions, an oral surgeon handles the more complex cases.
You should see an oral surgeon if your wisdom teeth are impacted (fully or partially trapped in the jawbone), if the infection has occurred more than once, if you want IV sedation for the extraction, or if there are complicating factors like close proximity to a nerve. Your general dentist can refer you, or you can contact an oral surgeon directly.
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