Updated: December 2018
Problems with impacted wisdom teeth relate to infection of the Operculum Periconitis – decay in the wisdom tooth, decay in the adjacent teeth, food packing and gum disease.
Let’s look at each of these problems that can occur with impacted wisdom teeth in turn.
Infection of the Operculum
As mentioned previously, the Operculum is simply a gum flap which covers wholly or partially part of the wisdom tooth. It is quite easy for the Operculum to become infected or inflamed.
The most common way the Operculum does get infected or inflamed, is when food or plaque becomes trapped underneath the gum flap which is overlying that wisdom tooth. When the plaque, or the food, has been there for a while and it is not being removed on the daily basis with your toothbrush and mouthwashes this gum flap becomes infected or inflamed.
The symptoms that you will get from an infected or inflamed Operculum are those of: pain on the gum flap, swelling of the gum flap, and just general soreness around the whole area. The Operculum problem occurs much more often on lower wisdom teeth than upper wisdom teeth because nearly all of the problems that you do get with an infected or inflamed Operculum relate to a lower partially erupted impacted wisdom tooth.
Interestingly, when the Operculum or gum flap does become swollen and infected, the tooth immediately above it often then will bite down on this gum flap or Operculum. When the tooth above starts to bite on this gum flap, the gum flap will get traumatized, and it becomes even more swollen and even more infected.
This phenomenon however can be used to our advantage because one of the treatments for an impacted and painful wisdom tooth is to remove the opposing tooth. Often the opposing tooth will simply be the upper wisdom tooth, which you are probably are going to have to remove anyway. It is not uncommon for a patient to be booked in to have an upper and a lower wisdom tooth taken out for example on one side of the mouth, and when the upper wisdom tooth has been taken out it sometimes then no longer becomes necessary to take out the lower wisdom tooth out as well. Once the Operculum no longer is inflamed or red raw, then often it just can be left like that as long as you make sure that it is being cleaned every day properly. The best way to clean the gum flap or deeper column is threefold:
- Just brushing normally as you would do with the all your other teeth, you can tilt the head of your toothbrush so the bristles actually get right under that gum flap. You will know that you are cleaning the Operculum properly because you will be able to feel the bristles of your toothbrush getting right underneath the gum flap and you’re almost massaging the gum around it.
Do not worry if, while you are brushing under the Operculum, the Operculum feels a bit sore and a bit painful – or even you get some bleeding from it as well. In fact if you do get soreness or bleeding while you are brushing the Operculum, that is actually good because it indicates that the Operculum is in fact inflamed and therefore you are getting food or plaque trapped underneath it. So, by cleaning underneath the Operculum you are getting rid of all the plaque and the food that is being collected underneath it , which in turn over a period of time will prevent any infection or inflammation of the Operculum.
- Often a normal toothbrush will only be able to get up to a certain distance under the Operculum for cleaning purposes. Therefore, it will also be necessary for you to buy a small interdental toothbrush. You can buy an interdental toothbrush from our practice, or you can buy an interdental toothbrush from any chemist, supermarket, and even Online.
An interdental toothbrush is simply a toothbrush with one or two tufts only. In this way the interdental toothbrush can get right under the gum flap.
You will need to use an interdental toothbrush to clean out the Operculum in front of a mirror. At first it will be quite tricky to use because you are looking at the mirror and it’s working like backwards to front.
However, once you have got used to using an interdental toothbrush to clean out the Operculum you will quickly notice a big improvement. At first it will be sore, it will bleed, and it may even become uncomfortable; however as you are getting rid of all the food debris and plaque underneath the Operculum any inflammation or infection will be kept at bay.
- An important part of cleaning the Operculum as well as using your normal toothbrush and your interdental toothbrush, is to consider using a mouthwash as well.
There are many different mouth washes that you can use, most of these mouth washes will probably have no effect whatsoever around an Operculum of the wisdom teeth.
There are only three mouth washes which will actually have some effect on an infected or inflamed Operculum around a wisdom tooth.
The best mouthwash for getting rid of pain around and the Operculum, and also for keeping the Operculum clean, is one that contains a chemical called chlorhexidine. There are only two or three brands of mouthwash that contain chlorhexidine.
Chlorhexidine is actually a very strong mouthwash, and you will notice when you are using it in your mouth you will get a slight burning sensation; especially if there already is some inflammation or infection around the gum.
The mouthwash must be kept over the Operculum for at least one and a half minutes. You must time on your watch that you are holding the mouthwash on the Operculum for at least one and a half minutes. Once one and a half minutes is over, you simply just spit out the chlorhexidine mouthwash. It is important not to rinse your mouth out with water afterwards because you want to keep the chlorhexidine mouthwash in contact with the operculum so that it continues to work. You may think that after a very short time there will be no traces left around the Operculum anyway, because your saliva will have diluted it and some of it you will have swallowed.
However chlorhexidine works by actually binding onto the soft tissues of your mouth so that its action continues for over a long period of time.
As mentioned above, chlorhexidine is a very effective mouthwash in preventing plaque and infection around in Operculum, however it tastes absolutely vile. Even after you have used the mouthwash and it has been spat out into the sink, the taste will linger on for many hours afterwards. You will in fact notice the altered taste in your mouth even the next day, but after a while what you do notice is that it is having a good effect on the Operculum so you don’t mind the taste that much.
Unfortunately, another side effect of chlorhexidine mouthwash is that it will discolour your teeth as well. Before you start panicking that all your teeth may go black by using a chlorhexidine mouthwash, don’t. Staining of your teeth by using chlorhexidine mouthwash is only temporary. The staining can be prevented by making sure you brush your teeth first, and you actually remove every single last trace of the mouthwash with the toothpaste before you start using the mouthwash. This is because some of the staining occurs when the chlorhexidine reacts with the remnants of the toothpaste that you have used. However, there will be some staining and this is best removed by asking your dentist to give you a thorough scale and polish.
Decay in a wisdom tooth?:
One of the most common reasons for having a wisdom tooth taken out is dental decay. Often, it is simply not expedient to fill a wisdom tooth. One of the reasons why is because once you have removed decay, and placed a filling inside the wisdom tooth, the decay will simply reoccur and you will be back to square one again. Decay in a wisdom tooth is often a very difficult procedure because the tooth is very far back in your mouth and it is just very difficult for the dentist technically to clean and fill the tooth. So if decay is noticed in your wisdom tooth, it is usually better to have the wisdom tooth or teeth taken out.
Decay spread to adjacent teeth?:
A wisdom tooth, or wisdom teeth, are often taken out not because of decay in the wisdom tooth itself but in the adjacent tooth. An impacted wisdom tooth creates a food and plaque trap which causes decay in the adjacent tooth. At our dental clinic, we saw a patient a year ago who had some early decay in his wisdom tooth. We advised the patient to have the wisdom tooth extracted, because we felt that the decay would reoccur and in any case it was going to be very difficult to treat the decay let alone place a filling in the tooth.
The patient decided that they knew better and said that they didn’t want to have the wisdom tooth taken out. A year later the patient came back with a swollen face, bad breath and in excruciating pain. With the use of a dental x-ray, the decay in the wisdom tooth had spread into the nerve and even worse, the decay had now affected the adjacent tooth which was previously totally healthy. At this point, we had to then take out the wisdom tooth and the adjacent tooth as well. It didn’t actually stop there though, because the tooth immediately above the wisdom tooth and the adjacent tooth at the top as well became over erupted and they had to be removed as well. So instead of just having one wisdom tooth out, the patient had now lost four teeth unnecessarily altogether.