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Pain associated with a swelling in the back region of the tooth gives rise to suspicion that a wisdom tooth is involved. There are a few other causes that should be ruled out which can cause similar problems, but the wisdom tooth is by far the most likely thing that causes such problems.

Likely causes:

Wisdom tooth

An erupting wisdom tooth commonly does not find enough space to erupt in the proper position. It is actually a vestigial remnant from our carnivorous past, much like the appendix. What usually happens is that the wisdom tooth partially erupts and then becomes an area where it is almost impossible to avoid bacterial colonization.

As food gets trapped and subsequent bacterial infection continues, the relevant area of the mouth starts to develop swelling and pain. The typical clinical presentation of the tooth is one where it is covered by an overlying flap which is extremely painful to the touch.

The flap also comes in between the opposing teeth as you chew and that causes it to swell further. This leads to a further increase in the size of the flap and the same vicious cycle is repeated again and again.

The solution to this problem lies in either getting an operculectomy done, which is basically getting the overlying flap removed while still keeping the third molar intact, or in getting the third molar removed.

Pericoronal Abscess

The other cause where similar clinical symptoms are seen is in a condition known as a pericoronal abscess. This is where an abscess can develop under the overlying flap due to constant bacterial accumulation. This is seen most commonly in people who have a somewhat compromised immune system like someone with diabetes although it can be seen in normal, non-immunocompromised individuals also.

Gingival Abscess

This kind of abscess can occur anywhere in the mouth and is caused by the presence of a foreign particle inside the gums. This can happen by biting into an apple or a piece of bone, for example. The symptoms that appear with this kind of abscess are sudden in onset. The pain will begin within a day of the particle becoming stuck, and will be severe in nature. It will also be easy to localize and be accompanied with a swelling.

The treatment for this kind of abscess is quite straight forward. The abscess needs to be drained and the foreign body needs to be removed. Antibiotics are not required in most cases, however that decision is based on a number of other factors as well so may vary from person to person.

The treatment should not be delayed in cases like these as some severe complications like the development of a tonsillar abscess can develop as a consequence of this infection. More often than not, relief from the pain is immediate after removal of the offending tooth. Accompanying signs like difficulty in swallowing and opening the mouth take a little longer to go away as these are associated with inflammation and swelling. Antibiotic coverage is almost always given in cases of acute infection associated with wisdom teeth as well.

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