Wisdom tooth gum issue: Trim or extraction?


Joined
Nov 15, 2014
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Hello,

I would like some advice on the most appropriate treatment for a minor problem with the gum around one of my wisdom teeth. I am a 36 year old male, with all four wisdom teeth through, living in the UK. The gum around the lower right one has given me trouble on occasion (say once per year) probably since my mid-20s. The gum becomes inflamed after eating certain foods (typically nuts) and I have to visit the dentist to have him flush the debris out and sterilize the area. The most recent case of this was about a month ago, and I was also prescribed a 5 day course of anti-biotics. As per usual it settled down after a few days. However, one thing that I have become aware of is that, even after it settles down, if I press the gum firmly with my finger right at the back, the gum hurts. Also my finger then stinks (like rot). This suggests there is still an infection, although I wouldn't otherwise notice. If I press the gum on the other side it doesn't hurt nor does my finger smell.

My previous, now-retired dentist suggested to me 3 years ago if the problem recurs I should have the gum trimmed. My new dentist, when I saw him a month ago, said if it happens again I should have the tooth extracted. My gut feeling is I'd prefer to hang onto the tooth (the dentist said there is no decay) but at the same time I'd like to get rid of this long standing problem once and for all. Some questions that spring to mind are:
  • I'm not sure who's advice is best here; my old dentist or the new one. How should I proceed? One approach might be to have the gum trimmed and if that doesn't help have the extraction, rather than dive straight into (a possibly unnecessary) extraction.
  • When extracting a wisdom tooth is it normal practice to also have the other, unaffected lower wisdom tooth extracted at the same time? I can see it makes sense for symmetry but again I don't like the idea of having a perfectly good tooth removed.
I'm attaching two images (sorry about the image quality). The affected wisdom tooth is ever so slightly angled in the direction of my cheek, whereas the opposite side (not in either image) is almost perfectly aligned with the molar in front.

Thanks :)
 

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Joined
Oct 28, 2014
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they are both correct.
Current standard of care is that if you get that infection more than three times extraction is recommended. Obviously the infection arises because you are not able to adequately clean the area between the tooth and the gums leading to the accumulation of food debris and bacteria. you should not want to be on a regular regimen of antibiotics. If you can purchase a plastic syringe with a curved tip (or not) you can flush between the tooth and the gums as part of your normal oral hygiene regimen. Brushing and flossing is also a must. Trimming is a good option, but the gums may regrow to their original height.
If you still cant clean the area properly and you have recurrent infection, extraction should be considered. But, because of your age you may have some bone loss behind your second molar after the extraction.
Weigh the pros and cons and make a decision that is best for your case in consultation with your dentist.

actually you should consider extracting the opposing wisdom tooth (the one on top) rather than the one on the opposite side. Again consult with your dentist.
 
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Joined
Nov 15, 2014
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Thanks very much for your advice. I shall arrange an appointment with my dentist.

No I definitely don't want any more antibiotics. The side effects were not good: a metallic taste in my mouth, a white coating on my tongue which has only just cleared, as well as a feeling like there is something stuck on the roof of my mouth.

:)
 

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