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Orthodontics/Wisdom Tooth confusion

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Question
The back of my mouth
The back of my mouth  
I'm not sure if this is a wisdom tooth coming in or some sore in the back of my mouth. It is hurting very bad. Can you please help me out. Thanks in advance

Answer
Ardent\'s Mouth
Ardent's Mouth  

Hello Ardent,

I received your question just recently and appreciate the fact that you included a picture.

What I write here are only my opinions based on very limited information. My comments should not be viewed as any form of diagnosis, definitive or otherwise,  or any form of  treatment recommendation.  Indeed, in the ultimate analysis all final decisions, particularly clinical ones, should  only be made by qualified doctors who have had a chance to see you in person and who have had an opportunity to take and analyze proper diagnostic records.

Okay… having said  that…  your  questions focused on wisdom teeth.  You  wrote:

"I'm not sure if this is a wisdom tooth coming in or some sore in the back of my mouth. It is hurting very bad. Can you please help me out. Thanks in advance     "

The image appears to show the lower right first and second molars. A  possible lower right third molar is not visible, but may be about to emerge through the gum tissue. Without a radiograph I can not tell for sure.Patients often complain of discomforts when third molars erupt. One reason is that while many other adult teeth actually first push out a baby tooth, and then simply slide into the space previously occupied by that baby tooth, the third molars have no bay tooth to push out. In fact, third molars must emerge through the existing gum tissue, and this often causes discomfort. Sometimes, due to insufficient available space,  eruption problems occur and a third molar can become impacted ( does not emerge through the gums  ) or semi-impacted ( emerges only partially through the gums ).

Ardent, in your case, assuming you have third molars, what you may be experiencing is the emergence of the wisdom tooth through the gum tissue.

There are other possibilities you and your dentist or other oral health care professional may wish to consider. If the opposing upper right third molar has erupted ahead of the matching lower right third molar, in some situations, the upper molars can "over-erupt" and in so doing begin to contact and impinge upon the lower gum tissue in back of the lower right second molar. If you look at your image, there is a slight suggestion of some color change in this area.

Sometimes patients with no third molars whatsoever have similar discomforts. What could be the cause? Well, it turns out that food debris, tomato seeds, etc can sometimes become lodged in the gum tissue that wraps around the back side of the lower second molar. A small seed which is lodged in the tissue can cause some gum irritation, and along with decreased hygiene, can create discomforts due to swollen tissues.

My recommendations as to what to do at this point Ardent include the following:

1) Get an X-ray or radiograph to better determine the existence and orientation of any wisdom teeth, especially in the area of the lower right posterior jaw area.
2) If you do have impacted or semi-impacted third molars, get an opinion or two regarding the need for extraction. Not all third molars necessarily need to be extracted.
3) If it is a matter of chronic food debris lodging itself in the rum tissues surrounding the lower second molars, then i would recommend additional time flossing and maybe an oral irrigation device to better flush out and clean the gum areas.

Ardent, I hope I have been able to give you a sense of what might be some of the possibilities regarding your discomforts. I am not able to see you or to examine radiographs. I have tried to be as complete as possible given the limited information at my disposal. Please feel free to resubmit your question with radiographs if you feel that would be helpful for you.

Paul Supan, DDS, MA, MPH
Board Certified Orthodontist

Specialist in Orthodontics
Specialist in Dental Public Health
http://www.braces.com
http://www.leesburgbraces.com  

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Paul Supan, DDS, MA, MPH

Expertise

First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites braces.com and Leesburgbraces.com are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for allexperts.com.

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.

Experience

Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

Organizations
American Dental Association, American Association of Orthodontists, Academy of General Dentistry, College of Diplomates of the ABO, OSAP - Office Sterilization & Asepsis Procedures Organization, Others

Publications
Available upon Request.

Education/Credentials
BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

Awards and Honors
Available upon Request Please see my personal websites braces.com and Leesburgbraces.com for further personal background.

Past/Present Clients
Available upon Request

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