06/03/2026
𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱
This 53 year old patient was referred by their GDP with recurrent pain and intermittent drainage of pus associated with the lower left quadrant impacted LL8. This was consistent with a chronic low-grade infection.
She wasn’t aware of a wisdom tooth being present in the mouth unerupted until intense swelling, pain and pus discharge one week before referral to me which was treated with antibiotics from their GDP.
𝗔𝘀𝘀𝗲𝘀𝗺𝗲𝗻𝘁 𝗮𝗻𝗱 𝗜𝗺𝗮𝗴𝗶𝗻𝗴
A clinical exam showed pus discharging from a small pocket in the LL8 gingiva. An OPG accompanied the referral, and a CBCT of the lower left quadrant was taken on the day to assess the position of LL8 and its relationship to the inferior alveolar nerve. Imaging demonstrated external resorption of LL8 with features consistent with acute-on-chronic periapical periodontitis and resorptive process of the LL8 tooth itself.
𝗠𝗮𝗻𝗮𝗴𝗲𝗺𝗲𝗻𝘁
Given the clinical and radiographic findings, extraction of LL8 was advised. The procedure and associated risks were discussed in detail including inferior alveolar and lingual nerve disturbance and numbness, as well as postoperative pain, swelling, bleeding and infection. The patient was understandably nervous however clear 3D imaging with the CBCT showed the inferior alveolar nerve running separate to the tooth itself therefore reducing the chance of longstanding numbness. She then elected to proceed with the removal of the LL8.
Under local anaesthesia, a mucoperiosteal flap was raised and buccal bone removal carried out to facilitate a controlled surgical extraction. The tooth was removed intact. The socket was irrigated and gently curetted with care taken to avoid trauma to the inferior alveolar nerve. The site was closed with 4/0 Vicryl Rapide sutures and haemostasis achieved.
𝗔𝗳𝘁𝗲𝗿𝗰𝗮𝗿𝗲 𝗮𝗻𝗱 𝗥𝗲𝘃𝗶𝗲𝘄
Post-operative instructions were provided verbally and in writing. This patient was reviewed at 3 weeks after the procedure and wound closure was successfully achieved without any complications.
𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗧𝗮𝗸𝗲𝗮𝘄𝗮𝘆
Impacted or unerupted third molars may remain asymptomatic and undetected for many years before presenting with acute infection. This case highlights how pathology may develop quietly around these teeth. Where appropriate, radiographic assessment and periodic review may help detect developing pathology and support timely management +/- the removal of wisdom teeth when required.
