06/03/2026
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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 wasnโt 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.
๐๐๐๐ฒ๐๐บ๐ฒ๐ป๐ ๐ฎ๐ป๐ฑ ๐๐บ๐ฎ๐ด๐ถ๐ป๐ด
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.
๐ ๐ฎ๐ป๐ฎ๐ด๐ฒ๐บ๐ฒ๐ป๐
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.
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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.
๐๐น๐ถ๐ป๐ถ๐ฐ๐ฎ๐น ๐ง๐ฎ๐ธ๐ฒ๐ฎ๐๐ฎ๐
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.
