Have you noticed a hole that is forming from where your wisdom tooth is? It was never there before but the hole has been growing in size for the past few weeks. At the moment it appears to look like a small black hole by the side of your cheek.
Table of contents:
Why a hole is forming in your cheek
Impacted or ectopically erupting wisdom teeth can form a hole in your cheek while normally erupting ones will not cause it.
Impacted wisdom tooth
Wisdom teeth (third molars) can be impacted in all kinds of directions that you can think of.
Horizontal - these are the sideways ones. It can be angulated towards the front of the jaw or towards the back of it.
Distal - tooth is angled towards the back.
Mesial - tooth is angled towards the front.
Vertical - these are upright but below the height of the second molar.
Lingually - they are angulated towards the tongue.
Buccally - wisdom tooth is angulated towards the cheek.
In the PANO x-ray above, you can see the lower wisdom teeth being sideways and also mesially angulated. This is simply to demonstrate to you the directions that they can be impacted in.
However in the case of a hole that is developing in your cheek, the direction of impaction would be buccal. Buccally impacted wisdom teeth are oriented or angulated towards the cheek. That means they are trying to come out into the cheek but are unable to since they're stuck in the jaw bone.
What you'll find with buccally impacted third molars is that the hole near the cheek typically will not increase in size. The size of the hole should stay the same since the tooth is stuck and can't erupt.
Ectopic eruption
Wisdom teeth that are erupting ectopically can cause a hole to form in your cheeks. That is if they are erupting in the direction of your cheek. These teeth are not impacted since they are able to fully erupt. It's just that they're not growing in straight. The end result would be a fully erupted wisdom tooth that is angled towards your cheek.
You can distinguish an ectopic eruption from a buccal impaction by the size of the cheek hole over time.
Buccal impaction hole will not change in size.
An ectopic eruption hole will slowly get bigger and bigger until the tooth fully erupts.
In summary, an ectopically erupted third molar in the buccal direction will temporarily cause a hole in the cheeks. The hole will disappear or resolve once the tooth is finished erupting. On the other hand, an impacted third molar will cause a permanent cheek hole.
Treatment
If the hole in your cheek is caused by your wisdom tooth you will need to have them extracted. That is the only way to get rid of the hole that is forming.
What to expect for a surgical third molar removal:
Obtain consent. Review all of the risks and benefits for undergoing the procedure.
Administer local anesthesia. Apply numbing gel to pre-numb the area. Then the local anesthesia is administered via an injection.
Reflect a flap. Using a scalpel, your dentist will make an incision through the gums and through the cheek hole to expose the tooth.
Remove bone. Drill away the bone surrounding the impacted molar..
Section wisdom tooth. It'll be easier to remove the tooth in sections by separating it into pieces by drilling into it.
Elevate each piece. An elevator is used to loosen and remove each portion of the tooth.
Deliver tooth with forceps. Grab the tooth with forceps and extract it securely.
Curette socket. Clean out the inside of the socket by scraping the walls.
Irrigate socket. Clean out the extraction hole by flushing out the residual debris.
Place stitches. Since the gums had to be cut in order to expose the tooth, you will need wisdom teeth stitches. All of the cut gum will need to be sutured back together so that they're not loose or flapping around in your mouth.
Note: If you're going to have sutures placed, there will be a good chance where you'll find the wisdom teeth stitches stitched to your cheek. After all, the tooth was coming out of it.
Alternative
If the tooth is ectopically erupting and not impacted, you don't necessarily have to extract it right at this moment. If you're not in any discomfort you can actually wait for the tooth to finish erupting. Once it fully erupts, the cheek hole will vanish.
However we must say that a wisdom tooth that is fully erupted but angled towards the cheek is not hygienically blessed. It will become a plaque/food trap and probably more prone to caries. In other words it'll still be a good idea to have it extracted eventually.
Closing the hole without an extraction
Unfortunately it is impossible to get the hole in your cheek to close without removing the tooth. In case you were wondering, stitching it up will not help. It will reopen all on its own.
Besides, it is actually impossible to suture it because you don't have enough gums to pull the soft tissue together to close it. If you do manage to force it, it'll feel very uncomfortable as if the stitches were pulled too tight.
Consequences of no treatment
If you decide to leave the hole in your cheek alone, it may cause you problems down the road.
Food and plaque trap. A hole in your cheek will be extremely prone to trapping food and plaque. It'll be extremely difficult for you to clean since your toothbrush can't reach into it.
Inflammation. If something gets lodged into the cheek hole it can become inflamed and start bleeding or cause you pain.
Swelling. It will swell up if you can't get the food out.
Infection. The hole can get infected and may even turn into an abscess since its difficult to clean. If it does you will need to see your dentist.
There is really no way to repair the hole or close it. The only permanent solution would be to get the tooth removed and then it'll close up afterwards all on its own.
Takeaway
Wisdom teeth that are impacted or erupting ectopically can potentially form a hole in your cheek. The best way to fix it would be to have the offending tooth removed. There is simply no other way around it.
Our dentists in Long Island City highly recommend to have the wisdom tooth removed as soon as possible.
