Although wisdom tooth extraction is a common procedure, certain complications—ranging from mild discomfort to life-threatening conditions—can occur. Even a tooth with a filling may start hurting years later, indicating potential underlying dental issues.
Pneumomediastinum: Air Trapped in the Chest Cavity
Pneumomediastinum occurs when air becomes trapped in the mediastinum, the space between the lungs. This condition is often related to subcutaneous emphysema, where air is forced into soft tissues, but pneumomediastinum can involve a larger volume of air and lead to severe discomfort.
A 32-year-old woman developed both subcutaneous emphysema and pneumomediastinum after the extraction of a damaged molar. An air-driven dental drill was used, and six hours after surgery, she experienced swelling in her throat and face. By the next morning, the swelling extended to her chest, throat, and skin. X-rays and a CT scan confirmed the diagnosis, and she was treated with antibiotics (cephalexin monohydrate) and pain relievers (acetaminophen). Fortunately, after two weeks of standard treatment, her condition improved.
A 1993 medical review identified at least 13 cases of pneumomediastinum linked to wisdom tooth removal, with more cases reported since.
Pneumothorax: Collapsed Lung Due to Air Leakage
A pneumothorax (collapsed lung) can occur when a large volume of air is forced into the chest cavity, exceeding the amount seen in pneumomediastinum or subcutaneous emphysema.
A 45-year-old man underwent wisdom tooth extraction under IV sedation, during which an air-driven dental drill was used. While the procedure was ongoing, he complained of chest tightness. The surgery was stopped immediately, and dangerous subcutaneous emphysema was detected. A CT scan revealed both bilateral pneumothorax and pneumomediastinum. He required surgical drainage and antibiotic treatment, but his symptoms resolved within four days.
Descending Necrotizing Mediastinitis: A Severe Infection Spreading to the Chest
Mediastinitis is a serious infection of the tissues in the mediastinum (the area between the lungs). If an oral infection spreads downwards through the fascial spaces of the head and neck, it can lead to descending necrotizing mediastinitis—a life-threatening condition requiring emergency surgery.
A 23-year-old woman developed mediastinitis with a fistula (abnormal connection) to her left main bronchus after having her wisdom teeth removed.
In another case, a 23-year-old man had four wisdom teeth extracted under sedation. Five days after surgery, he developed:
- Severe swelling
- Difficulty opening his mouth
- High fever (103.5°F or 39.7°C)
A CT scan revealed swelling and fluid accumulation in the left submandibular and parapharyngeal areas. He was treated with IV antibiotics, and fluid was drained. However, his condition worsened, requiring three separate thoracic surgeries and 26 days of hospitalization. He was diagnosed with descending necrotizing mediastinitis and Lemierre’s syndrome, a rare but serious bloodstream infection. Fortunately, he made a full recovery.
Why Does a Tooth with a Filling Hurt Years Later?
Even years after getting a dental filling, some patients experience persistent pain. Possible reasons include:
- Cracked Tooth Syndrome – Tiny fractures can cause sharp pain when chewing.
- Nerve Damage – A deep filling may irritate or injure the tooth’s nerve, leading to long-term sensitivity.
- Reinfection or Decay – Bacteria can seep into gaps around old fillings, causing new decay beneath them.
- Referred Pain – If nearby teeth or nerves are affected, pain may be felt in a previously filled tooth.
If a filled tooth hurts years later, a dentist should evaluate whether it needs a replacement filling, root canal therapy, or further treatment.
Though wisdom tooth extractions and dental fillings are generally routine procedures, serious complications can arise, including:
- Air trapped in the chest (pneumomediastinum)
- Collapsed lung due to air leakage (pneumothorax)
- Life-threatening infections spreading to the chest (necrotizing mediastinitis)
- Long-term pain in a previously filled tooth
Recognizing early warning signs and seeking immediate medical attention can prevent these rare but severe consequences.
