MASSETERIC SPACE ABSCESS DUE TO IMPACTED WISDOM TOOTH DURING PREGNANCY – A SERIOUS COMPLICATION THAT REQUIRES VIGILANCE

Pregnancy is a sacred journey but also a physically demanding one for women. While most attention is focused on nutrition and fetal development, oral health—especially issues related to wisdom teeth—is often overlooked. In fact, impacted or misaligned wisdom teeth can silently lead to serious complications, threatening both maternal health and fetal safety. The following patient case is a clear example: what started as a dull ache in the left cheek quickly developed into a spreading abscess and jawbone inflammation requiring emergency surgery post-delivery. So why are wisdom teeth so dangerous during pregnancy? And what should expectant mothers do to prevent this? Let’s explore in detail below.

1. General Overview 

A pregnant female patient was admitted with swelling and pain in her left cheek, significant discomfort, and limited mouth opening. Notably, she was at 34 weeks of gestation. The swelling began in the 8th month of pregnancy and was diagnosed as a masseteric space abscess. However, due to pregnancy, treatment was limited to temporary control with antibiotics.

The abscess worsened in the days leading to delivery: the left cheek was severely swollen, extremely painful, and mouth opening was reduced to about 1.5 cm. Five days after a vaginal delivery, the patient was brought to the hospital for further examination and specialized treatment.

2. Examination and Diagnosis 

Upon admission, the patient underwent clinical and paraclinical examinations such as soft tissue ultrasound and CT scans of the maxillofacial region. Findings included:

• Swelling at the left cheek and jaw angle measuring 5x5 cm, firm to the touch.
• Intraoral exam: restricted mouth opening (1.5 cm), no visible pus discharge.
• X-rays revealed an impacted and misaligned tooth #38.
• CT scan detected a large lesion in the left masseteric space, accompanied by bone loss in the jaw angle and mandibular body.

Based on symptom analysis and imaging, the diagnosis was: Left mandibular osteomyelitis – spreading abscess in left cheek and masseteric muscle caused by impacted wisdom tooth #38. 

3. Treatment Procedure and Results

The patient underwent surgery under general anesthesia, which included:

• Incision and drainage of the abscess
• Removal of inflamed bone and periosteum
• Debridement of necrotic bone, excision of inflamed masseter muscle
• Extraction of teeth No. 28 and 38
• Placement of drainage to manage infection

After surgery, the patient’s swelling and pain significantly reduced, and recovery began steadily.

WISDOM TEETH RISKS DURING PREGNANCY

Pregnant women are particularly vulnerable to dental issues due to significant changes in hormones, immunity, nutrition, and psychological state. Without proper monitoring and care, minor dental problems can escalate into dangerous complications for both mother and baby.

Wisdom teeth – a ticking time bomb during pregnancy. Wisdom teeth are a common risk factor. When impacted or misaligned, they can cause:
Răng khôn là một trong những yếu tố nguy cơ thường gặp nhất trong thai kỳ. Khi mọc lệch, mọc ngầm, răng khôn có thể gây ra:

• Pericoronitis (inflamed gum tissue over tooth)
• Abscesses in soft tissue
• Jawbone infection (osteomyelitis)
• Limited mouth opening and spreading infections

Hormonal changes—especially increased progesterone—lower mucosal resistance and create an environment conducive to bacterial growth. Meanwhile, the immune system is altered, making it easier for infections to develop and harder to control once they occur.

SERIOUS CONSEQUENCES IF LEFT UNTREATED

Risk of systemic infection: Oral infections can spread through the bloodstream, becoming systemic, which is especially dangerous during the immunocompromised state of pregnancy.
Nhiễm khuẩn từ vùng răng miệng có thể lan rộng qua máu, ảnh hưởng đến toàn thân, đặc biệt nguy hiểm trong thời kỳ miễn dịch suy giảm của thai kỳ.

Adverse effects on maternal and fetal health
Prolonged pain, high fever, insomnia, and poor nutrition can severely impact maternal health, increasing the risk of uterine contractions, miscarriage, or preterm labor.

Limited treatment options during pregnancy
Due to risks to the fetus, the use of anesthetics, antibiotics, pain relievers, or X-rays is restricted. This makes diagnosis and treatment more complex, requiring highly experienced dental professionals.

EXPERT ADVICE: PREVENTION IS BETTER THAN CURE

To avoid passive and risky situations during pregnancy, women should:

• Get a comprehensive dental check-up before pregnancy, with special attention to wisdom teeth.
•  Extract impacted or misaligned wisdom teeth if indicated before planning a pregnancy.
•  Maintain strict oral hygiene and schedule regular checkups during pregnancy.
•  Maintain strict oral hygiene and schedule regular checkups during pregnancy.

If you are pregnant or planning to become pregnant, don’t neglect your oral health. A seemingly harmless wisdom tooth can have unpredictable consequences if not detected and managed in time.
Be proactive with your dental care—so that every motherhood journey is safe and fulfilling. Contact our team of experienced specialists Herident Dental!