Impacted tooth

Impacted wisdom teeth (also known as impacted third molars) is the failure of the wisdom teeth to erupt fully into the mouth because of blockage from another tooth. An impacted tooth is a tooth that gets blocked as it is pushing through the gum into your mouth (erupting). Wisdom teeth often are impacted.

Wisdom teeth usually begin to come in between the ages of 17 and 21. Dentists call these teeth third molars. Wisdom teeth likely become impacted because of a mismatch between the size of the teeth and the size of the jaw. Impacted wisdom teeth are classified by their direction of the impaction, depth compared to the biting surface of adjacent teeth and the amount of the tooth’s crown that extends through bone or mucosa. They may become impacted because there’s not enough room in your mouth for them. A wisdom tooth also might be trying to come in sideways. Or, it might be tilted in your jaw.

An impacted tooth can be painless. You may not even realize it’s there. However, when an impacted wisdom tooth tries to come in, the flap of gum on top of it can become infected and swollen. This can hurt. You might even feel pain in nearby teeth, or in the ear on that side of your face.

An impacted tooth can lead to an infection called pericoronitis. If untreated, this infection can spread to the throat or into the neck. Severe infections require a hospital stay and surgery.

If the wisdom teeth establish a communication to the mouth, pain can develop with the onset of inflammation or infection or damage to the adjacent teeth. Impacted wisdom teeth can also be classified by the presence or absence of symptoms and disease. A treatment controversy exists about the necessity and timing of the removal of asymptomatic, disease-free impacted wisdom teeth. Proponents of early extraction cite the cumulative risk for extraction over time and costs of monitoring to retained wisdom teeth. Advocates for retaining wisdom teeth cite the risk and costs of unnecessary operations.

Impacted teeth also can get cavities. An impacted tooth can push on the neighboring molar. This can lead to tooth movement, decay or gum disease. It also can change the way your teeth come together. Rarely, impacted teeth can cause cysts or other growths in the jaw.

Classification

Impacted wisdom tooth with a backward tilt (distoangular impaction) and chronic infection to back of crown (green arrow)

Distoangular_impacted_wisdom_tooth

Impacted wisdom tooth with no tilt (vertical impaction)

Vertical_impaction_wisdom_tooth_infection

Impacted wisdom tooth that is tilted forward (mesioangular impaction)

Mesioangular_full_bony_wisdom_tooth_impaction

Impacted wisdom tooth with a horizontal orientation (horizontal impaction)

Symptoms

Symptoms include:

  • Swelling of the gum in the back of your mouth
  • Difficulty opening your jaw
  • Bad breath
  • A bad taste in the mouth
  • Pain when you open your mouth
  • Pain when chewing or biting

Pain can occur for several days and then disappear. It can come back weeks or months later.

Diagnosis

Your dentist will examine the area. If necessary, he or she will take X-rays. X-rays can show where your wisdom teeth are and if they are impacted.

Expected Duration

When the tooth is taken out, the symptoms will go away.

Prevention

There is no way to prevent an impacted tooth. You can prevent cavities by brushing and flossing.

Treatment

You can sometimes relieve minor irritation by rinsing with warm salt water (1/2 teaspoon of salt in 8 ounces of water). Over-the-counter pain relievers also may help.

If the tooth continues to cause pain, is infected or interferes with nearby teeth, the usual treatment is to take it out. Extracting one tooth can take 5 to 30 minutes, depending on where it is. In some cases, an infection requires antibiotics.

Patients are often referred to an oral and maxillofacial surgeon to have an impacted tooth removed. Before removing the tooth, your dentist or surgeon will discuss the procedure and the type of anesthesia and sedatives he or she will use. You will not be able to eat for six hours before surgery. If you take any medicines, keep on schedule with them. Someone should drive you to the appointment and drive you home.

After the surgery you may have swelling of the cheeks and jaw. It may be hard to eat certain foods. Follow your dentist’s or surgeon’s instructions carefully for the best recovery. Complications of surgery are rare, but do occur.

An impacted tooth may not bother you or affect nearby teeth. In this case, you won’t need immediate treatment. However, your dentist probably will recommend that the tooth be taken out to avoid future problems.

Many people have all four of their wisdom teeth taken out at once. Sometimes this surgery is done before the teeth have started coming in. This prevents future problems. This usually is done in an oral and maxillofacial surgeon’s office with sedation and local anesthesia. Often, it is better to have your wisdom teeth taken out before you turn 21. The surgery usually is less complicated. The tissue and bone also heal better.

When To Call a Professional

Call your dentist if you feel pain in your back teeth. If you visit your dentist regularly, he or she will keep track of your wisdom teeth and let you know if you need to have them taken out. Your dentist may take extra X-rays to check your wisdom teeth. Routine X-rays often don’t show these teeth.

Prognosis

The outlook after surgery is excellent.