Impacted Wisdom Teeth

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. 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.

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.

Symptoms of impacted wisdom teeth 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.

Impacted Wisdom teeth is caused when there is not enough room in the jaws to allow for all of the teeth to erupt into the mouth. Because the wisdom teeth are the last to erupt, due to insufficient room in the jaws to accommodate more teeth, the wisdom teeth become stuck in the jaws, i.e., impacted.

There is a genetic predisposition to tooth impaction. Genetics plays an important, albeit unpredictable role in dictating jaw and tooth size and tooth eruption potential of the teeth.

Some also believe that there is a devolutionary decrease in jaw size due to softer modern diets that are more refined and less coarse than our ancestors.

Your dentist or oral surgeon can evaluate your teeth and mouth to diagnose impacted wisdom teeth.

Your dentist will look for swollen tissue over the area where a tooth has not emerged, or has only partially emerged. The impacted tooth may be pressing on nearby teeth.

The gums around the area may show signs of infection such as redness, drainage, and tenderness. As gums swell over impacted wisdom teeth and then drain and tighten, it may feel like the tooth came in and then went back down again.

Dental x-rays confirm the presence of one or more teeth that have not emerged.

The safest and most effective treatment of impacted wisdom teeth is removal.

If the impacted tooth is completely embedded in the jaw bone, or if the partially erupted wisdom tooth has no discomfort and doesn't cause any problem to adjacent tissues, it may not be necessary to remove it.

However, one must keep good oral hygiene to prevent any problem. On the other hand, if the impacted wisdom tooth causes frequent discomfort or causes severe problems, it may have to be extracted.

Consider removal of impacted wisdom tooth.

Severe problems associated with wisdom tooth include:

• Frequent inflammation of gingivae covering the wisdom tooth causing recurrent Pericoronitis
• Suffered from severe Pericoronitis
• Severe decay, gum disease, pulpitis or periapical infections of wisdom tooth
• Impacted wisdom tooth causing root resorption of adjacent teeth
• Cyst around the wisdom tooth can damage the structure of jawbone.(If there is a cyst formation, the cyst together with the impacted wisdom tooth must be extracted.)

Prior to the following treatments:

• Extraction of mal-positioned wisdom tooth prior to orthodontic treatment
• Radiotherapy
• Jawbone reconstruction surgery

Procedures on surgical extraction of impacted wisdom tooth:

It has to take balance between the risks and benefits of the surgical extraction of tooth. In some cases, the impacted wisdom tooth is deeply embedded in the jaw bone and its roots are close to main nerve, surgical extraction may impose risk of damaging the nerve, leading to numbness of the mouth. Therefore, the decision on removal or not or when to remove the wisdom tooth is dependent on clinical situation.

The dentist will take radiographs to confirm the position and shape of the wisdom tooth, and explain to the patient on the situation, procedures and any risks. Usually, the procedures will be done under local anesthesia (numbness of mouth only), but in some cases, it may be done under general anesthesia or under sedation. The procedures should be painless.

There are five main steps:

1. Raise the gum flap
2. Remove the covering bone
3. If needed, cut the tooth into few parts
4. Rinse and clean the wound
5. Close the wound with sutures, and stop the bleeding

One week after extraction, remove the sutures by the dentist who will check the healing of the wound. If the suture is of self dissolve type, then it is not necessary to remove the sutures by the dentist. However, it is still necessary to let the dentist to check the healing of the wound. In general, the wound will heal within 2 weeks.

To avoid bleeding from the wound after the surgical extraction of the wisdom tooth, you should pay attention to the followings:

• On the same day after surgery

        o Do not disturb the wound, rinse the mouth or brush the teeth
        o Take soft diet for a few days and use the teeth of the opposite side of the jaw for chewing
        o Do not perform heavy work or strenuous exercise
        o Do not smoke or drink alcoholic beverages

• On the following day after surgery

        o Resume gentle tooth brushing and chew normally

Reduce discomfort after surgical extraction of wisdom tooth

Wound pain, facial swelling and difficulty on mouth opening are common after surgery

• On the day of surgery, apply ice pack to minimize facial swelling to the affected side of your face
• On the second day, apply a warm towel to the swollen area to reduce discomfort
• Maintain good oral hygiene to prevent wound infection
• On day 3 or 4, continue to take soft diet. If there is pain from these wound ,take painkiller as prescribed by the dentist

Normally, any discomfort will slowly subside in a week after surgery. Meanwhile, consult your dentist if you have any queries.

There is no way to prevent an impacted wisdom tooth.

You can prevent cavities by brushing and flossing.

An impacted wisdom tooth is very common and mostly causes no discomforts, however, sometimes it can lead to certain complications. Some of these complications are:

• If the impacted tooth is pushing the tooth adjacent to it, that tooth can get damaged, requiring treatment from an orthodontic.
• Since impacted wisdom teeth are partially up, bacteria and food particles get easily lodged in these teeth which increases the chances of teeth decay.
• An impacted wisdom tooth is very difficult to clean. So pericoronitis, a very painful inflammatory gum disease will occur.
• If the wisdom tooth does not appear but develops inside the jawbone, a cyst can get created. This cyst can harm the nerves, teeth and the jaw bone. In rare cases, a benign tumor can occur, which would require removal of bones and tissues.
• Misalignment of the bite is another complication because an impacted wisdom tooth would put pressure on the molar next to it, which would in turn push the tooth adjacent to it.