Impacted wisdom teeth

Definition

Impacted wisdom teeth are third molars at the back of the mouth that don't have enough room to emerge or grow normally.

Wisdom teeth are the last adult teeth to come into the mouth (erupt). Most people have four wisdom teeth at the back of the mouth — two on the top, two on the bottom.

Impacted wisdom teeth can result in pain, damage to other teeth and other dental problems. In some cases, impacted wisdom teeth may cause no apparent or immediate problems, but they may be particularly vulnerable to disease.

Impacted wisdom teeth that cause pain or other dental complications are usually removed. Some dentists and oral surgeons also recommend removing impacted wisdom teeth that don't cause symptoms to prevent future problems.

Impacted wisdom teeth

Impacted wisdom teeth

Wisdom teeth are the last of your teeth to come in, or erupt, through the gums. Sometimes wisdom teeth become impacted, or stuck below the surface of your gums, and grow at odd angles, possibly ...

Symptoms

Impacted wisdom teeth don't always cause symptoms. However, when an impacted wisdom tooth becomes infected, damages other teeth or causes other dental problems, you may experience some of the following signs or symptoms:

• Pain
• Red or swollen gums
• Tender or bleeding gums
• Swelling around the jaw
• Bad breath
• An unpleasant taste in your mouth
• Headache

When to see a doctor
See your dentist if you experience pain, swelling or other symptoms in the area behind your last molar that may be associated with an impacted wisdom tooth.

Keep all six-month dental appointments for cleanings and checkups. Regularly updated dental X-rays may indicate the presence of impacted wisdom teeth before any symptoms develop.

Causes

Wisdom teeth (third molars) become impacted because they don't have enough room to erupt or grow normally.

Wisdom teeth usually erupt sometime between the ages of 17 and 25. Some people have wisdom teeth that emerge without any problems and line up with the other teeth behind the second molars. In most cases, however, the mouth is too crowded for third molars to develop normally. These crowded third molars become trapped, or impacted.

An impacted wisdom tooth may partially erupt so that a part of the crown is visible (partially impacted), or it may never break through the gums (fully impacted). Whether partially or fully impacted, the tooth may:

• Grow at an angle toward the next tooth (second molar)
• Grow at an angle toward the back of the mouth
• Grow perpendicular to the other teeth, as if the wisdom tooth is "lying down" within the jawbone
• Grow straight up or down like other teeth but stay trapped within the jawbone

Why do we have wisdom teeth?
Early humans had diets of tough food that probably resulted in enough wear on teeth to make room for the relatively late-emerging wisdom teeth. The softer diets of modern humans — and relatively recent practices of preventive dental care and orthodontic care to straighten teeth — have resulted in mouths that often can't accommodate a third molar.

Impacted wisdom teeth

Impacted wisdom teeth

Wisdom teeth are the last of your teeth to come in, or erupt, through the gums. Sometimes wisdom teeth become impacted, or stuck below the surface of your gums, and grow at odd angles, possibly ...

Complications

Impacted wisdom teeth can cause several problems in the mouth:

• Damage to other teeth. If the wisdom tooth pushes against the second molar, it may damage the second molar or make it more vulnerable to infection. This pressure can also cause problems with crowding of the other teeth or orthodontic treatments to straighten other teeth.
• Cysts. The wisdom tooth grows in a sac within the jawbone. The sac can fill with fluid, forming a cyst that can damage the jawbone, teeth and nerves. Rarely, a tumor — usually a noncancerous tumor — develops, a complication that may require removal of tissue and bone.
• Decay. Partially impacted wisdom teeth appear to be more vulnerable to tooth decay (caries) than other teeth. This problem probably occurs because wisdom teeth are more difficult to clean and because food and bacteria are easily trapped between the gum and a tooth that is only partially erupted.
• Gum disease. The difficulty of cleaning impacted, partially erupted wisdom teeth also makes them a vulnerable site for the development of a painful, inflammatory gum condition called pericoronitis.

Preparing for your appointment

Keeping regular six-month dental appointments for cleaning and checkups enables your dentist to monitor the growth and emergence of your wisdom teeth.

If you're experiencing pain, swollen gums or other dental problems that may indicate an impacted wisdom tooth, see your dentist as soon as possible. Your dentist may recommend that you see an oral surgeon if your impacted wisdom teeth are likely to be difficult to treat.

Be prepared to answer the following questions:

• When did your symptoms begin?
• Does anything worsen symptoms, such as chewing toward the back of your mouth?
• Have you noticed any bleeding while brushing or flossing your teeth?
• What are your typical teeth-cleaning habits?

Tests and diagnosis

Your dentist or oral surgeon can evaluate your teeth and mouth to determine if you have impacted wisdom teeth or if another condition is causing your problems. Such evaluations typically include:

• Questions about your dental symptoms and general health
• An examination of the condition of your teeth and gums
• Dental X-rays that can reveal the presence of impacted teeth, as well as signs of damage to teeth or bone

Treatments and drugs

Impacted wisdom teeth that are causing pain or other dental problems are usually surgically removed, or extracted.

If you have medical conditions that may increase surgical risks, your dentist will likely ask you to see an oral surgeon who will communicate with your primary care doctor and dentist about the best course of action.

Managing asymptomatic wisdom teeth
If impacted wisdom teeth aren't causing symptoms or apparent dental problems, they're called asymptomatic. Some disagreement exists in the dental community about how to manage asymptomatic impacted wisdom teeth. And research on this topic doesn't strongly favor one strategy over the other.

Some dentists and oral surgeons recommend removing asymptomatic wisdom teeth to prevent future potential problems. The arguments for preventive treatment include the following:

• An asymptomatic tooth may not be free of disease and may be a particularly vulnerable site for gum disease and tooth cavities.
• The procedure rarely results in serious complications in younger adults.
• The procedure is more difficult and more likely to cause complications later in life, particularly among older adults.

Other dentists and oral surgeons recommend a more conservative approach. They note that there isn't enough evidence to suggest that impacted wisdom teeth not causing problems in young adulthood will later cause problems. Therefore, they suggest that the expense and risks of the procedure don't justify the expected benefit.

With a conservative approach, your dentist will monitor your teeth for decay, gum disease or other complications. He or she may recommend an extraction if problems arise.

Surgical extraction
Surgical extraction of a wisdom tooth is almost always done as an outpatient procedure, which means that you will go home the same day. You may have local anesthesia that numbs the mouth or sedation anesthesia that makes you unaware of the surgical procedure.

During an extraction your dentist or oral surgeon makes an incision in the gums and removes any bone that blocks access to the impacted tooth. After the tooth is removed, the surgical wound is usually stitched closed and the empty space (socket) is packed with gauze.

You'll receive instructions for caring for the surgical wound after the procedure and for managing pain and swelling.

Most wisdom tooth extractions don't result in long-term complications. Problems that can occur include:

• Dry socket, or exposure of bone when the post-surgical blood clot is dislodged from the socket — a complication that can be painful and delay healing
• Infection in the socket from bacteria or trapped food particles
• Damage to sinuses near the upper wisdom teeth
• Weakening of the lower jawbone
• Damage to nerves that results in altered sensation in the lower lip, tongue or chin

Coping and support

A visit to the dentist may cause so much anxiety that you can't get yourself to go, despite the pain you're experiencing. The thought of having a tooth extracted may be overwhelming, but delaying care can lead to serious and permanent problems.

It's important to talk to your dentist about your concerns. Anxiety is common and not something you should be embarrassed about. Discuss with your dentist ways to address your comfort. Many dentists offer ways to ease your anxiety, such as listening to music or watching videos. You may be able to bring along a supportive family member or friend. You can also learn relaxation techniques, such as deep breathing and imagery. If you have severe anxiety, talk to your dentist or doctor about medications that may help.