Impacted Wisdom Teeth

Impacted wisdom teeth are third molars at the back of the mouth that don't have enough room to emerge or develop 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 in the upper and two in the lower arch.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 because they're hard to clean, they may be more vulnerable to tooth decay and gum disease than other teeth are.

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 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 these signs or symptoms:

  • Red or swollen gums
  • Tender or bleeding gums
  • Jaw pain
  • Swelling around the jaw
  • Bad breath
  • An unpleasant taste in your mouth
  • Difficulty in opening your mouth

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 increase the risk of infection in that area. This pressure can also cause problems with crowding of the other teeth or require orthodontic treatment to straighten other teeth.
  • Cysts. The wisdom tooth develops 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 noncancerous (benign) — develops. This complication may require removal of tissue and bone.
  • Decay. Partially impacted wisdom teeth appear to be at higher risk of tooth decay (caries) than other teeth. This probably occurs because wisdom teeth are harder to clean and because food and bacteria get easily trapped between the gum and a partially erupted tooth.
  • Gum disease. The difficulty in cleaning impacted, partially erupted wisdom teeth increases the risk of developing a painful, inflammatory gum condition called pericoronitis in that area.

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

Wisdom teeth usually emerge 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 many cases, however, the mouth is too crowded for third molars to develop normally. These crowded third molars become trapped (impacted).

An impacted wisdom tooth may partially emerge so that some 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 at a right angle 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

You can't keep an impaction from occurring, but keeping regular six-month dental appointments for cleaning and checkups enables your dentist to monitor the growth and emergence of your wisdom teeth. Regularly updated dental X-rays may indicate impacted wisdom teeth before any symptoms develop.

How is it diagnosed?

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

How is it treated?

If your impacted wisdom teeth are likely to be difficult to treat or if you have medical conditions that may increase surgical risks, your dentist will likely ask you to see an oral surgeon to discuss the best course of action.

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

Impacted wisdom teeth that are causing pain or other dental problems are usually surgically removed (extracted). Extraction of a wisdom tooth is usually required for:

  • Infection or gum disease (periodontal disease) involving the wisdom teeth
  • Tooth decay in partially erupted wisdom teeth
  • Cysts or tumors involving the wisdom teeth
  • Wisdom teeth that are causing damage to neighboring teeth

Extraction is almost always done as an outpatient procedure, so you'll go home the same day. The process includes:

  • Sedation or anesthesia. You may have local anesthesia, which numbs your mouth; sedation anesthesia that depresses your consciousness; or general anesthesia, which makes you lose consciousness.
  • Tooth removal. During an extraction your dentist or oral surgeon makes an incision in your gums and removes any bone that blocks access to the impacted tooth root. After removing the tooth, the dentist or oral surgeon typically closes the wound with stitches and packs the empty space (socket) with gauze.
  • Wisdom tooth extractions may cause some pain and bleeding, as well as swelling of the site or jaw. Temporarily, some people have trouble opening their mouth wide due to swelling of the jaw muscles. You'll receive instructions for caring for wounds and for managing pain and swelling, such as taking pain medication and using cold compresses to reduce swelling.

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