Impacted Wisdom Tooth: Causes, Symptoms, Complications, and Treatment Options

By Dr. Austin Chan on 15th June 2020

Categories: Dental Care
X ray of impacted wisdom tooth

An impacted wisdom tooth is a third molar that fails to fully erupt due a lack of oral cavity space.

If not taken care of properly, it can lead to problems like tooth decay and gum infection. 

Wisdom tooth impactions can generally be classified under 2 categories: soft tissue impaction or bony impaction.

Soft Tissue Impaction

Soft tissue impaction occurs when the gum, and not the jaw bone, blocks the wisdom tooth from growing healthily. This is commonly seen during the eruption of the upper wisdom teeth.

For this type of impaction, the dentist may be required to make a surgical incision to expose the tooth before extracting it. The need for an incision depends on how exposed your impacted tooth is.

Bony Impaction

Bony impactions can manifest as vertical, mesial, distal, or horizontal impactions. They are very common in the lower wisdom teeth and usually require surgery to remove them.

  • Vertical impaction

    A wisdom tooth with this type of impaction grows in a vertical direction but lacks the space to erupt healthily.

  • Mesial impaction

    Mesial impaction is the most common type of impaction and is also referred to as “angular impaction”.

    With a mesial impaction, the tooth erupts partially and grows at an angle facing the front of the mouth.

  • Distal impaction

    A distal impaction is the rarest type of tooth impaction. Unlike a mesial impaction, a distal impacted tooth grows at an angle facing the back of the mouth

  • Horizontal impaction

    Horizontal impaction is a type of impaction where a tooth grows horizontally beneath the gums. 

    Like the mesial impaction, horizontal impaction causes food to be trapped easily between the wisdom tooth and the tooth in front, causing dental decay and gum problems.

  • Lack of space in oral cavity

As wisdom teeth are typically the last to grow in the mouth, they become impacted if there’s insufficient space to accommodate them.

 

  • Obstruction from surrounding structures

Obstruction from structures such as neighbouring teeth or surrounding jawbone causes the tooth to erupt in a wrong angle, resulting in an impacted tooth.

 

  • Genetics

Historically, our ancestors had bigger jaws that could accommodate wisdom teeth. This is because wisdom teeth played a vital role in their survival; they were used to help with the chewing and grinding of plant tissue.

However, as the modern human diet changed to contain softer foods, our jaws started to become smaller. 

As a result, our wisdom teeth often end up becoming impacted when they form.

Symptoms of an impacted wisdom tooth can develop for a few reasons. They are commonly caused by food stuck between your teeth; an impacted tooth that’s partially exposed in the mouth can cause food to be trapped between the wisdom tooth and the tooth in front. 

This makes it very difficult to clean, especially if the food is stuck deeper down between the teeth. 

Moreover, the removal of the trapped food will be tough even if you go to the dentist for scaling and polishing.

Over time, this can lead to an infection and the growth of cysts, causing the symptoms listed below.

  • Swollen, tender or bleeding gums around the wisdom tooth area
  • Bad breath
  • Difficulty in breathing
  • Toothache and facial swelling
  • Jaw pain and earache
  • Looseness of the tooth in front due to infection
  • Advanced bone loss from gum disease
  • Difficulty in opening mouth and eating 
  • Difficulty in swallowing
  • Possible obstruction of airway from swelling of the area

If not diagnosed and treated, an impacted wisdom tooth may cause the following complications.

  • Tooth decay

    Patients with an impacted wisdom tooth are prone to having tooth decay. This problem occurs because food gets trapped between the gums and the impacted tooth easily, creating a breeding ground for decay-causing bacteria.

  • Gum infection

    An impacted wisdom tooth can increase the risk of developing pericoronitis – a painful condition that occurs when food gets trapped, causing bacteria to accumulate around the gums.

If you’re experiencing pain and suspect that it’s caused by an impacted wisdom tooth, visit a dentist to get yourself diagnosed. 

An evaluation will be carried out to determine if you have impacted wisdom teeth.

The evaluation will typically involve

  • Questions about your symptoms and general health
  • An extraoral evaluation of any facial swelling and pain
  • Palpation of the area for pain or swelling
  • An intraoral examination of your teeth and gums
  • Dental X-rays (panoramic radiograph) to reveal signs of damage to your teeth and bone, and the presence of an infection or impacted teeth.

At times, symptoms can be caused by the adjacent teeth rather than the impacted teeth. Therefore, visiting your dentist to get a correct diagnosis is important.

Wisdom Tooth Surgery

Wisdom tooth surgery is a permanent solution to treat an impacted wisdom tooth. It’s a minor surgery that can be carried out by a dentist or specialist oral surgeon, either in a private dental clinic or hospital. 

Many patients choose to carry it out in private clinics due to convenience. For those who experience dental fear or anxiety, the surgery can be performed under IV sedation or dental anaesthesia in clinics or hospitals. 

In some cases,  the surgery might also be required before patients start orthodontic treatment like braces or Invisalign. This is because the impacted tooth can hinder the movement of your teeth, resulting in prolonged treatment.

Home Remedies

A wisdom tooth extraction or surgery is a permanent solution to treating the pain caused by the impacted tooth.

However, in the event that the surgery can only happen at a later date due to difficulty in getting appointments or work commitments, below are some temporary pain relief while waiting for your dental visit.

  • Ice packs

    Applying an ice pack can help to reduce inflammation and swelling. In addition, ice packs provide a numbing effect that may aid in relieving your pain.

    To create an ice pack, wrap a towel around some ice or frozen vegetables and apply it to your jaw for up to 15 – 20 minutes.

  • Saltwater rinse

    A saltwater rinse can soothe inflamed gums and ease your pain. 

    To make a saltwater rinse, dissolve a few teaspoons of salt in lukewarm water. Once the water is cool, swirl it around your mouth for several minutes before spitting it out.

  • Pain Relief Medication

    Pain relief medication is used to manage the pain caused by your impacted wisdom tooth.

    The effectiveness of this pain relief treatment may vary and is often used as a temporary solution.

Note!

We generally don’t encourage home remedies as delay in treatment can cause further complications.

Damage to adjacent nerves

This is perhaps the most important risk to consider before undertaking a wisdom tooth surgery. 

There are 2 nerves that are close to the wisdom teeth – the inferior alveolar nerve and the lingual nerve. The inferior alveolar nerve supplies sensation to the lower teeth and the lingual nerve innervates sensations to part of the tongue. 

Damage to these nerves can happen, although uncommon. Moreover, even if these damages happen, they are seldom permanent. Your dentist should always inform you of this risk prior to the surgery. 

Do consider going to a specialist oral surgeon for the surgery if your occupation is highly dependent on your sense of taste. You should also consult a specialist if your dentist deems your case to be a high risk and difficult one.

However, for most cases, experienced dentists who do wisdom teeth surgeries routinely can handle them without problems.  

Bruising, swelling, and pain

These are common post-op complications that happen with any surgery. They can be managed well if you don’t have any significant medical issues and follow your dentist’s post-op instructions diligently.

Trismus of the jaw

After the surgery, you will face difficulty with opening your mouth fully. This is normal, and you shouldn’t attempt to deliberately open your mouth wide. Additionally, it’s advised that you stick to a soft food diet for a few days to allow the wound to heal. 

Seeking Treatment For Your Impacted Wisdom Tooth

If left alone over a long period of time, an impacted wisdom tooth can cause irreversible problems such as gum disease and tooth decay. Moreover, you often won’t feel any symptoms until the problem has progressed significantly.

Thus, it may be worthwhile to visit a dental clinic for routine check-ups and have your dentist diagnose any problems in the early stages.

This also allows your dentist to determine if any treatment required, and if necessary, discuss treatment options with you. 

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