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

By Dr. Austin Chan on 25 August 2021

Categories: Dental Care
X ray of impacted wisdom tooth

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 the impacted tooth is.

Bony Impaction

Bony impactions can manifest as vertical, mesial, distal, or horizontal impactions. They’re 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 the 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 at 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’re 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 the 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.

For those who experience dental fear or anxiety, the surgery can be performed under IV sedation or dental anaesthesia.

In some cases, surgery might also be required before patients start orthodontic treatment such as 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 a delay in treatment can cause further complications.

 

Do’s

  • 1. Have a good meal 1 – 2 hours before the removal

    After the wisdom tooth has been removed, you’re likely to experience difficulties eating and drinking due to the numbness.

    Thus, you should have a good meal 1 – 2 hours before the procedure.

  • 2. Brush and floss your teeth

    Cleaning your teeth thoroughly will ensure that all plaque is removed, decreasing any risks of an infection.

  • 3. Ensure that someone is available to bring you home

    Once the removal is completed, you may feel groggy and unsettled because of the anaesthetic administered. 

    Getting someone to take you home would be a safer option.

Don’ts

Don’t smoke 8 hours prior to surgery

You’re advised to stop smoking at least 8 hours before the procedure.

Smoking can cause breathing difficulties both during and post-surgery. Additionally, you may have a higher risk of developing pneumonia.

Do’s

  • 1. Bite on gauze for 10 minutes

    After the procedure, bite on the gauze pad on the wound for 10 minutes. The pressure will help to stop the bleeding. 

    After which, it should be disposed of.

  • 2. Take prescribed painkillers when necessary

    After the anaesthetic wears off, you may start to feel pain. The degree of pain varies for each individual. 

    You should take painkillers as prescribed by your dentist if the pain is unbearable.

  • 3. Use ice packs to reduce swelling

    Within a day or two, you may notice a slight swell on your cheeks. 

    To counter this, you can place ice packs on your face where the surgery was done right after the procedure.

  • 4. Consume high calorie and protein soft foods

    It’s advised that you consume soft foods and chew using non-surgical areas. 

    Additionally, you should stick to a high calorie and protein diet to help to speed up the healing process. Some examples of foods you can eat include mashed potatoes, bananas and scrambled eggs.

Don’ts

  • 1. Don’t rinse your mouth or spit

    Avoid rinsing, spitting and anything that may dislodge the blood clot and cause more bleeding.

  • 2. Don’t engage in any vigorous activity

    Refrain from engaging in any intense activities that may cause discomfort. Only resume such activities when you’re ready.

  • 3. Don’t use straws

    When drinking liquids, you should drink directly from the cup. The sucking motion from using a straw will dislodge the blood clot and cause bleeding.

  • 4. Don’t drink carbonated, caffeinated or hot beverages

    Avoid consuming the following beverages 24 hours after the surgery:

    • Carbonated drinks
    • Caffeinated drinks
    • Hot drinks

    These beverages can cause the blood clot to be dislodged, resulting in more bleeding.

    Hot drinks will also prolong the healing.

  • 5. Don’t consume alcoholic drinks

    Alcoholic drinks can cause swelling and healing can be delayed.

    Additionally, it’s dangerous to take certain medications together with alcohol.

    Thus, you’re advised to avoid alcoholic drinks for at least 24 hours after surgery.

  • 6. Don’t smoke for at least 72 hours after surgery

    You should avoid smoking for the first 72 hours after the surgery.

    Smoking can slow the healing process and increase the risk of post-surgery complications.

  • 7. Don’t brush the extraction area in the first 24 hours

    Avoid brushing the extraction area 24 hours after the procedure. You should also avoid using an electric toothbrush for at least 2 weeks after the surgery.

    You may gently brush with a toothbrush or use cotton buds to clean the extraction area one day after the removal.

  • 8. Don’t use toothpaste in the first 24 hours

    You’re advised against using toothpaste to brush your teeth within the first 24 hours after the procedure.

    Simply brush your teeth gently with water, avoiding the extraction site.

FAQs

If your wisdom teeth are impacted, it’s advised to remove them even if you don’t experience any form of pain.

Impacted wisdom teeth are often difficult to clean. Thus, plaque can build up easily and cause cavities and gum diseases. Furthermore, impacted wisdom teeth can sometimes turn into a cyst, which is a sac filled with fluid. This will require a more complicated surgery.

 

If you experience any of the symptoms listed below, you should schedule a date to have your wisdom tooth removed.

  • Pain
  • Gum disease
  • Nearby teeth that are damaged
  • Severe tooth decay
  • Soft tissue behind the bottom last teeth experiencing repeated infections
  • Tumours
  • Cysts

  • Wisdom tooth extraction

In Singapore, wisdom tooth extraction typically costs $150 – $350 per tooth. MediSave cannot be used to pay for this procedure.

At i.Dental, this procedure will cost $192.60 – $267.50 per tooth (inclusive of GST).

  • Wisdom tooth surgery

Wisdom tooth surgery will be more expensive and range from $800 – $1,250 per tooth. You may claim up to $950 for each tooth extracted through MediSave, depending on how complex the surgery is.

At i.Dental, wisdom tooth surgery will cost between $695.50 – $1658.50 per tooth (inclusive of GST).

FAQs

Yes, you can resume your daily activities a couple of hours after your surgery!

Yes, you can brush your teeth after the procedure except for the area around the extraction! Do take note to avoid using toothpaste within the first 24 hours of the extraction.

Additionally, you’re advised to only brush the extraction site with gentle strokes the day after the procedure. You may use cotton buds to clean the extraction site as well.

Some common side effects after wisdom tooth surgery include swelling, bruising and pain. You can manage this well by following the post-surgery instructions from your dentist.

Other possible complications include:

  • Infections
  • Dry socket
  • Dental trismus
  • Damage to nerves
  • Numbness
  • Tooth root fracture
  • Jaw fracture
  • Displaced tooth

Stitches from your wisdom tooth surgery will typically dissolve within 2 weeks of the procedure. However, in the event that a stitch comes loose, you should contact your dentist immediately.

 

FAQs

It depends! You may be required to remove them before starting Invisalign or braces treatment as they may affect the movement of your teeth.

On the other hand, if your wisdom teeth have erupted fully in a proper position, you may delay the removal to a later date after your treatment is complete.

Your dentist will advise you on the recommended course of action based on the X-rays taken during the first consultation for your Invisalign or braces treatment.

 

In the event that your wisdom teeth erupt during Invisalign or braces treatment, your dentist may suggest removing them to avoid hindering your teeth movement. They may also make adjustments to your current set of aligners or issue you a new one due to swelling from the procedure.

If possible, you’re advised to remove your wisdom teeth prior to receiving Invisalign or braces treatment to avoid any delays during treatment.

According to Dr. Pua, an impacted wisdom tooth may potentially cause your teeth to shift post-treatment. In comparison, a fully erupted one is less likely to affect the treatment results.

It’s crucial that you wear retainers after your treatment to maintain your new smile. In addition, you should work with your dentist to reduce the effects of your erupted wisdom tooth.

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