Impacted wisdom teeth

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 28, 2016
StartDiseasesImpacted wisdom teeth

Impacted wisdom teeth occur when the last four teeth to emerge from the gums, which are located the farthest back along the top and bottom rows of teeth, don’t have enough room to fully grow in. As a result people with this condition often experience pain, teeth crowding, infection, and other dental problems. Typically patients can have some or all of their wisdom teeth removed to correct the problem.

Contents

Definition & Facts

Patients typically begin to experience impacted wisdom teeth around 17 to 21 years of age when wisdom teeth finally begin to grow in. For many people wisdom teeth grow in without causing any problems, but for about seven out of ten people, wisdom teeth get blocked as they attempt to emerge from the gums either due to inadequate space or gum tissue, or they grow in sideways. When this happens the teeth push against the gums, jaw, and other teeth. In some cases this does not cause any problems but in others, it makes the gums on top swollen and painful, requiring dental extraction.

Symptoms & Complaints

The first and most recognizable symptom of impacted wisdom teeth is pain in the back jaw area where the teeth are growing in. This pain can radiate into the face and ears as the teeth press upon the neurovascular bundle of nerves located in the jaw. Other teeth may begin to hurt as well as the new teeth crowd and move them. If impacted wisdom teeth are not removed, the crowding of the gums can result in permanently crooked teeth.

In severe cases infection of the area can occur, called pericoronitis, as the gum area becomes inflamed and is difficult to reach with a toothbrush. As crowding worsens other symptoms may occur which include difficulty and pain when opening the mouth, pain and swelling around the jaw, bleeding from the gums, cavities to the wisdom teeth because of an inability to reach when flossing or brushing, and bad breath and an unpleasant taste in the mouth. With any of these symptoms a dentist or orthodontist can determine if the cause is impacted wisdom teeth or something else.

Causes 

Impacted wisdom teeth are caused by a lack of space when the third molars, or wisdom teeth, begin to grow in. For some people, their wisdom teeth grow without any problems as there is adequate space in the gums and jaw, but for a large percentage of the population, inadequate space leads to crowding and an inability for the tooth to emerge from the gums, also known as impaction. Wisdom teeth can either be fully impacted, when no part of the tooth is visible, or partially impacted, when a portion of the crown of the tooth is able to break through the gums and become visible.

The level of symptoms experienced often relies on the amount of crowding that occurs and whether or not the gums become infected. Especially uncomfortable or painful cases occur when the teeth grow in sideways, pushing harder upon the other teeth, or when they are blocked by the bone and begin to push back into the nerves of the jaw.

Diagnosis & Tests

To diagnose a suspected case of impacted wisdom teeth, patients need to see a dentist or oral surgeon for a dental examination. At the office, professionals can physically examine the teeth and gums to evaluate whether the wisdom teeth are growing in normally or being blocked and impacted. They can also see if any other issues might be causing any of the symptoms.

During the diagnostic process, dentists might use X-rays to get a visual of what is going on below the gums and see if any damage is occurring to the jaw bone or other teeth. They will also ask the patient questions about their symptoms to get a better idea of the situation and their pain level.

During this examination they attempt to determine if the wisdom teeth are causing misalignment of the teeth and any damage to the jaw, gums, or nerves, which need to be corrected. After taking all of this information into account the dentist or oral surgeon can decide the best course of treatment to treat the problem.

Treatment & Therapy

After a dentist or oral surgeon determines that the patient has impacted wisdom teeth, they will decide whether to treat the condition surgically or not. Some impacted wisdom teeth have no symptoms of pain or crowding; these cases are considered asymptomatic. In the case of asymptomatic wisdom teeth, dentists or oral surgeons will decide if they may become a problem in the future and require operation or if they can be left where they are. If removal is determined to be unnecessary they will be monitored for future problems.

There is some controversy in the medical community about the necessity of removing asymptomatic wisdom teeth at the current rate at which extractions are performed. Some argue that surgeries are performed too often and are often unnecessary. Studies have shown that the risk posed by asymptomatic wisdom teeth may be less than what is commonly disseminated to the public.

In cases where impacted wisdom teeth are causing symptoms like cavities, pain, or crowding, either all or some of the teeth will be removed either with local anesthesia or general anesthesia and sedation. During the surgery, the dentist will cut open the gum, remove any blocking bones, and remove the impacted tooth. Afterwards they will close the wound with stitches and pack the empty socket with gauze.

After surgery there will be some discomfort during healing, but afterwards all symptoms should be relieved. The same oral surgeon who removed the teeth should treat any complications that arise such as dry or infected sockets and nerve damage.

Prevention & Prophylaxis

Unfortunately, preventing wisdom teeth from becoming impacted is impossible. However, patients who maintain good oral hygiene and regularly visit the dentist can seek early treatment when symptoms arise. If discomfort does occur due to impacted wisdom teeth patients can treat it with anti-inflammatory pain medication and ice.

To prevent cavities and infection in wisdom teeth patients should regularly floss and brush. Patients can take steps after removal surgery to aid in proper healing, like icing, eating soft foods, rinsing with salt water, avoiding straws, and quitting smoking.