Impacted Tooth

Causes, incidence, and risk factors

Teeth emerge through the gums during infancy and when the primary (baby) teeth are replaced by the permanent teeth. If a tooth fails to emerge, or emerges only partially, it is impacted. Because they are the last teeth to emerge, the most common teeth to become impacted are the wisdom teeth (the third set of molars), which normally emerge between 17 and 21 yearsold.

An impacted tooth remains embedded in soft gingiva (gum) tissue or bone beyond its normal eruption time. The cause may be overcrowding, often because the jaw is too small to fit the third set of molars. Teeth may also become twisted, tilted, or displaced as they try to emerge, resulting in impactedteeth.

Impacted wisdom teeth are very common. They are often painless and cause no trouble; however, in some cases some schools of thought feel the impacted tooth pushes on the next tooth and causes it to become misaligned, eventually causing the bite to become shifted. A partially emerged tooth can trap food, plaque, and other debris in the soft tissue around it; leading to inflammation and tenderness of the gums and unpleasant mouth odor. This is called pericoronitis.

Symptoms

• Pain or tenderness of the gums (gingiva) or jaw bone
• Unpleasant taste when biting down on or near the area
• Visible gap where a tooth did not emerge
• Bad breath
• Redness and swelling of the gums around the impacted tooth
• Swollen lymph nodes of the neck (occasionally)
• Difficulty opening the mouth (occasionally
• Prolonged headache or jaw ache

Signs and tests

Examination of the teeth by the dentist may show enlargement of the tissue over the area where a tooth has not emerged, or has emerged only partially. The impacted tooth may be pressing on adjacent teeth. The gums around the area may show signs of infection (such as redness, drainage, and tenderness). As gums swell over impacted wisdom teeth and then drain and tighten, itmay feel like the tooth came in and then went back down again.

Dental X-rays confirm the presence of a tooth (or teeth) that has not emerged.

Treatment

The goal of treatment is to relieve irritation of the mouth caused by the impacted tooth. If the impacted tooth is not causing infection or inflammation, or is not affecting the alignment of the other teeth, no treatment maybe necessary.

Extraction (removal) of the tooth is the usual treatment for a symptomatic impacted tooth. This often is performed in the dentist’s office under local anesthesia. If the tooth is deeply impacted or difficulty with extraction is expected, the dentist may refer the person to an oral surgeon for tooth removal. Antibiotics may be required prior to tooth extraction if the area around the tooth is infected.

Expectations (prognosis)

Impacted teeth may cause no problems for some people and may never require treatment. If the impacted tooth is causing symptoms, treatment, including extraction, is usually successful in resolving the symptoms. It is often preferable to have wisdom teeth extracted when a patient is younger (under 30), due to the flexibility of bone which will allow an easier extraction and better healing. As a person ages the bone becomes more rigid and complications can develop.