Did you know that humans can have up to 32 adult teeth? Amongst them lie the elusive third molars; which are commonly known as wisdom teeth. Wisdom teeth grow in the back corners of your jaw and are arguably the most problematic teeth in the dentition.
You may wonder why wisdom teeth are so commonly associated with pain and trouble. This is due to their nature of erupting late into the oral cavity. They are the third and last set of molars to erupt and this usually happens in early adulthood (at the age of 18 to 21) or later in life.
However, your jaws may not be able to house these extra latecomers. When there is not enough space, this can cause the wisdom teeth to grow suboptimally and this condition is known as impacted wisdom teeth.
Types Of Wisdom Tooth Impaction
Impacted wisdom teeth lack the space to grow in the ideal upwards direction. Impacted wisdom teeth may erupt partially (partially impacted) so that some parts of the crown are visible or can be fully submerged in the bones (fully impacted). This can lead to 2 forms of impaction: soft tissue impaction or bony impaction.
Soft Tissue Impaction
Soft tissue impacted wisdom tooth occurs when the tooth is able to grow above the upper border of the jawbone but is unable to break through the gum line completely.
Some parts of the crown of the tooth may be visible but the other parts lie beneath a flap of gum tissue known as an operculum. An operculum makes the area harder to clean and acts as a food trap that can lead to inflammation.
Bony impacted wisdom tooth occurs when the tooth is completely submerged in the jawbone. There are four types of bony impaction based on the angulation of the tooth:
The orientation of the tooth is almost vertical and ideal for eruption. However, the impacted tooth is stuck in the jawbone and may put pressure onto the tooth in front or the bones behind. This can lead to a cavity forming on the second molar or jaw discomfort.
The impacted tooth lies horizontally to the neighbouring teeth in the bone. Without removal, the wisdom tooth may impinge into the adjacent teeth causing tooth decay.
Mesial impaction is the most common type of wisdom tooth impaction. The impacted tooth is angled towards the tooth in front and often leads to a partial eruption. This causes a buildup of trapped food between which leads to cavities. It is also known as angular impaction.
Distal impaction is the rarest type of impaction and occurs when the impacted tooth is in the wrong angle facing towards the back of the mouth, which is the direct opposite of mesial impaction.
There is a higher chance of the lower (mandibular) wisdom teeth being impacted compared to the upper (maxillary) teeth. Upper wisdom teeth are also usually easier to remove compared to lower wisdom teeth but this is not always the case. Ultimately, it depends on each individual’s case.
Causes Of Impacted Wisdom Tooth
Genetics plays a huge role in the occurrence of wisdom teeth. In the olden days, our ancestors used their third molars to grind and bite into their tough foods. As humans progressed, a softer diet was introduced leading to the evolution of smaller jaw sizes. This has decreased the space for wisdom teeth to erupt properly.
Lack Of Space
A lack of space in the oral cavity is the primary reason for impacted wisdom teeth. There is not enough room for the late erupting wisdom teeth to grow optimally so the developing wisdom tooth may become impacted.
Symptoms Of Impacted Wisdom Tooth
If you are experiencing soreness in the back corners of your mouth, it is highly likely that your wisdom tooth is about to make an appearance. Below are some common signs and symptoms that you may experience for impacted wisdom teeth:
- red, tender or swollen gums
- difficulty opening mouth
- unpleasant taste in your mouth
- bad breath
- swelling or pain in the jaw area
- difficulty swallowing or eating
The symptoms may come and go in intermittent pulses over days or weeks.
Some people may not feel pain whilst their wisdom tooth is growing. However, this does not mean that your wisdom tooth is not impacted as it could be asymptomatic (not showing any symptoms).
Complications Of Impacted Wisdom Tooth
A partially impacted wisdom tooth can form a pocket between the tooth and gums leading to a high risk of food stuck inside. It is also harder to clean, increasing the chances of gum disease and periodontal disease (gum and bone loss).
Your impacted wisdom tooth can also grow towards and damage its neighbouring teeth, causing tooth decay and cavities.
Impacted wisdom teeth can also cause problems such as pericoronitis, infection and cyst formation in the bone may also occur. Pericoronitis is the inflammation of gum tissue surrounding an impacted tooth. This can be caused by an infection and you may experience intense and severe pain.
For people interested in orthodontic treatment (braces), your impacted wisdom teeth may obstruct the movement of your other teeth. It may be necessary to remove wisdom teeth to make room for this treatment.
Preventing Wisdom Tooth Impaction
Unfortunately, impacted wisdom teeth cannot be prevented. However, regular checkups and X-rays at the dentist’s could help monitor the growth of your wisdom teeth. Early detection of impacted wisdom teeth and regular scaling & polishing could prevent future problems to the nearby teeth as well.
It may be advisable for certain cases to remove your wisdom tooth as early as you can to avoid other dental problems. Younger people also tend to recover faster and have fewer risks in a surgical procedure, therefore having your wisdom teeth removed at an early stage is better.
How To Diagnose An Impacted Wisdom Tooth
If you feel pain and suspect that your wisdom tooth is impacted, the best way to confirm would be scheduling a visit to the dentist for a checkup. During the visit, the dentist would:
- ask you a few questions about your pain and dental problems
- inquire about your overall health
- take a look into your mouth for intraoral examination
- palpate your jaw for swellings for extraoral examination
- take a dental X-ray (panoramic radiograph or cone beam CT) to confirm the diagnosis
Once the correct diagnosis is confirmed, the dentist will list treatment options for the impacted tooth and other teeth that might have been affected.
Treatment Of An Impacted Wisdom Tooth
The most common reason for tooth removal is due to pain from impacted wisdom teeth.
In the case of impacted teeth, a wisdom tooth surgery is usually performed rather than a wisdom tooth extraction as the tooth is stuck and requires surgical removal.
A surgical incision is required to expose the wisdom tooth hidden in the bone and when the tooth has been removed, the dentist will stitch the gum back. This procedure may involve bone removal and tooth division.
Surgical extractions can be performed by your local dentist. In some cases that are more complex, surgery is referred and performed by oral and maxillofacial surgeons.
Local anaesthesia is sufficient for numbing the gums and tooth. For dentally anxious patients, the option for sedation (eg. intravenous sedation) and general anesthesia are also available in some private clinics and hospitals. Sedation helps you to relax whereas for GA, you will be unconscious for the treatment.
Managing Asymptomatic Impacted Wisdom Teeth
Some people do not feel any symptoms from their impacted tooth. For asymptomatic third molars, some dentists would recommend wisdom teeth removal whereas others would go for the conservative approach of leaving and monitoring it.
The dentist or oral surgeon would also weigh the risks and benefits of surgical removal versus retention of the tooth and provide you with their professional opinion.
Home Remedies For Impacted Wisdom Tooth Pain
The following home remedies may alleviate pain temporarily:
- Gargling warm saltwater
Rinsing your mouth gently with warm salt water can soothe inflammation. Adding a quarter to half teaspoon of salt to a cup of warm water and gargling gently can ease the pain.
- Pain relieving medications
Pain relieving medication such as paracetamol is often effective in alleviating pain.
- Ice pack or cold compress
Applying an ice pack will reduce swelling and numbs the area which acts as pain relief.
- Eating soft foods
A softer diet reduces the pressure on the gums which contributes to pain.
However, these remedies are only for temporary relief and will not benefit you in the long term. It is advisable to seek treatment as soon as possible as a delay would lead to further complications.
Complications Of Wisdom Tooth Surgery
The following are some possible complications of wisdom tooth surgery:
Pain and Bruising
The most common complication is pain and swelling. The dentist would provide a list of post-op instructions to follow to manage the pain. This includes placing an ice pack to minimize swelling and sticking to a soft diet for the next few days. A medical leave of 5-7 days would also be given so you can have ample rest and recover.
After the third molar removal, blood clot will form in the tooth socket as part of the healing process. However, vigorous activities may cause the newly formed blood clot to dislodge which leads to a painful condition known as dry socket.
Dry socket is fairly common and leads to delayed wound healing. It has a high rate of occurrence in smokers and is more common in the lower jaw.
Another possible complication of lower wisdom tooth surgery that may occur is nerve damage. The inferior alveolar nerve and lingual nerve lies in close proximity to the roots of the lower teeth.
During oral and maxillofacial surgery, there is a risk of damaging the nerves. It could either be permanent or temporary depending on the nerve’s condition. However, the risk of a permanent nerve injury is very rare.
Perforation Into Maxillary Sinus
The maxillary sinus (aka antrum) is a hollow cavity that lies beneath the bones of the cheek and next to the nose. The bottom of the sinuses lie at a close proximity to the roots of the upper molars.
During surgery whilst removing the tooth, it is possible to tear the lining separating the oral cavity and sinus, forming a direct link between the two. This could cause infection of the sinuses and sinusitis.
If you notice obvious symptoms of impacted teeth, it is highly recommended to visit a dentist for a check up to confirm. You can visit your local dental clinic and following the consultation, you can choose to remove your tooth there or be referred to an oral and maxillofacial surgeon. It is wise to extract third molars in the wrong position as soon as you can.
At Ocean Dental, we have a regular visiting oral surgeon specialist coming in every month for more complex surgery cases. We also have X-ray machines for panoramic X-ray (OPG) and CBCT (for 3D scans). We aim for every step to be done within our clinic for your own comfort and convenience.
Need help? Check out our wisdom tooth extraction service for more information.