Impacted wisdom teeth are third molars at the back of the mouth that lack enough room to grow normally. In young people, these teeth present few complication and are said to heal faster. In most people, it is not considered a dental worry, it can, however, be accompanied by swelling of gums, jaw pain, tooth decay and gum disease. Here are the causes, meaning, effects, treatment and how to remove impacted wisdom teeth.
What is impacted wisdom teeth?
For you to understand impacted wisdom teeth better, you should understand what wisdom teeth are. Wisdom teeth, also called third molars, are the third and final set of molars that most people get between the ages of 17-25. They are the last four of your 32 teeth to erupt.
These teeth are third molars at the back of the mouth that lack enough room to break from under the gums normally. There is also a genetic predisposition to tooth impaction, and they play an unpredictable role in dictating jaw and size of the tooth, as well as tooth eruption potential of the teeth. If this happens, pain can develop with the onset of inflammation or infection or damage to the adjacent teeth.
You may also consider the angle at which the 3rd molars sit the stage of root formation of the third molars at the point of screening and the depth of impaction. They are classified on the basis of their direction and depth of impaction, the amount of space available for tooth eruption, and the amount of the soft tissue or bone that covers them. The following are the common terms you may hear dentists use when describing impacted teeth;
- Mesial/Distal impaction– this is the most common form of impaction commonly angled forward towards the mouth and this could end up pushing your other teeth forward.
- Vertical impaction– these teeth come in fairly straight, but there isn’t enough room in the mouth to accommodate them.
- Bony Impaction– this deals particularly with the teeth that do not erupt through the gum line but instead remains trapped beneath the bone in the jaw. This tooth in question is completely covered by a layer of bone and is referred to as full bony.
- Soft tissue impaction– this is a condition whereby the tooth gets stuck in the gum tissue before it finishes growing as it tries to erupt. This kind of impaction is characterized pain and disruption of dental alignment.
- Partial impaction– this is a condition when a third molar becomes impacted when it gets obstructed by some other neighboring tooth hence preventing a full eruption. When you suffer this condition, bacteria and food debris can lodge underneath the edges of the gum tissue opening, and an infection could develop, leading to pain or some other oral health issues.
- Horizontal impaction– these types of teeth are lying on their side within the jawbone and directly towards the existing teeth, rather than growing vertically towards the gum line.
This classification structure helps the dentists estimate the risks for impaction, infections and some of the complications associated with the teeth removal.
Sometimes, impacted wisdom teeth don’t cause any symptoms, and the only way your dentist can find out about them is from examining your regular dental X-rays. However, as the condition persists, they can lead to problems such as;
- Bad breath- when impacted teeth are removed, there are gum sockets formed and are tough to clean, given how high or how far back they are in the jaw. The food debris and bacteria can easily get trapped, leading to bad breath or even an infection.
- Swelling around jaw this is another symptom of impacted wisdom teeth. This condition can extend from the chin and back to the underwear area. When the tooth shifts deep in the jaw, it disrupts the nerve endings spanning the entire mouth. You should have a doctor give you a professional opinion in case you suffer this condition.
- Swelling- many people develop swelling on the gum flap, known as peritonitis. This condition causes inflammation of the soft tissue around the tooth and can be very painful. It makes it difficult to chew.
- Bleeding and tender gums- the impacted tooth affect the gums the most. It can cause shifting and if strong enough can cause tenderness in other teeth. This is when the gums begin to bleed and swell. This condition should be notified to the dentist if it persists beyond the normal time.
- Damage to teeth- impacted teeth can not only damage the other teeth but could interfere with the alignment of the adjacent teeth. This is because they could end up pushing the other teeth around them, resulting in infections or forcing them out.
- A headache or jaw ache– impacted teeth are characterized by a sudden onset of headaches. This happens because whether impacted or partially erupted, swelling can occur and gum tissues may get infected. The swollen gums can leave you with a badly aligned bite, which may cause pain in the jaw area or even a headache.
- Occasional swollen lymph glands- along with the pain, impacted tooth can cause sore throats and swollen lymph glands just beneath the jaw. These swellings may be accompanied by swelling of the face and jaw, pus drainage, and presence of bad smell or taste in your mouth. You may also have difficulties chewing or swallowing.
- Tooth decay- when the impacted teeth lie at the wrong angle and probably point back to the adjacent tooth, it increases the possibility of damage to both teeth. This could cause dental cavities.
- Pain- this condition will cause throbbing pain in the back of your mouth. The pain is also more felt around the impacted tooth and other molars.
Effects of impacted wisdom teeth
If trapped in the gums, impacted wisdom teeth may lead to various dental problems such as infections, pain, swelling or misalignment of other teeth. The following is an insight of these common problems;
- Gum infections- when your impacted tooth is removed or it partially erupts through the gum, bacteria and food particles can accumulate beneath the gum, resulting in a local infection. This infection is accompanied by pain, swelling of the gums and bad breath. It also causes difficulties in chewing while your mouth is fully open. If untreated early, it can spread to the cheek and neck.
- Cyst development- this is made possible by the fact that the sac that holds the impacted tooth has a capacity to be filled with fluid. This causes pain and may damage your entire jaw bone, and therefore could a wide area of your teeth and nerves.
- Extensive tooth decay– impacted teeth welcome collection of saliva, food debris, and bacteria around it. This could cause decay on the wisdom tooth or on the adjacent teeth. This condition is characterized by a painful infection which can only be cured through tooth removal first.
- Pain- when you develop an impacted tooth, it causes a lot of pressure against the other teeth in the mouth as it tries to create its own space. This can cause severe pressure pain that could lead to erosion of the other teeth.
- Cysts formation from the tissue that surrounds the impacted tooth is a common condition. This could cause jaw enlargement, bone destruction and possibly decay of the nearby teeth. This condition requires removal of the tooth and the cyst to avoid development of tumors inside the cysts or bone loss.
- Plaque caught between teeth and gums– impacted wisdom tooth can help you know when to get proper dental help. When this happens, the tooth may be covered partially with a flap of gum tissue, which can trap food, plaque or bacteria. These are accompanied by painful wisdom tooth infection
- Damage to teeth- impacted teeth commonly affects the adjacent teeth leading to an irregular alignment of teeth, toothache and sensitive teeth. The inflammation of the surrounding tissues caused by the dental plaque, together with the pressure of the wisdom tooth pushing on the adjacent tooth in front, this causes the root of the adjacent tooth to resorb.
Horizontally impacted wisdom teeth
Impacted wisdom teeth are classified according to the nature of their growth. Horizontally impacted wisdom teeth are one of the common complications. A horizontal impaction describes a wisdom tooth that grows sideways within the jawbone. This tooth grows directly towards existing teeth rather than growing vertically towards the gum line.
You don’t need to administer any treatment if the impacted tooth is not causing any problems. You may take some over-the-counter pain relievers that could curb with the discomfort caused by this condition.
Coronectomy this is a surgical procedure used by the surgeon when there is a high risk of inferior alveolar nerve injury. The roots of the wisdom teeth in the lower jaw often press on or wrap around the nerves that supply feeling to your tongue, lip, and chin. Research shows that surgical extraction may cause damage to the lingual nerve or inferior alveolar nerve, leaving you with a temporary or permanent loss of feeling.
The procedure for this treatment involves removing the crown of the tooth and leaving the roots intact in your jaw. When the roots are within the immediate vicinity of the inferior alveolar nerve, this form of treatment is preferred since it prevents neurological damage. Damage to these nerves often interferes with speaking, eating and general quality of life.
Your surgeon will be the one to recommend this form of treatment for your condition. The following are some of the situations when this treatment is advisable;
- If the roots of your tooth are close to the nerves
- If the tooth or the root is infected
- If the tooth is horizontally impacted along the inferior alveolar nerve (IAN)
- If there is root mobility discovered during the surgery
2. Local treatments
A situation where there is inflammation of the soft tissues around the impacted tooth, you can treat it through local cleaning, an antiseptic rinse or through antibiotics for the severe cases.
Impacted wisdom teeth removal
Do you need to remove an impacted wisdom tooth if it isn’t causing any problems? When a wisdom tooth is impacted, it is almost certain to cause issues if ignored, especially if it is on the lower jaw. Some impacted wisdom teeth don’t require removal, while symptomatic cases usually need surgical extraction by a dentist or an oral surgeon in an outpatient setting. For proper treatment, proper diagnosis needs to be conducted. The dentists will look for swollen gums or signs of infection such as tenderness, redness, and drainage. A diagnosis can be confirmed through dental X-rays which indicate the position of the impacted tooth and the damage to other teeth or the jawbone.
They also cause a lot of pain and therefore it is important that you remove them as soon as the problem is detected in order to avoid some other complications.
The following is the procedure of extracting impacted wisdom teeth;
Your dentist will administer a local, sedation or general anesthesia in order to numb your mouth or suppress your consciousness during surgery. The following are a different number of anesthetics used depending on how your wisdom tooth is to remove;
- Local anesthetic-this injection is administered into the gum surrounding the impacted wisdom tooth. This injection takes a couple of minutes to numb the area and this means you will feel no pain while the tooth is removed.
- Local anesthetic and intravenous sedation- this kind of injection make you feel relaxed and less aware of the procedure. With this, you will stay awake but you may have a little or no memory of the extraction process
- General anesthetic- these injections put you to sleep completely and thus prevents pain in the whole body. These are given depending on the length of the surgery, mostly when the dentist is to remove several teeth.
An incision will be made on the gum to expose the tooth and bone- your dentist will open up and separate the tissue connecting the tooth to the bone and then remove the tooth. Sometimes the dentist will cut the tooth into smaller pieces in order to make it easier to remove. This can take around 20 minutes.
After the surgical procedure, patients are sent home with clear instructions regarding the diet modifications and other measures that help manage post-surgical complications.
Gently bite on the gauze pad periodically, and change them more frequently if they get soaked with blood. This helps control and stop bleeding
You will need to eat a soft diet for a week or so. Such foods include gelatin, pudding, or a thin soup.
It is important to keep the extraction site clean- since it is difficult to clean the wound because of its position, you can simply prevent food debris from reaching the place. And in case some food is trapped, rinse it off with mouthwash or warm salt water.
Apply an ice pack on the outside of your cheek for 15 to 20 minutes at a time for a day. You can use moist heat such as a washcloth soaked in warm water
Rinse your mouth with warm salt water several times in a day to reduce swelling and relieve pain. Prepare your own salt water by mixing 1 tsp. of salt in a medium-sized glass of warm water. This helps loosen any blood clots that may delay healing.
Avoid disturbing the wound, by not touching the site. You should chew on the opposite side of your mouth for the first 24 hours
Common complications associated with teeth removal
While rare, there are complications associated with impacted wisdom teeth removal. Symptoms include;
- Swelling in patients is the most common side effects that could last up to 2 weeks. The swelling could vary in different patients depending on nature of the surgery undergone. This can, however, be healed with an aid of ice packs or salt water rinse.
- Bleeding- it is normal to experience bleeding after any sort of surgery but it usually stops quickly. This won’t bother you if the area gets stitched, but if it bleeds at home, you can apply pressure over the area for at least 10 minutes.
- Restricted mouth opening– this condition is as a result of swelling and it heals immediately when the swelling subsides. When suffering from this condition, your mouth opening is restricted and you may have to modify your diet to eating soft foods. You should also maintain proper oral hygiene to avoid an infection that could complicate the swelling.
- Nerve injury– nerves get occasionally bruised during tooth removal. There are two nerves that lie in proximity to the impacted wisdom teeth; the lingual nerve- this nerve provides sensation in your tongue, while the inferior alveolar nerve gives sensation to the lower lip and skin overlying the chin. In case of such a situation, you may have numbness or pins and needles in either the tongue, lower lip, or any combination of these. It is rarely a permanent condition and could, therefore, take up to 18 months to recover.
- Infection– an infection following the removal of an impacted wisdom tooth is also referred to as a dry socket. This condition can be minimized by adopting scrupulous oral hygiene during the recovery phase. This usually encompasses avoiding any foreign substances that may disturb the wound like smoking. You should also be serious about normal tooth brushing and the mouthwashes recommended.
- Weakening of the jaw– this could possibly be as a result of the fracture. It happens in very rare cases, like 1% of the surgeries undertaken.
- Abscess- an abscess is a collection of pus in any part of the body that could be swollen and inflamed. The skin, under the skin, and the teeth are the most common sites. This condition is caused by bacteria, parasites or some other foreign substances. After you tooth gets removed, it becomes vulnerable to such infections.
How to remove impacted wisdom tooth
- Impacted wisdom teeth: http://www.mayoclinic.org/diseases-conditions/wisdom-teeth/basics/definition/con-20026676
- The symptoms of impacted wisdom teeth: http://www.colgate.com/en/us/oc/oral-health/conditions/wisdom-teeth/article/the-symptoms-of-impacted-wisdom-teeth-0113
- Impacted wisdom teeth, what you need to know: http://www.colgate.com/en/us/oc/oral-health/conditions/wisdom-teeth/article/impacted-wisdom-teeth-what-you-need-to-know-0413
- Removal of impacted wisdom teeth, possible problems: https://www.baoms.org.uk/patients/procedures/23/removal_of_impacted_wisdom_teeth
- Symptoms of impacted wisdom tooth: http://coronationdentalspecialty.ca/services/oral-and-maxillofacial-surgery/removal-of-impacted-wisdom-teeth/