banner image

Impacted Wisdom Teeth

Wisdom teeth, which are the third molars located at the back of the mouth, are typically the last set of adult teeth to emerge. Most individuals have four wisdom teeth—two in the upper jaw and two in the lower. When these teeth are impacted, it means they do not have sufficient space to come through normally.

Impacted wisdom teeth are likely to inflict pain, impair adjacent teeth, and cause other dental issues. In some cases, they might not cause immediate problems. However, since cleaning is more challenging, wisdom teeth are at a higher risk of cavities and gum disease compared to other teeth.

Usually, impacted wisdom teeth causing discomfort or any other issues are removed. Sometimes, dentists may also recommend removing them even if they are asymptomatic, as a preventive measure against future problems.

By Able Health I Medically reviewed by Dr. Alireza Estedlal

Page last reviewed: February 2024 I Next review due: February 2026

Symptoms

Impacted wisdom teeth do not always present symptoms. However, if an impacted tooth gets infected, destroys adjacent teeth, or results in other dental issues, you might experience the following symptoms:

  • Red or inflamed gums
  • Bleeding or tender gums
  • Jaw pain
  • Swelling near the jaw
  • Bad breath
  • A bad taste in the mouth
  • Difficulty opening the mouth

Causes

Wisdom teeth get impacted when there is insufficient space for them to emerge or develop normally.

These teeth typically start coming in at the age of 17 to 26 years. For some people, wisdom teeth develop at the back of the second molars and align with the rest of the teeth without complications. However, in most situations, the mouth gets overcrowded for the proper emergence of the third molars, leading to impaction.

When impacted teeth partly develop, with part of the crown visible, it is known as a partially impacted wisdom tooth. Conversely, if the tooth does not emerge through the gums, it is referred to as a fully impacted wisdom tooth.

Whether partially or fully impacted, wisdom teeth can:

  • Develop at an angle towards the second molar
  • Develop at an angle towards the back of the mouth
  • Develop at a right angle to the other teeth, appearing as though the wisdom tooth is ‘lying flat’ in the jawbone
  • Develop straight up or downwards like the other teeth but remain trapped in the jawbone

Risk Factors

Factors that are likely to increase the likelihood of impacted wisdom teeth include insufficient space in the mouth or a blockage that prevents the teeth from developing properly.

Complications

Impacted wisdom teeth can lead to various oral issues, such as:

  • Damage of the adjacent teeth: When a wisdom tooth presses up on the second molar, it can cause damage or increase the possibility of infection within the area. Additionally, this pressure may result in crowding problems affecting adjacent teeth or potentially necessitate orthodontic care to correct.
  • Cysts:Naturally, wisdom teeth grow within sacs inside the jawbone. These sacs are sometimes packed with fluid, which creates cysts that may damage the teeth, jawbone, and nerves. In rare cases, a benign (non-cancerous) tumour may develop, which might require the removal of surrounding tissue and bone.
  • Cavities: In most cases, partially impacted teeth are more prone to decay than other teeth, as their position makes them difficult to clean. Food particles and microorganisms may become trapped in the middle of the gum line and partially erupt teeth.
  • Gum disease: Impacted or partially erupted teeth are difficult to clean, making them more susceptible to pericoronitis, an excruciating inflammatory gum disorder.

Diagnosis

An oral surgeon or dentist can examine the mouth and teeth to identify impacted wisdom teeth or other issues contributing to symptoms. This evaluation typically includes:

  • Inquiring about your symptoms and general dental health
  • Assessing the condition of the teeth and gums
  • Performing dental X-rays to reveal impacted teeth and any damage to teeth or bone

Treatment

If impacted wisdom teeth are challenging to manage or if there are underlying health conditions that could increase surgical risks, the dentist may refer you to an oral surgeon. He/she will then discuss the most appropriate treatment options with you.

Managing Asymptomatic Wisdom Teeth

Dental professionals have differing opinions on whether to extract impacted teeth that do not cause any symptoms, known as asymptomatic wisdom teeth.

Most experts suggest having asymptomatic wisdom teeth removed during the late teen years or in the early twenties. At this stage, there are fewer chances of problems, and the treatment process is generally safer and better endured by young individuals.

Other oral surgeons and dentists advise removing wisdom teeth despite the absence of any symptoms to avoid future problems. Their recommendations are based on:

  • Asymptomatic wisdom teeth may still be prone to disease.
  • Limited space in the mouth for wisdom teeth to emerge can make proper cleaning difficult.
  • Serious complications related to wisdom teeth are less common among young individuals.
  • The correction process becomes more complex with increasing age and can lead to complications later on.

Conversely, some oral surgeons and dentists suggest a more conventional method, noting that:

  • There is insufficient evidence to prove that asymptomatic impacted wisdom teeth in teen years will necessarily cause issues later on.
  • The costs and risks associated with the procedure may not be justified by the anticipated benefits.

With this conservative approach, the dentist will monitor your teeth for signs of cavities, gum disease, and other issues. If problems arise, they may then recommend removing the tooth.

Wisdom Tooth Extraction Surgery

When impacted wisdom teeth are painful or trigger other dental issues, they are often removed through a surgical procedure called extraction. This surgery is generally required for the following reasons:

  • Gum disease or infection (also referred to as periodontal disorder) affecting the wisdom teeth
  • Cavities in partially erupted wisdom teeth
  • Cysts or tumours affecting wisdom teeth
  • Wisdom teeth damaging adjacent teeth
  • Prevention of future dental problems

The extraction of wisdom teeth is usually performed as an outpatient execution, meaning you can return home on that same day. Generally,the removal process involves these steps:

  • Sedation or anaesthesia: Before the procedure, you may receive local anaesthesia to numb the area, sedation anaesthesia to minimise your awareness during extraction, or general anaesthesia to put you to sleep.
  • Tooth extraction: The dentist or oral surgeon will create an incision in the gums and remove any bone blocking access to the root of the impacted tooth. Once the tooth is extracted, the wound is usually closed up.

After extraction, you may experience some pain, bleeding, and swelling around the surgical area or jaw. Other individuals may also find it difficult to open their mouth widely for a short period due to inflammation of jaw muscles.

The dental specialist will provide directions on effective ways of caring for surgical cuts as well as pain and inflammation management. This may include taking pain medication and applying ice packs to minimize swelling.

Less frequently, some might experience problems such as:

  • Excruciating dry socket. Occurs when the blood clot fails to form or is dislodged from the socket following surgery, exposing the bone
  • Socket infection caused by stuck food bits or bacteria
  • Damage to surrounding teeth, jawbone, nerves, or sinuses

Prevention

Although you cannot prevent impaction from occurring, regular dental visits every six months for professional cleanings and check-ups allow your dentist to monitor the development of wisdom teeth. Frequently updated dental X-rays can also reveal impacted wisdom teeth before symptoms arise.

Coping and Support

The thought of having your tooth removed can lead to worry or anxiety. Conversely, delaying treatment may result in severe and long-lasting complications. Therefore, it is essential to discuss your concerns with your dentist. Feeling nervous is common and nothing to be ashamed of. Your dentist can also suggest ways to manage your nervousness and discomfort.

Most dentists provide options to help reduce nervousness. They include watching videos or listening to music during the procedure. You can also bring a supportive friend or family member. Additionally, consider relaxation techniques, including imagery and deep breathing. For severe cases of anxiety, you may need to see a dental surgeon who can administer medications or provide sedation methods to lower your anxiety level, making the procedure more comfortable and safer.

A Note from MD.co.uk

Impacted wisdom teeth can lead to various symptoms, such as swelling, an unpleasant taste in the mouth, and pain radiating through the jaw and face.

Extraction of the wisdom tooth is a common oral surgical procedure that helps alleviate these symptoms and minimise the risk of future dental health issues. Discuss with your dentist to determine if this treatment is suitable for you.