Wisdom teeth are the mouth’s original party crashers. These four late-arriving molars make it their mission to squeeze in, but space is highly limited.
Many people don’t have enough mouth room for wisdom teeth to emerge properly. In some cases, these teeth become trapped inside the gums and jawbone. Known as impaction, the stuck tooth puts pressure on neighboring teeth, increases vulnerability of infection, and causes pain.
Learn more about wisdom tooth impaction, the different types of wisdom teeth impaction, how wisdom teeth impaction affects other teeth and oral health, and more.
What is an Impacted Wisdom Tooth?
An impacted wisdom tooth is a third molar that is partially or completely stuck in the gums or jawbone. Impaction can happen to any tooth, but it mostly affects wisdom teeth because they’re the last to grow in, which means mouth and jaw space is tight.
Types of Wisdom Tooth Impactions
Impacted wisdom teeth can grow in four general directions. Here are the four types of impaction:
- Mesial impaction: the wisdom tooth remains partially or completely under the gums or jawbone and angles forward towards its neighboring tooth; the most common type of wisdom tooth impaction
- Vertical impaction: the wisdom tooth is correctly aligned but doesn’t properly break through the gum or jawbone
- Horizontal impaction: the wisdom tooth grows sideways and is partially or completely under the gums or jawbone
- Distal impaction: the wisdom tooth remains partially or completely under the gums or jawbone and angles backward; the rarest type of wisdom tooth impaction
The degree also varies as to how much the wisdom tooth is embedded in the gums or jawbone. Soft tissue impaction is when a tooth emerges from the jawbone but not through the gums. Hard tissue impaction is when a tooth is fully covered by the gums and jawbone. Hard tissue impactions are the most difficult to remove.
Why Do Wisdom Teeth Get Stuck?
There are several reasons why wisdom teeth can become stuck, but one of the biggest factors is the size and shape of the jawbone.
Genetics are responsible for traits like jawbone and tooth size, and also when teeth develop. Inheriting a smaller face and/or jaw structure are precursors to tooth impaction.
There are evolutionary reasons, too. Long ago, people ate raw, tough foods that required virtuous chewing, such as uncooked meat, roots, fibrous plants, and coarsely ground grains. Strenuous chewing forced the jawbone to grow bigger, thus accommodating wisdom teeth. Wisdom teeth grew in last to replace second molars, which wore down from such intense chewing. Our diets have since shifted to much softer foods, which led to smaller jawbones over time.
Smaller jawbones can cause teeth to grow in at unfavorable angles, like horizontally and inside the gums or jawbone. Teeth attempting to emerge will try to bypass neighboring teeth, which doesn’t always leave them upright and vertical. In other cases, teeth make it partially through the gums, but don’t have room to make the full trip.
Is Everyone at Risk of Having Impacted Wisdom Teeth?
No, many people will not experience an impacted wisdom tooth. Some people genetically have larger jawbones and can accommodate their wisdom teeth better. Even in these cases though, dentists and oral surgeons will continuously monitor the teeth to ensure the wisdom teeth aren’t causing issues.
What Happens When a Wisdom Tooth is Impacted?
Impacted wisdom teeth make teeth more susceptible to infections. Some of the issues caused by having an impacted wisdom tooth include:
- Pain in the jaw, mouth, or cheek
- Gum inflammation and infection (pericoronitis) caused by food and bacteria becoming trapped around a partially erupted tooth
- Cavities caused by trapped debris, which can spread to neighboring teeth if left unaddressed
- Damage to neighboring teeth by putting pressure on teeth roots or pushing against other teeth
- Cysts, namely the dentigerous cyst, a fluid-filled sac that forms around an impacted tooth that’s stuck in the jawbone.
Early intervention from a dentist and oral surgeon can help alleviate pain and prevent ongoing issues caused by impacted wisdom teeth.
Does Every Impacted Wisdom Tooth Need to Be Removed?
Oral surgeons handle impacted wisdom teeth on a case-by-case basis.
If a tooth is causing obvious problems, such as pain and discomfort, or decay, damage to neighboring teeth, and vulnerability to infection, tooth removal may be recommended.
An impacted tooth that is currently asymptomatic, disease-free, and isn’t jeopardizing the oral health or positioning of neighboring teeth, may be monitored closely rather than removed immediately.
It’s possible for impacted teeth to cause problems without pain. Routine dental exams and X-rays are critical for early detection.
How Does an Oral Surgeon Determine What to Do?
Before seeing an oral surgeon, you’ll see your regular dentist. Your dentist will periodically take X-rays of your teeth, known as bitewing X-rays, to check for impacted teeth, cavities, and other possible issues. X-ray frequency is based on patient need.
Bend Oral Surgery will review the results of your dental exam and X-rays, and consider factors such as:
- Pain and/or pressure caused by the impaction, if any
- Presence of decay, infection, or disease
- Tooth position and angle
- Effects on nerves, surrounding bone, and neighboring teeth
Depending on the above-mentioned factors, the oral surgeon will recommend monitoring or surgical removal.
Monitoring an impacted wisdom tooth involves visiting your dentist every six months and taking periodic X-rays to watch for changes, both obvious and hidden. The patient is also required to take special measures at home to prevent decay, such as using a water flosser.
If removal is recommended, you’ll schedule a date and time with the oral surgeon to surgically remove the impacted tooth.
Don’t Ignore an Impacted Wisdom Tooth
Having an impacted wisdom tooth can be painful, stirring up issues with your oral health (and peace of mind). Or, it can be completely asymptomatic.
Scheduling routine dental exams can help your dentist watch for changes and determine whether monitoring or surgical removal is appropriate for you. Early detection is best when it comes to caring for an impacted wisdom tooth and your neighboring teeth.
If you have an impacted wisdom tooth or suspect you may have one, schedule an appointment with your dentist, and if needed, they will refer you to Dr. DeLisi at Bend Oral Surgery. Taking action early can help prevent pain, infection, and damage, and protect your oral health.