When it comes to wisdom teeth, the term impacted wisdom tooth is one many people encounter during early adulthood. These “last teeth” to emerge often cause dental problems when they fail to erupt properly. Let’s explore what impacted wisdom teeth are, the issues they can cause, and the available treatment options to manage them.
What Is an Impacted Wisdom Tooth?
Wisdom teeth, also known as third molars, typically erupt between the ages of 17 and 25. However, due to a lack of enough space in the jaw, many wisdom teeth become impacted. This means they remain trapped under the gum tissue or grow at the wrong angle, unable to emerge fully.
There are different types of impaction:
- Fully Impacted Wisdom Tooth: Completely trapped within the jawbone or gum tissue.
- Partially Impacted Wisdom Tooth: Only a portion of the tooth emerges through the gum line.
- Vertical and Horizontal Impactions: When wisdom teeth grow in an incorrect position, they can press against nearby teeth or the jawbone.
Why Do Impacted Wisdom Teeth Happen?
Impacted wisdom teeth occur when these molars cannot fully emerge or grow in the proper position. This condition is primarily due to evolutionary and anatomical changes in the human jaw and other contributing factors. Let’s explore the reasons behind impacted wisdom teeth.
Lack of Enough Space
One of the most common causes of impacted wisdom teeth is the absence of enough room in the jaw. Over time, human jaws have become smaller due to dietary changes and reduced reliance on coarse, unprocessed foods. This evolution often leaves little to no space for four wisdom teeth to grow properly, resulting in impaction.
Late Eruption of Wisdom Teeth
Unlike other teeth, which emerge during childhood, wisdom teeth erupt much later—typically between the ages of 17 and 25. By this time, the jaw is already developed, and all other teeth are in place, leaving limited space for third molars. This can lead to:
- Teeth growing at the wrong angle.
- Wisdom teeth can get lodged beneath the gum tissue or within the jawbone.
Evolutionary Redundancy
Wisdom teeth are considered vestigial, meaning they have lost their primary function due to changes in human diets and habits. While they were once essential for chewing hard, fibrous foods, modern diets don’t require this additional set of molars. This redundancy contributes to their frequent impaction and associated dental problems.
Genetics and Jaw Size
Genetic factors play a pivotal role in determining the likelihood of impaction. People with smaller jaws or atypical jaw development are more prone to impacted wisdom teeth. Additionally, the angle at which developing wisdom teeth grow is often influenced by inherited traits.
Irregular Tooth Development
Sometimes, the third molars develop at an unusual angle or orientation, such as:
- Vertical Impaction: Teeth grow upright but fail to fully erupt.
- Horizontal Impaction: Teeth grow sideways and press against nearby teeth.
- Angular Impaction: Teeth grow at a slant, potentially damaging the second molar.
Such irregular growth can result in impaction and damage to adjacent teeth or structures in the mouth.
Overcrowding in the Jaw
Even if the jaw is adequately sized, overcrowding from other teeth can block the proper eruption of wisdom teeth. This is especially true in cases where orthodontic issues, such as misaligned teeth, already exist.
Impact of Early Orthodontic Work
For those who received orthodontic treatment during their teenage years, wisdom teeth eruption may disrupt the results of braces or aligners. To preserve alignment, some dentists recommend preemptive wisdom tooth extraction to prevent future problems.
Dense Bone Structure
In some cases, the jawbone itself may be too dense or compact, making it harder for unerupted wisdom teeth to break through the surface. This condition increases the likelihood of fully impacted wisdom teeth.
Recognising the Symptoms of Impacted Wisdom Teeth
Not all impacted wisdom teeth cause immediate problems, but many show obvious symptoms, such as:
- Pain at the back of the mouth or jaw
- Swollen gums around the impacted tooth
- Bad breath and a foul taste in the mouth
- Difficulty opening the mouth
- Gum infections or periodontal disease
- Pressure or discomfort in other teeth due to crowding
These symptoms often indicate underlying dental problems, such as tooth decay, gum disease, or cysts forming around the impacted tooth.
Dangers of Ignoring an Impacted Wisdom Tooth
If left untreated, impacted wisdom teeth can lead to:
- Tooth Decay: Partially erupted wisdom teeth are hard to clean, increasing the risk of cavities.
- Gum Infections: Bacteria can accumulate around the gum tissue, causing inflammation.
- Damage to Nearby Teeth: Pressure from the impacted tooth may harm second molars.
- Cysts or Tumours: Fluid-filled sacs may develop, potentially damaging the jawbone.
- Jaw Fracture: In severe cases, the weakening of the jawbone from cysts can lead to fractures.
- Dry Socket: A common complication after tooth removal, where the blood clot in the tooth socket dislodges prematurely.
When Should You Remove Wisdom Teeth?
Deciding whether to remove wisdom teeth depends on the patient’s symptoms, the tooth’s position, and the potential risks. While some choose to monitor the situation, dentists often recommend early intervention to avoid future problems.
Why Early Adulthood is Ideal for Wisdom Teeth Removal
Extracting wisdom teeth at a younger age has several advantages:
- The roots are not fully developed, making the procedure simpler.
- Healing is faster compared to later years.
- It prevents future problems like cysts, crowding, or damage to nearby teeth.
Step-by-Step Guide to Wisdom Tooth Removal: What to Expect
If you’ve been told that your impacted wisdom tooth needs to be removed, understanding the process can help ease any concerns. Here’s a detailed breakdown of the procedure, from consultation to recovery.
The Consultation: Your First Step
Your journey starts with a visit to your dentist. During this initial consultation, the dentist will:
- Examine your mouth and take X-rays to evaluate the position of your wisdom teeth.
- Discuss whether the removal is necessary and recommend the best approach for your situation.
- Review anaesthesia options, such as local anaesthetic, sedation, or general anaesthetic, depending on the complexity of the extraction.
Preparing for the Procedure
Before the removal, your dentist will provide instructions to ensure a smooth process. These may include:
- Avoiding food or drink for a set period before the procedure (if general anaesthetic is used).
- Arrange for someone to drive you home after the surgery.
Numbing the Area
On the day of the procedure, the dentist will begin by administering anaesthesia. This ensures you are comfortable throughout the process. The options include:
- Local Anaesthetic: Numbs only to the area around the tooth.
- Sedation Anaesthetic: Keeps you relaxed and drowsy during the procedure.
- General Anaesthetic: Used in complex cases, ensuring you are completely unconscious.
Creating Access: Getting to the Tooth
For partially erupted or fully impacted wisdom teeth, the dentist may:
- Make an incision in the gum tissue to reach the tooth and underlying bone.
- Remove a small section of the bone covering the impacted tooth.
This step ensures that the tooth can be accessed safely for extraction.
Tooth Removal: Extracting the Problem
Depending on the tooth’s position and impaction level, the dentist will:
- Use specific tools to loosen the tooth.
- In some cases, the tooth can be broken into smaller pieces for easier removal.
This step is performed carefully to avoid damaging nearby teeth or surrounding structures.
Cleaning the Area: Ensuring a Healthy Recovery
Once the tooth is extracted, the dentist will:
- Clean the tooth socket to remove debris or infection-causing bacteria.
- Check for any remaining fragments of the tooth or bone.
Closing the Wound: Stitching Things Up
In most cases, stitches will be placed to help the gum tissue heal properly. Some stitches dissolve on their own, while others may require removal during a follow-up appointment.
Recovery Begins: Protecting the Site
A gauze pad is placed at the extraction site to promote blood clot formation, which is crucial for healing and preventing dry sockets, a common post-surgery issue.
What Happens After Surgery? Post-Procedure Care
The removal process doesn’t end at the dentist’s office. Proper aftercare is critical for a smooth recovery:
- Manage Pain and Swelling: Over-the-counter medications and cold compresses can reduce discomfort.
- Soft Foods Only: Stick to a diet of soft foods like soup, mashed potatoes, and yoghurt for the first few days.
- Avoid Straws and Smoking: These can dislodge the blood clot and cause a dry socket.
- Keep It Clean: Follow your dentist’s instructions for gentle rinsing to keep the site free of bacteria.
Common Concerns About Wisdom Tooth Removal
Does It Hurt?
With modern techniques and anaesthetics, the procedure is tolerable and comfortable. Post-operative discomfort is expected, but it can be easily managed with medications and proper care.
How Long is the Recovery?
Most people recover within a week, although swelling and tenderness may last longer.
What Are the Risks?
While complications are rare, potential risks include:
- Dry socket
- Infection
- Nerve damage affecting the lower lip or tongue
- Sinus issues, especially for upper wisdom teeth
The Anatomy of Wisdom Teeth: Development and Function of Third Molars
Wisdom teeth, also known as third molars, are the last set of molars that usually appear in late adolescence or early adulthood. They were evolutionarily significant for our ancestors, who relied on these extra molars to chew coarse, raw foods like nuts, roots, and meat. At that time, jaw sizes were larger, allowing ample space for all 32 teeth, including the four wisdom teeth.
However, as human diets shifted to softer, processed foods, jaw sizes have reduced over generations. This evolutionary change often leaves not enough room for wisdom teeth to grow properly, resulting in impacted wisdom teeth.
Why Are Wisdom Teeth Vestigial and Problematic?
Wisdom teeth are considered vestigial because they no longer serve a necessary function for modern humans. Their redundancy often causes dental issues, including:
- Impaction: Wisdom teeth frequently fail to erupt correctly, becoming partially erupted wisdom teeth or fully impacted wisdom teeth.
- Crowding: The eruption of third molars can press against other teeth, disrupting alignment.
- Dental Problems: Their hard-to-reach position at the back of the mouth makes them prone to tooth decay and gum disease.
Do all wisdom teeth need to be removed? When Removal May Not Be Necessary
Not all wisdom teeth require removal. If the teeth erupt correctly, align with the nearby teeth, and do not cause discomfort or dental issues, they can be left in place. Scenarios where removal may not be necessary include:
- Fully erupted wisdom teeth with proper alignment.
- Adequate enough space in the jaw to accommodate wisdom teeth.
- No evidence of dental problems such as tooth decay or gum infections.
The Importance of Individualised Assessment
A detailed evaluation by a dentist is essential to determine whether wisdom teeth removal is required. Factors such as the angle of eruption, proximity to nerves, and the health of the gum tissue and surrounding teeth play a role in the decision. Routine dental examinations and X-rays are valuable for tracking wisdom teeth development and identifying potential risks.
Alternatives to Wisdom Tooth Removal: Non-Surgical Management Options
In some cases, wisdom tooth removal may not be immediately necessary, and non-surgical approaches can be considered:
- Monitoring: Regular dental visits to keep track of partially erupted wisdom teeth and their impact on the jaw and nearby teeth.
- Antibiotics: Prescribed for treating gum infections or abscesses caused by partially erupted wisdom teeth.
- Pain Management: Over-the-counter pain relievers and oral rinses can alleviate discomfort.
- Improved Oral Hygiene: Special care, such as using a soft-bristled toothbrush and antibacterial mouthwash, can minimise the likelihood of dental caries and gum disease.
These alternatives are most effective when the symptoms are mild, and there are no signs of worsening conditions, such as cysts or significant misalignment of the teeth.
Signs Your Wisdom Teeth Are Coming In
Recognising the early signs of wisdom teeth emergence can help in taking timely action:
- Mild Discomfort: A dull ache or pressure at the back of the mouth.
- Swollen Gums: Redness, puffiness, or tenderness in the gum tissue surrounding the developing wisdom tooth.
- Jaw Stiffness: Difficulty opening the mouth wide or chewing comfortably.
- Unpleasant Taste or Odour: Caused by trapped food or bacteria around partially erupted wisdom teeth.
Partially Erupted Wisdom Teeth vs Fully Impacted Teeth
Partially Erupted Wisdom Teeth: These occur when only a portion of the tooth breaks through the gum line. Common issues include:
- Food Trapping: Difficulty cleaning the area leads to an accumulation of debris, increasing the risk of tooth decay and gum infections.
- Swollen Gums: The partially exposed area can become inflamed and tender.
Fully Impacted Wisdom Teeth: These are completely trapped within the jawbone or gum tissue. They may cause:
- Cysts or Tumours: Fluid-filled sacs that can damage the bone and nearby teeth.
- Jaw Pain: Pressure exerted by the impacted tooth can lead to discomfort or even a jaw fracture.
Comparing these two scenarios highlights the need for timely evaluation and tailored treatment options to address the unique challenges posed by each type.
Wisdom Teeth and Orthodontic Treatment
Developing wisdom teeth can interfere with the results of braces or aligners by causing:
- Crowding: Pressure from erupting wisdom teeth may shift previously aligned teeth.
- Pain and Discomfort: Swelling and soreness may complicate orthodontic adjustments.
Is It Necessary to Remove Wisdom Teeth Before Starting Orthodontic Treatment?
In many cases, dentists recommend removal of wisdom teeth before starting braces or aligners to prevent future problems. This ensures the long-term success of the orthodontic treatment.
Final Thoughts
An impacted wisdom tooth can cause remarkable discomfort and dental problems if left untreated. Whether it’s a partially impacted wisdom tooth, a fully impacted wisdom tooth, or one growing at a wrong angle, timely intervention by a qualified dentist is crucial.
If you’re experiencing pain, swollen gums, or other symptoms, consult a dentist to explore your treatment options. Early action can prevent complications, ensuring a healthier smile in the long run.
For professional advice and personalised care, contact Beyond Infinity Dental today at (02) 8806 3799 to book your consultation.
Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.
References:
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Mayo Clinic. (n.d.). Wisdom teeth. Retrieved from https://www.mayoclinic.org/diseases-conditions/wisdom-teeth/symptoms-causes/syc-20373808#:~:text=Wisdom%20teeth%20are%20the%20last,called%20an%20impacted%20wisdom%20tooth.
Colgate. (n.d.). What age do wisdom teeth come in? Retrieved from https://www.colgate.com/en-gb/oral-health/wisdom-teeth/what-age-do-wisdom-teeth-come-in.
Healthline. (n.d.). Dental anesthesia. Retrieved from https://www.healthline.com/health/dental-and-oral-health/dental-anesthesia.
Orthodontics Australia. (n.d.). Dental crowding: Causes and treatment options. Retrieved from https://orthodonticsaustralia.org.au/dental-crowding-causes-and-treatment-options/#:~:text=Dental%20crowding%20is%20when%20you,your%20teeth%20rotating%20or%20displacing.
