Impacted Teeth/Wisdom Teeth

What is an impacted tooth?

All teeth are formed deep within the jaw bones. As the root develops most teeth travel toward their future place in the dental arch. This movement is called eruption. If a tooth travels in the wrong direction, or is blocked by another tooth or dense bone, it is said to be impacted.

What harm do impacted teeth do?

Since it is not normal for a tooth to remain beneath the surface after the age of 18-21, it is easy to understand why difficulties develop.

Whenever saliva can reach the crown - and this may happen even though the impacted tooth cannot be seen in the mouth - decay may occur just as in ordinary teeth. There is no way to fill such cavities and a severe toothache finally results.

Likewise, the germs in the saliva may cause periocoronitis, an infection around the crown of the tooth. This infection may spread to the cheek, throat, or neck, with severe pain, stiffness of the jaws and general bodily illness.

As impacted teeth press against other good teeth, they injure their roots or push these teeth out of position.

Are there any complications?

Any operation carries some risk. This is reduced by pre-operative appraisal of your physical condition and how you may respond on that day to the operation.

The wound remaining after an impacted tooth is removed is quite large and healing may be delayed because the body is unable to build normal tissue as quickly as with a small wound. Due to the size of the wound the clot formed, which is essential for healing, may break down. This leaves a large, empty, painful socket of exposed bone which may have to be packed several times until the pain is comfortable. This will eventually close over.

Lower impacted teeth often rest on the main nerve to the lower jaw. sometimes, in spite of all precautions, this nerve is bruised. Most often, the result will be numbness of the lower lip or tongue on that side. This effect often does not last more than a few weeks, however, it could last months or even be permanent.

Upper impacted third molars lie against the wall of the maxillary sinus or antrum. The surgeon will use great care to see that no unnecessary injury occurs to this structure, but occasionally the thin wall of bone cracks slightly and blood seeps into the sinus. In such an event the patient may notice a trace of blood in the nose. In a few days this heals normally, usually without complications. It is also possible to open a hole (fistula) from the mouth to the sinus. If this occurs antibiotic therapy and further surgical procedures may be necessary. Smoking makes this complication worse.

It may be necessary to leave a small piece of root in the jaw, when removal would cause extensive damage to surrounding structures.

Stretching of the corners of the mouth with resultant cracking and bruising may occur.

Because the bone supporting the teeth is thin and we try to preserve bone, it is possible for small pieces of bone to come through the gingiva (gum tissue) for months after surgery. If these are painful or become infected we will treat them. If not, they will resolve.

The temporomandibular joint is the hinge which allows us to open and close our mouth. during any prolonged dental procedures it is possible to fatigue or even bruise the muscles which support this joint. If this happens prolonged trismus (stiffness) or clicking in the joint may result. Usually, with time, these symptoms will go away. However, it is possible that joint damage may occur, particularly in patients that have existing joint problems prior to surgery.

All patients about to have impacted teeth removed should understand that adjacent teeth may have been weakened or otherwise injured by the presence of the impacted tooth. This injury may not become apparent until the impacted tooth is removed. Adjacent teeth must therefore be considered on probation for three to six months after the impacted tooth has been taken out.

Sometimes a large cyst forms around the crown of an impacted tooth with the destruction of much bone and damage to other teeth in the region.

Why should impacted teeth be removed when they do not cause trouble?

While it is true that not all impacted teeth cause the complication that have been describe, no one can tell by an x-ray picture which ones are going to give difficulty or when. Trouble usually comes unexpectedly and at inconvenient times. Older individuals don't tolerate the operation for removal as well as younger people, and the operation is more difficult with advancing age. For these reasons, all adults with impacted teeth are advised to have them removed.

If a patient with an impacted tooth waits until it causes trouble, he will often have to be treated for the infection or other complication before the operation for removal can be done. This means additional loss of time and expense, as well as some added risk.

What is it like to have an impacted tooth removed?

Many ordinary teeth can be extracted simply by grasping with a forcep and manipulating carefully form the socket. This is, of course, not possible with impacted teeth since they are partially or completely beneath the surface.

The removal of an impacted tooth is an operation in every sense of the word. This is not said to frighten the patient, but to give better understanding about certain features regarding the cost, careful preparations, selection of surgeon, and the need for good after care.

The actual removal of the tooth is done in keeping with surgical principals - sterile instruments, good light, a dry operative field, and gentle handling of the soft tissues and bone. Depending on the difficulty of the procedure, it may last for twenty to sixty minutes. The wound will be closed with stitches (sutures). Printed instructions for home care will be furnished.