Wisdom teeth, also known as third molars, are the final set of adult teeth to emerge, typically between ages 17 and 25. Located at the back of the mouth, an “impacted” wisdom tooth does not fully erupt or grows in an improper position, often due to insufficient jaw space. This is a common dental issue, affecting approximately 90% of people.
Understanding Impacted Wisdom Teeth
Impactions can be classified based on the tooth’s angle and position. Mesial impaction is the most common type, where the tooth angles forward toward the front of the mouth. In contrast, distal impaction, the rarest type, involves the tooth angling toward the back of the mouth.
A horizontal impaction means the wisdom tooth lies completely on its side, often pressing into the adjacent tooth. Vertical impaction occurs when the tooth is in the correct upright position for eruption but remains trapped beneath the gums or bone. The primary reasons for impaction include a lack of sufficient space in the jaw, genetic factors influencing jaw and tooth size, and the tooth developing at an improper angle.
Common signs indicating an impacted wisdom tooth can include pain or swelling in the jaw or face, particularly near the back of the mouth. Redness, swelling, or bleeding of the gums around the affected area are also frequent symptoms. Individuals might also experience bad breath, an unpleasant taste in the mouth, or difficulty opening their mouth fully.
Potential Complications of Untreated Impacted Wisdom Teeth
Leaving an impacted wisdom tooth untreated can lead to various oral health problems. One common issue is pericoronitis, an inflammation of the gum tissue surrounding a partially erupted wisdom tooth. This condition causes pain, swelling, pus discharge, and difficulty swallowing, often recurring. Trapped food and bacteria around the tooth contribute to this infection.
Impacted wisdom teeth can also cause damage to neighboring teeth. The pressure from an impacted tooth pushing against the adjacent second molar can lead to tooth decay or cavities on that molar. This pressure may also contribute to root resorption, which is the gradual damage to the root structure of the adjacent tooth. Furthermore, the difficulty in cleaning around partially erupted wisdom teeth increases their susceptibility to decay and gum disease themselves.
Less commonly, fluid-filled sacs called cysts can form around an impacted wisdom tooth within the jawbone. These cysts can expand over time, potentially causing damage to the jawbone, nerves, and nearby teeth. In rare instances, benign tumors can develop in association with these cysts, which may necessitate more extensive surgical intervention to remove affected tissue and bone. The constant pressure from an impacted tooth can also weaken the jawbone in the area, potentially increasing the risk of fracture.
Factors Guiding Treatment Decisions
The decision to remove an impacted wisdom tooth or monitor it depends on several factors, as there is no fixed timeframe for how long it can be left. Extraction is advised when the impacted tooth causes persistent pain or recurrent infections, like pericoronitis. Damage to adjacent teeth, like decay or root resorption, also indicates removal. Cysts or tumors around the tooth are clear indicators for extraction. If an impacted wisdom tooth interferes with orthodontic treatment or causes crowding, removal may be recommended.
Conversely, observation may be an option for asymptomatic impacted wisdom teeth not causing problems. This applies when the tooth is fully encased in bone and not exposed to the oral cavity, reducing infection or decay risk. Dentists may also consider observation if surgical removal risks, especially in older patients, outweigh benefits. The procedure can be more complex with age as roots are fully formed and jawbones are denser.
Even with observation, regular dental check-ups and X-rays are important. This monitoring tracks the tooth’s position and identifies changes or complications early. The duration an impacted wisdom tooth can remain depends on its stability and whether it stays symptom-free and without pathology. If new symptoms or complications arise, intervention becomes necessary.