An impacted tooth is a dental condition where a tooth fails to erupt fully into its proper position, remaining trapped partially or completely within the gum tissue or jawbone. This common occurrence can affect various teeth, with some more frequently involved due to their developmental timing and available space. An impacted tooth cannot emerge as it should, potentially leading to complications that require professional dental intervention.
What is an Impacted Tooth
An impacted tooth occurs when it is unable to grow into its correct position, blocked by another tooth, dense bone, or excessive soft tissue. This often happens due to insufficient space in the jawbone to accommodate the emerging tooth. The most frequently impacted teeth are wisdom teeth, which are the last teeth to erupt, typically between ages 17 and 25. Canines, particularly upper ones, and sometimes premolars, can also become impacted.
Impacted teeth are classified by their position and the surrounding tissue. These include soft tissue impaction (tooth through jawbone but not gum line), partial bony impaction (partially through bone, not gums), and full bony impaction (completely encased in jawbone). Impactions are also categorized by the angle of the tooth:
Mesioangular (angled toward the front of the mouth)
Distoangular (angled toward the back)
Horizontal (lying sideways)
Vertical (straight up but trapped)
Recognizing an Impacted Tooth
An impacted tooth might not always cause noticeable symptoms, especially if fully trapped beneath the gums. However, when symptoms do occur, they can include pain or tenderness in the gums or jawbone, particularly when biting down. Swelling and redness of the gums around the emerging tooth are also common indicators.
Other signs can involve difficulty opening the mouth fully, jaw stiffness, or a persistent bad taste in the mouth, which may indicate an infection. Lingering or recurring headaches or jaw aches can also be linked to pressure from an impacted tooth. Dentists diagnose an impacted tooth through a comprehensive oral examination and dental imaging, such as panoramic X-rays or 3D scans, which reveal the tooth’s position and any surrounding issues.
Treatment Approaches
When an impacted tooth is not causing pain or affecting adjacent teeth, dentists may suggest observation and regular monitoring. This approach is often considered for asymptomatic cases, particularly in older adults. Regular dental check-ups and imaging help ensure no complications develop over time.
Surgical extraction is the most common treatment for impacted teeth, particularly wisdom teeth. This outpatient procedure typically involves local anesthesia, though sedation or general anesthesia may be used for complex cases. The oral surgeon makes an incision in the gum to expose the tooth, sometimes removing bone blocking access. The tooth may be divided into smaller sections for easier removal, and the wound is usually closed with sutures.
For impacted canines, exposure and orthodontic alignment is a frequently used method. This involves surgically uncovering the impacted tooth by removing gum tissue and bone. After exposure, a small orthodontic bracket or chain is attached to the tooth. This attachment is then used with braces to apply gentle, continuous pressure, gradually guiding the tooth into its correct position within the dental arch over several months.
Coronectomy is an alternative procedure, typically considered for impacted lower wisdom teeth positioned very close to the inferior alveolar nerve. In this technique, only the crown of the impacted tooth is removed, while the roots are intentionally left in the jawbone. This approach aims to reduce the risk of nerve damage, which can lead to temporary or permanent numbness in the lip, chin, or tongue, a rare but possible complication of full extraction.
Recovery and Aftercare
Following an impacted tooth procedure, careful aftercare helps ensure proper healing. Patients can expect some pain, swelling, and possibly minor bleeding in the initial days. Pain management typically involves prescribed medication or over-the-counter pain relievers like ibuprofen or acetaminophen. Applying an ice pack to the outside of the cheek in 20-minute intervals during the first 48 to 72 hours can help reduce swelling.
A soft food diet is recommended for several days to avoid irritating the surgical site, with examples including applesauce, mashed potatoes, yogurt, and soup. Maintaining good oral hygiene is important, but gentle rinsing with warm salt water should replace vigorous brushing directly over the extraction site. Patients should avoid using straws, spitting forcefully, or smoking for at least a week, as suction can dislodge the blood clot that forms in the socket, potentially leading to a painful condition called dry socket. Follow-up appointments are scheduled to monitor healing and remove any non-dissolvable stitches.