Impacted Wisdom Teeth

WISDOM TEETH

Most adults have 32 teeth, including four wisdom teeth, two on the top, and two on the bottom.

The wisdom teeth or third molars are the last adult teeth to come (erupt), right at the back of the mouth. They usually appear when you are between 17 and 25, although sometimes they appear many years later. People often have jaws that are too small for all 32 teeth to fit – 28 are often the most we have room for.

An impacted tooth is a tooth that fails to fully emerge (pass) or emerges only partially through the gums as the jaw bone or neighbouring teeth block the teeth from erupting and is entrapped within the jawbone.

Impacted wisdom teeth are third molars at the back of the mouth which do not fully erupt into the mouth as they don’t have enough room to develop normally and properly as the area are too overcrowded for third molars to emerge. For example, the jaw may be too small to fit the wisdom teeth.

If the wisdom teeth do not have an open connection to the mouth, it can lead to potential problems such as they can be partially or completely entrapped within the gums or jaw bone or only partially break through, or erupt, through the gum.  When they are misaligned as they can position themselves horizontally, be angled toward or away from the second molars and may also become twisted, tilted, or displaced as they try to emerge, resulting in impacted teeth.

Poor alignment or partial eruption can crowd or damage adjacent teeth, the jawbone or nerves. As wisdom teeth begin to erupt through the surface of the gums, pain can develop with the onset of inflammation as it allows an opening for bacteria to enter around the tooth which can result in infection or damage to the other adjacent teeth, jaw stiffness and other dental problems. This pain will gradually increase with time as the wisdom teeth continue to grow in misaligned or sideways, pressing on nerves and bone, and crowding surrounding teeth.

Wisdom teeth that lean toward the second molars or are partially erupted make those teeth more vulnerable to decay and gum disease by entrapping food, plaque and debris in the soft tissue around it as they are hard to clean and awkward positioning makes brushing and flossing difficult.

However, it is also believed an impacted tooth pushes on the next tooth, which pushes the next tooth, eventually causing a misalignment of the bite.

As individuals age, the effects of impacted wisdom teeth can be more consequential. Periodontal(gum) defects tend to get worse in the presence of impacted third molars as you age. So too does the prevalence of caries (tooth decay).

Impacted wisdom teeth that cause pain or other dental complications, they may need to be removed.  As their roots continue to elongate, and the longer wisdom teeth pain persists, the more likely it is that an infection will result from bacteria entering open tissue. Also the longer they remain impacted, the more likely they are to cause problems for your oral and general health as Oral infections have been shown to affect your overall health as well.

Impacted wisdom teeth can also put you at risk for cysts, which are pockets of fluid that form around the tooth. Rarely, tumours can form around the tooth. Cysts and tumours can result in permanent damage to your jaw bone as well as your other teeth.

In some cases, impacted wisdom teeth are often painless and may cause no apparent or immediate trouble and emerge without any problems and line up with the other teeth behind the second molars so they may never require any treatment.

Dentists are more likely to recommend removing wisdom teeth if problems arise or may recommend wisdom teeth be removed that don’t cause any symptoms to prevent future problems before they become a problem for oral health.

How do I know if I have impacted wisdom teeth?

Wisdom teeth pain is not always a sign that your wisdom teeth are impacted, but the longer you wait to see a dental professional, the more likely it is that your wisdom teeth can become impacted.

It is especially important to have routine dental check-ups between the ages of 17 – 25, when third molars are typically coming in, because impacted wisdom teeth may cause no pain.

See your dentist and ask about the positioning of your wisdom teeth.  He or she may take an X-ray periodically to evaluate the presence, alignment of your wisdom teeth and to monitor your teeth for decay, gum disease or other complications.

If you experience symptoms in the area behind your last molar or if there is an unemerged tooth (or partially emerged tooth) and there is pain in the gums or other symptoms that may be associated with an impacted wisdom tooth.

Your dentist will look for swollen tissue over the area where a tooth has not emerged, or has only partially emerged. The impacted tooth may be pressing on nearby teeth. The gums around the area may show signs of infection such as redness, drainage, and tenderness. As gums swell over impacted wisdom teeth and then drain and tighten, it may feel like the tooth came in and then went back down again.

Your dentist may recommend that your wisdom teeth be removed even before problems develop. This is done to avoid a more painful or more complicated extraction that might have to be done a few years later.

Dentists in India are regularly counselling patients on the complications that impacted wisdom teeth may have. Depending on the situation they advise extraction or a symptomatic relief through medicines.

Symptoms

Impacted wisdom teeth don’t always cause symptoms. However, when an impacted wisdom tooth becomes infected, damages other teeth or causes other dental problems. If you look into a mirror, you may even notice that your wisdom teeth have begun to poke through your gums. You may experience some of these signs or symptoms:

• The area might be red, en-flamed and tender to touch
• Pain at the back of your mouth, around  your molars
• Prolonged headache or jaw pain
• Swelling of the gums around the tooth
• Bad breath
• Pain and discomfort when chewing food
• An unpleasant taste in your mouth when biting down on or near the area
• Difficulty opening your mouth(occasionally)

Complications

Impacted wisdom teeth can cause several problems in the mouth:

• Plaque trapped between teeth and gums
• Chronic discomfort in the mouth
• Damage to other teeth – If the wisdom tooth pushes against the second molar, it may damage the second molar or increase the risk of infection in that area. This pressure can also cause problems with crowding (misalignment or malocclusion) of the other teeth or require orthodontic treatment to straighten other teeth.
• Decay- Partially impacted wisdom teeth appear to be at higher risk of tooth decay (caries) than other teeth. This probably occurs because wisdom teeth are harder to clean and because food and bacteria get easily trapped between the gum and a partially erupted tooth.
• Gum problems or gum disease- The difficulty cleaning impacted, partially erupted wisdom teeth increases the risk of developing a painful, inflammatory gum condition in that area. This is the most common consequence of impacted wisdom teeth and the most frequent consideration for their removal. Their presence can adversely affect the periodontal tissues of the adjacent second molars by disrupting the periodontal tissue attachment.  They can also cause root resorption (eating away) and damage to adjacent tooth roots.
• Abscess of the tooth or gums
• Cysts or tumours- Impacted, submerged, third molar teeth can become cystic (surrounded by a closed sac or membrane) and cause loss of the surrounding jawbone.

Treatments

Pain relievers and warm salt water rinses (one-half teaspoon of salt in one cup of water) may help if the impacted tooth causes discomfort.

Impacted wisdom teeth that are causing pain or other dental problems are usually surgically removed (extracted). Removal of an impacted wisdom tooth is usually required for:

• Infection or gum disease (periodontal disease) involving the wisdom teeth
• Tooth decay in partially erupted wisdom teeth
• Cysts or tumours involving the wisdom teeth
• Wisdom teeth that are causing damage to neighbouring teeth

After extraction your dentist will give you important instructions for caring for your wound and you can go home the same day.

It is often preferable to have wisdom teeth removed before age 30 due to the flexibility of bone, which will allow an easier removal and better healing. As a person ages, the bone becomes more rigid and complications can develop.

Dental clinics in Delhi are conducting wisdom teeth extractions as part of their regular treatments.

Dentist in Delhi especially the oral surgeons are treating impacted/ stuck wisdom teeth routinely.

Posted By – Dr. Shriya