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Impacted Tooth

Overview

An impacted tooth is one that remains trapped within the gums or jawbone (instead of erupting normally). While impaction usually affects wisdom teeth and canines (cuspids), other teeth may also be affected. Impaction is classified into three main types:

  • Soft-tissue impaction: The tooth erupts through the jawbone but does not break through the gums.
  • Partial bony impaction: Only a part of the tooth erupts through the jawbone; the tooth does not break through the gums.
  • Full bony impaction: The tooth remains completely trapped within the jawbone. 

The main causes of an impacted tooth are as follows: 

  • Twisted/crooked teeth that erupt sideways.
  • Overcrowding: this prevents the teeth from erupting normally.
  • Insufficient space in the jawbone: this may happen when the jaw is small or in the presence of extra (supernumerary) teeth.

The symptoms of impacted teeth may come and go or be persistent. These include the following:

  • Red, swollen, or bleeding gums
  • Pain and stiffness in the jaw (difficulty in opening the mouth)
  • Halitosis or dysgeusia
  • Headaches
  • Swollen lymph nodes in the neck

In some cases, impacted teeth can lead to one or more of the following oral health complications:

  • Tooth decay (cavity formation)
  • Tooth abscesses
  • Gum disease
  • Formation of cysts (fluid-filled sacs) under the gums
  • Pericoronitis
  • Malocclusion (bad bite)
  • Mandibular nerve damage (this is a large nerve in the lower jaw that controls important functions such as mastication and swallowing)

The diagnosis of impacted tooth usually involves the following:

  • Oral examination: Examination of the oral cavity for signs of inflammation, pericoronitis, swelling, or pus formation.
  • Dental X-ray: X-ray imaging to determine the location of the impacted teeth. Sometimes, cone beam CT is also used for determining the actual position of the impacted teeth and its proximity to vital nerves and vessels.

Patients with impacted teeth may not always experience symptoms; moreover, treatment is not always needed. However, if patients notice sudden and unexplained pain in the teeth or gums, they are advised to schedule a dental consultation. The severity and cause of the condition may reflect whether the symptoms will get better or worse; however, without proper care, the teeth will not heal and pain may persist.

Based on the symptoms, presentation, and severity of the condition, dentists decide whether treatment is required or not, and if it is, recommend the following treatments:

  • The “wait and see” approach: If an impacted tooth is detected but no symptoms are present, dentists may recommend that the affected region be monitored without further action (unless required), i.e., the tooth is frequently examined during routine dental checkups or cleaning sessions to ensure that it is healthy and does not cause any complications.
  • Impacted tooth removal: In cases where the impacted tooth causes oral health issues, such as pain, swelling, or infection, tooth extraction is recommended. This is an outpatient procedure performed under local anaesthesia or sedation.
  • Eruption aids: When a tooth does not erupt on its own, an eruption aid is applied to accelerate eruption. This treatment quite frequently performed among young patients (children and teenagers) with impacted canine teeth.
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