The topic of wisdom teeth, or third molar teeth, has been touched upon before on this site but never discussed in more detail. In this post, we would like to address the different causes of impaction, while also dwelling upon how wisdom teeth affect the jaw and how to remove wisdom teeth by surgery. Read on.
Types of Wisdom Tooth Impaction
There are a total of four wisdom teeth that develop in early adulthood, with some people having just one or none at all. As wisdom teeth erupt, their growth might be affected. Hence, there are fully (ingrown wisdom teeth) and partially impacted wisdom teeth.
A fully impacted wisdom tooth is one that is not visible at all because it is covered by the gums. With partial impaction, you can see part of the tooth. On that note, you can have an impacted upper wisdom tooth and an impacted lower wisdom tooth.
Now, let’s talk about the main types of impaction based on that.
Bony Impaction
Lower wisdom teeth are more affected by bony impaction than the upper wisdom teeth. Four different types can be distinguished:
- Angular or mesial impacted wisdom tooth: this is when the tooth partially erupted because the angle it is growing at faces the front of the mouth; food can easily get stuck in there
- Horizontal impaction: with this one, the wisdom tooth grows entirely horizontally and food can get stuck between the soft tissue (gum tissue) and the white structures, causing dental problems; horizontal impacted wisdom tooth removal may require general anaesthesia
- Vertical impaction: this is when the wisdom tooth grows vertically, pretty much the way it should; however, it doesn’t have sufficient space to erupt properly in the oral cavity
- Distal impaction: this is when the angle of growth faces the back of the mouth
Soft Tissue Impaction
As the name implies, with soft tissue impaction, it is the gums, or the soft tissue, that prevent the wisdom tooth from developing normally, and not the jaw bone. In order to take it out, oral and maxillofacial surgeons need to open up the gums.
Impacted wisdom teeth may not need to be removed at all times. A decision should be made by a specialist and it should be based on physical examination, X-rays, any oral issues present, and patient symptoms. Some people prefer to have their wisdom teeth removed as a preventative measure. But this isn't always necessary.
Causes of Impacted Wisdom Tooth
Let's review the main causes of impacted wisdom teeth.
Genetics
One of the biggest culprits of wisdom tooth impaction is the size of the jaw. Nowadays, our jaws are much smaller than what our ancestors were born with. They needed that extra pair of teeth for survival. But we don’t. We cook most of our food and we use cutlery to break it into smaller pieces.
This has changed the size of our jaws, making it difficult to accommodate so many teeth. When there is not enough room, your third molars at the back of the mouth can become impacted.
Lack of space
The lack of space is not always down to genetics, although it is the main culprit. Teeth come in many sizes. Some people just happen to have mouths that are too small to house all the teeth. Being the last teeth to erupt, the third molars just don’t have room to grow and could damage adjacent teeth.
Something is blocking the wisdom teeth
And lastly, sometimes the developing wisdom tooth has enough space to grow but it nevertheless erupts at a wrong angle because the surrounding jawbone or neighbouring teeth cause a blockage.
Symptoms of Impacted Wisdom Tooth
- Swollen gums
- Bone loss
- Earache
- Jaw pain
- Bad breath
- Difficulty opening the mouth wide
- Difficulty swallowing
- Unpleasant taste in your mouth
Complications of Impacted Wisdom Tooth
The two most common complications of having an impacted wisdom tooth are:
- Gum infections. When bacteria build up around the gums, you can develop a gum infection called pericoronitis.
- Tooth decay. It’s not uncommon for people with impacted wisdom teeth to experience tooth decay in the area. Since the tooth doesn’t grow normally, food gets trapped between the culprit and the gums. This feeds decay-causing bacteria. If left untreated, it could trigger gum disease.
Thus, it is important to have your wisdom teeth removed when they are the root of so much suffering.
How are Impacted Wisdom Teeth Diagnosed?
The first step is to have your teeth examined by a dental professional. They will check out the gums for swelling and redness. You will be asked questions about your symptoms. X-rays are a great diagnostic tool that can help identify impaction and inspect the condition of the underlying bone.
Impacted Wisdom Tooth Treatment Options
If you have an impacted wisdom tooth that is causing a slew of issues, the only effective treatment is tooth extraction, or impacted wisdom tooth surgery. Oftentimes it is performed by an oral surgeon. The site is numbed with a local anaesthetic.
If the patient is too uncomfortable and nervous before the impacted tooth removal, they may be put to sleep. That being said, sedation and general anaesthesia carry risks, so they are rarely employed in this scenario.
The oral surgeon needs to make an incision into the gums to get better access to the third molars in question. They may have to break the tooth into pieces, taking them out one by one. Once the mission is complete, the opening is closed with a suture. A gauze helps to prevent bleeding.
Impacted tooth surgery is all the same regardless of the type of impaction you are dealing with. That said, horizontal wisdom tooth extraction may require some jaw bone removal.
Home Remedies for Impacted Wisdom Tooth Pain
If you have discomfort, swelling or pain around your impacted wisdom tooth, you could try and combat these with some home remedies. One thing that can relieve the pain is saltwater rinse. Simply place a few teaspoons of salt in some water and swirl it around your mouth. Do not swallow it. After a few minutes, spit it out. You can also try mouthwash.
Another option is to apply an ice pack to the jaw for 5-10 minutes. Do not let ice come in direct contact with your skin. Always wrap it around a clean towel before you place it over the face.
If everything else fails, your best bet is pain relief medication. Don’t forget that these remedies provide short-term relief. At the end of the day, if you want to get rid of the pain and discomfort once and for all, you should have your offending wisdom tooth removed.
What to Do Before Wisdom Tooth Surgery
Here are some dos and don'ts before you remove impacted wisdom teeth:
- Do not smoke at least 12-24 hours before impacted wisdom teeth removal
- Tell your dentist about any supplements or recreational drugs you are taking
- Mention prescribed and over-the-counter medications
- If you are going to be put to sleep, you should avoid drinking and eating after midnight the day before your surgery
- Have some meals prepped in advance so you have something to eat as you get back home
What to Do After Impacted Wisdom Tooth Treatment
Once your impacted teeth are removed, you need to take extra care of the treatment area. Here is what you should and shouldn't do.
- Follow a soft diet (blend your foods for as long as you need to)
- Apply an ice pack or cold compresses to the jaw for a few minutes on the first day post-op
- Do not spit, drink through a straw or rinse your mouth on day 1 of your oral and maxillofacial surgery (a blood clot will form in the tooth socket to keep it from bleeding and you don’t want to force it out of the gums)
- Do not drink alcohol or smoke for at least 72 hours post-op - this will inhibit wound healing
- Avoid hot drinks as they could cause the blood clot to come loose
- Practice good oral hygiene during and after your recovery
- If your pain gets worse after two to three days, contact your dentist immediately
Preventing Impacted Wisdom Teeth
Unfortunately, there are no known methods of preventing vertical or horizontal impacted wisdom tooth from happening. What you can do is keep up with your monthly appointments with the dentist, undergo regular cleanings, and have your wisdom teeth monitored with occasional X-rays (if necessary).
Ensuring your teeth are free from decay and gum disease is vital regardless of whether you have impacted wisdom teeth or not. You are not safe from problems with other teeth.