Impacted Tooth

Definition

An impacted tooth is any tooth that is prevented from reaching its normal position in the mouth by tissue, bone, or another tooth.

Description

The teeth that most commonly become impacted are the third molars, also called wisdom teeth. These large teeth are the last to develop, beginning to form when a person is about nine years old, but not breaking through the gum tissue until the late teens or early twenties. By this time, the jaws have stopped growing and may be too small to accommodate these four additional teeth. As the wisdom teeth continue to move, one or more may become impacted, either by running into the teeth next to them or becoming blocked within the jawbone or gum tissue. An impacted tooth can cause further dental problems, including infection of the gums, displacement of other teeth, or decay. At least one wisdom tooth becomes impacted in nine of every ten people.

Causes and symptoms

The movement of an erupting wisdom tooth and any subsequent impaction may produce pain at the back of the jaw. Pain may also be the result of infection, either from decay in any exposed portion of the tooth or from trapped food and plaque in the surrounding gum tissue. Infection typically produces an unpleasant taste when biting down and bad breath. Another source of pain may be pericoronitis, a gum condition in which the crown of the incompletely erupted tooth produces inflammation, redness, and tenderness of the gums. Less common symptoms of an impacted tooth are swollen lymph nodes in the neck, difficulty opening the mouth, and prolonged headache.

Diagnosis

Upon visual examination, the dentist may find signs of infection or swelling in the area where the tooth is present or only partially erupted. Dental x rays are necessary to confirm tooth impaction.

Treatment

Because impacted teeth may cause dental problems with few if any symptoms to indicate damage, dentists commonly recommend the removal of all wisdom teeth, preferably while the patient is still a young adult. A dentist may perform an extraction with forceps and local anesthetic if the tooth is exposed and appears to be easily removable in one piece. However, he or she may refer a difficult extraction to an oral surgeon, a specialist who administers either nitrous oxide-oxygen (commonly called "laughing gas"), an intravenous sedative, or a general anesthetic to alleviate any pain or discomfort during the surgical procedure. Extracting an impacted tooth typically requires cutting through gum tissue to expose the tooth, and may require removing portions of bone to free the tooth. The tooth may have to be removed in pieces to minimize destruction to the surrounding structures. The extraction site may or may not require one or more stitches to help the incision heal.

Prognosis

The prognosis is very good when impacted teeth are removed from young healthy adults without complications. Potential complications include postoperative infection, temporary numbness from nerve irritation, jaw fracture, and jaw joint pain. An additional condition which may develop is called dry socket: when a blood clot does not properly form in the empty tooth socket, or is disturbed by an oral vacuum (such as from drinking through a straw or smoking), the bone beneath the socket is painfully exposed to air and food, and the extraction site heals more slowly.

ORGANIZATIONS

American Association of Oral and Maxillofacial Surgeons. 9700 West Bryn Mawr Ave., Rosemont, IL 60018-5701.(847) 678-6200. <http://www.aaoms.org>.

Bethany Thivierge

KEY TERMS

Dry socket—A painful condition following tooth extraction in which a blood clot does not properly fill the empty socket, leaving the bone underneath exposed to air and food.

Eruption—The process of a tooth breaking through the gum tissue to grow into place in the mouth.

Extraction—The removal of a tooth from its socket in the bone.

Pericoronitis—A gum condition in which irritation and inflammation are produced by the crown of an incompletely erupted tooth.

Wisdom tooth—One of the four last teeth on the top and bottom rows of teeth. Also called a third molar.