Definition

Impacted teeth refer to teeth that remain trapped in the gums, often due to improper alignment as they attempt to emerge. This condition commonly affects wisdom molar teeth in adults, particularly when the back molars grow at an angle or fail to align with the other teeth.

Causes

Impacted teeth can develop without causing noticeable pain or discomfort, but certain factors contribute to their occurrence:

• Consuming soft foods may hinder the growth and development of the jaw. In contrast, chewing harder foods activates the muscles in the mouth, stimulating optimal jaw development.
• Teeth may grow crooked.
• The teeth have grown in an irregular position, thus obstructing the teeth from emerging properly.
• A small jaw may not have enough room for teeth to grow, especially if the teeth are large and the space is narrow. This lack of space can result in crooked teeth or misalignment, leading to inflamed, swollen, or infected gums, often accompanied by intense pain.
• Genetic predisposition may cause the last molars to grow improperly.

Risk Factor

Factors that increase the likelihood of impacted molars include:

• Insufficient space for teeth to grow
• The presence of cysts

Symptoms

Impacted teeth do not always produce symptoms, but when they do, it is often because food particles become trapped around the partially erupted teeth. This can lead to bacterial growth, causing gum pain and swelling. The difficult-to-reach position of impacted teeth may also complicate oral hygiene practices.

Additional symptoms may include:

• Partial eruption of the tooth, visible on the gum surface
• Jaw pain
• Persistent headaches
• Red, swollen gums, possibly with pus around the affected tooth
• Soreness in the gums and back of the jaw, especially when touched or brushed
• Throbbing pain around the impacted tooth
• Difficulty opening the mouth
• Swollen lymph nodes in the neck
• Pain when biting, particularly near the impacted area

Diagnosis

To diagnose impacted molars, a dentist will inquire about the patient's symptoms and medical history, followed by a physical examination of the oral cavity. During the examination, the dentist will also assess how the patient maintains oral and dental hygiene.

Key diagnostic steps include checking for any problems related to the wisdom teeths. While examining the oral cavity, the dentist may ask questions about the onset, frequency, and location of the pain.

They may also ask you about how you maintain your oral and dental hygiene.

Other diagnostic tests may also be performed, including:

• Panoramic dental X-rays, to visualize unerupted teeth and detect any damage to the teeth or gums.
• CT scans, to provide a detailed view of the teeth, gums, nerves, and surrounding bones.

Management

To determine if molars are impacted, a dentist may use dental X-rays to assess whether your molars are problematic. In some cases, the dentist may suggest removing the impacted tooth even before symptoms arise to avoid a more complicated or painful extraction. It is easier to extract impacted molars when the tooth roots are not fully developed.

The removal of impacted molars is sometimes referred to as "minor surgery." This procedure is similar to regular tooth extraction but is typically required when the molars are partially embedded in the bone.

Molar extraction may be necessary in the following cases:

• Infection or gum disease affecting the teeth
• Tooth decay in multiple teeth
• Cysts or tumors caused by teeth
• Molars growing in a way that interferes with other teeth

Before performing the extraction, the dentist will numb the affected gums with an anesthetic injection to ensure you do not feel pain during the procedure. After administering the anesthesia, the dentist will cut the gum and remove any bone obstructing the molar. The gum is then closed with stitches, and the extraction site is covered with gauze to control bleeding.

Following the procedure, some bleeding may occur around the extraction site. It is recommended not to spit excessively to allow blood clots to form, aiding in healing. Once the anesthesia wears off, the dentist may prescribe painkillers such as paracetamol or ibuprofen, and applying ice to the jaw can help reduce discomfort.

Tooth extraction is typically an outpatient procedure, allowing you to return home the same day. However, if the impaction is particularly complicated, an overnight stay in the hospital may be required.

Complications

If left untreated, impacted teeth can result in several complications, such as:

• Periodontitis
• Abscesses in the teeth or gums
• Severe toothache
• Malocclusion
• Plaque buildup
• Nerve damage around the affected teeth

Prevention

While impacted teeth cannot be entirely prevented, regular dental visits—at least every six months—are recommended. This allows your dentist to monitor the growth of your molar teeth and address potential problems early.

If you notice a hard white lump at the back of your gums, particularly if it is accompanied by severe pain, it is important to see a dentist immediately.

Maintaining good dental hygiene is essential as well. Brush your teeth twice a day, including reaching the molars to prevent cavities from developing.

When to See a Doctor?

You should consult a dentist if your teeth are not growing properly, especially if you experience pain in the gums or other related symptoms.

If you frequently experience jaw pain that spreads to the face, head, ears, or neck despite normal nerve examination results, a dental check-up is also recommended.

Impacted teeth often require surgical removal through oral surgery or wisdom tooth extraction, particularly if the tooth remains buried in the gums. If you are considering this procedure, it is essential to consult your dentist.

While impacted teeth may not always cause discomfort, regular dental check-ups every six months are still advised to monitor the growth of wisdom teeth and ensure overall dental and oral health.

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