Impacted Teeth

An impacted tooth is a tooth that has not erupted (emerged fully in to the oral cavity). The impacted tooth can be totally surrounded by bone (a fully bony impaction), can be partially surrounded by bone (partial bony impaction), or be only surrounded by soft gum tissue (a soft tissue impaction).

Traditionally, the term impacted teeth usually refers to the wisdom teeth (the third molars, the teeth furthest back in the mouth). Both top and bottom wisdom teeth can be impacted. Many times if they appear to be causing no problems for the patient, they are left alone. If they are positioned in a fashion that they appear to be pushing up against the roots of the second molars (the next teeth forward) or if they are causing periodontal (gum) problems, they will need to be removed. While most general dentists are comfortable removing teeth, patients with impacted teeth are usually referred to a specialist (oral surgeon) for their removal.

Wisdom teeth are not the only teeth that can be impacted. Every permanent tooth can be impacted. If the impaction does not appear to affect adjacent teeth, no treatment may be required. If it affects other teeth, it may need to be removed.

It is not uncommon for “eye” teeth (canine teeth) to be impacted. This is usually discovered early in life, and recommendations for orthodontic treatment (braces) will be made accordingly. Most often, these impacted teeth are not removed, but rather surgically exposed and orthodontically moved over several months into their proper position. Early detection and diagnostic is important to the successful treatment of this situation.

Normally, there is bone separating tooth roots from adjacent teeth. If the impacted tooth, because of its angle and position, gets closer to the roots of the next tooth, the bone between the two teeth will dissolve. If this happens, it is possible that a deep, pathologic periodontal pocket may form. Further deterioration of the periodontal tissues surrounding the tooth in normal position could compromise its health and lead to additional dental treatment. To prevent this from happening, the impacted tooth is removed. If the impaction is deep and difficult to approach, and if there are four wisdom teeth to be removed at the same time, the dentist may elect to perform the procedure in a hospital or surgical center setting.

The more bone that surrounds the impacted tooth, the more difficult is it to remove. The position of the tooth near other teeth or nerves and the manner in which the impacted tooth is angled in the bone also affects the difficulty level of the extraction. The younger the patient is, the better and easier the healing appears to be. If there is a great deal of bone that is removed, the dentist may choose to place some “bone fill” material in the place the tooth used to be (the socket) to promote better healing of the bone.