Impacted Wisdom Teeth: Symptoms, Diagnosis & Treatment

What is an Impacted Wisdom Tooth?

Wisdom teeth are the last teeth to develop. Also known as the third set of molars, wisdom teeth grow at the back of the mouth. 

Not everyone gets wisdom teeth. But they tend to develop during early adulthood between the ages of 17 and 25. Most people grow four wisdom teeth, two on the top and two on the bottom. Some people are congenitally missing one or more wisdom teeth. 

Wisdom teeth may not cause problems when they grow in alignment with the teeth. But wisdom teeth can become trapped in the jawbone or gums when they don’t have enough room to grow or emerge properly. This is called an impacted wisdom tooth.

Types of Impacted Wisdom Teeth

Dentists use different terms to describe impacted wisdom teeth, such as:

• Fully impacted wisdom teeth — teeth are trapped entirely under the gums and are not visible.
• Partially impacted wisdom teeth — parts of teeth have erupted through the gums and are visible. 
• Soft tissue impaction— teeth have emerged from the jawbone, but not the gums.
• Hard tissue impaction — teeth have not emerged from the jaw or gums. 

A dentist may also describe the type of impacted wisdom tooth you have based on its positioning:

• Mesial impaction is when a wisdom tooth points toward the front of the mouth. This is the most common type.
• Distal impaction is when a wisdom tooth points toward the back of the mouth. This is the rarest type.
• Vertical impaction is when a wisdom tooth is in the correct position to erupt but remains trapped under the gums.
• Horizontal impaction is when a wisdom tooth is lying beneath the gums at a right angle. This puts pressure on adjacent or nearby teeth, causing pain.

What Causes Impacted Wisdom Teeth?

Impacted wisdom teeth occur for several reasons, or a combination of factors.

Common causes of an impacted wisdom tooth include:

• There’s not enough space in the mouth or within the jawbone
• Teeth grow at the wrong angle
• Teeth don’t form correctly or emerge from the jawbone or gums properly

Symptoms of Impacted Wisdom Teeth

In some cases, an impacted wisdom tooth doesn’t cause any symptoms. But people with impacted wisdom teeth can experience symptoms that develop gradually or suddenly.

Impacted wisdom teeth can cause:

• Swelling and pain in the face on one side
• Jaw pain and swelling
• Swollen, red, sensitive, or bleeding gums
• An unpleasant taste in the mouth
• Trouble opening the mouth wide 
• Bad breath
• Radiating pain that causes headaches
• Pressure in the back of your mouth 

When to See Your Dentist

Talk to a dentist if you experience or notice:

• Pain or swelling in the face and jaw
• Symptoms of an impacted tooth (listed above)
• Parts of teeth emerging from the gum line 
• Teeth that look buried in the gums

To diagnose someone with an impacted wisdom tooth, a dentist or periodontist will:

• Examine the gums in the back of the mouth
• Ask questions about your symptoms 
• Take dental X-rays

How are Impacted Wisdom Teeth Treated? 

Asymptomatic impacted wisdom teeth that don’t cause dental problems may not require surgical removal. They are sometimes recommended to be left alone if they are close to important structures like nerves or blood vessels. 

But in most cases, an impacted wisdom tooth requires surgical removal by oral and maxillofacial surgeons, if they:

• Cause pain
• Damage other teeth or the jawbone
• Become infected 
• Cause tooth decay or gum disease
• Interfere with your ability to practice good oral hygiene 
• Have cysts or tumors around them

Oral surgeons or periodontists (gum specialists) may also remove impacted wisdom teeth as a preventative measure to reduce the risk of future problems.

Extraction: What to Expect 

Wisdom teeth extraction is typically an outpatient procedure done by an oral surgeon. This means you can go home the same day.

Before the surgery, you’ll be given local medications that make it more comfortable, such as:

• Local anesthesia to numb the inside of your mouth
• Sedation anesthesia to reduce your level of consciousness
• General anesthesia to make you lose consciousness completely

After administering anesthesia, the periodontist will:

1. Make a small incision in the gums
2. Remove any bone blocking the wisdom tooth
3. Remove the wisdom tooth, including the roots 
4. Pack the open socket (hole left within the jawbone and gums) with sterile gauze and close it with stitches or sutures

Recovery & Aftercare

After surgery, most people experience throbbing pain and swelling on the impacted side of the face and mouth. This swelling tends to be most severe during the first 2 days, then gradually decreases. 

Many people experience other symptoms post-surgery, such as:

• A sore mouth for around 1 week
• Jaw stiffness and trouble opening the mouth wide for a few days to 2 weeks
• A bit of bleeding from the wound or socket
• Minor bruising on the cheek
• Sensitivity in other teeth, which can last for a few weeks
• Bad breath, often for 1 week or less
• Exhaustion for a few days

A doctor will typically give you pain relievers after surgery, usually a combination of tylenol and ibuprofen. Most people start taking pain medications once the anesthesia wears off, typically 3 to 4 hours after surgery. You should take these medications every few hours per the dentist’s instructions. 

To reduce pain and swelling, you can apply ice or a cold compress to the area for a few minutes, several times daily. It may also help to eat soft, cold foods and drinks.

A periodontist or dentist will tell you how to handle stitches or sutures before going home. Sometimes they dissolve naturally or with gentle brushing after a few days. Other times, a doctor needs to remove them. 

You can normally do gentle activities, like walking, a few days after surgery. Talk to your doctor about when to start doing more strenuous or high-impact activities. 

Most people recover fully 1 to 2 weeks after wisdom teeth surgery. They can resume most regular activities, like going to work or school, a few days after the surgery.

Complications 

As with most surgeries, you can experience some complications while recovering from wisdom teeth removal.

Common complications include:

Infection

Bacteria and bits of food can get stuck in and infect the tooth socket. Oral antibiotics treat infections. To prevent infection, practice increased oral hygiene after surgery. You can also use an antiseptic mouth rinse while the area heals.

Dry Socket

A dry socket develops when a blood clot doesn’t form over the socket or dislodges or dissolves too early. This leaves the bone and nerves exposed. It can be very painful and cause a bad taste in the mouth. 

To treat dry socket, a doctor cleans the area and fills the socket with medicated gauze.

To reduce the risk of dry socket, practice good oral hygiene and avoid things that put pressure on the healing socket, like using a straw. You can also rinse the area with warm saltwater.

Learn more about dry sockets here.

Damage to Surrounding Structures

In rare cases, surgery damages the jawbone, sinuses, nerves, or other teeth. This can lead to pain or paralysis. You may need to undergo additional oral surgery to repair the damage. 

Abscesses

A pocket of pus called a subperiosteal abscess can develop between the open socket and the tissue covering it. It will need to be addressed by a doctor, and you may need to take antibiotics.

What if You Don’t Remove Impacted Teeth?

Impacted wisdom teeth may be left in place if they don’t cause any symptoms or dental complications. If they aren’t removed, clean and floss around wisdom teeth frequently and visit the dentist regularly. 

But neglecting impacted wisdom teeth can cause several complications and dental problems, including:

• Chronic pain
• Damage to other teeth or the jawbone
• Infection, abscesses, and fluid-filled bumps called cysts in or around impacted teeth
• Tooth decay and gum disease in or around wisdom teeth or other teeth (because they’re hard to clean properly)
• Tumors around impacted teeth

Summary

Impacted wisdom teeth occur when wisdom teeth get trapped in the bone or gums. 

Most impacted wisdom teeth are removed surgically. Many people can return to their normal activities a few days to weeks after surgery.