Impacted Tooth: Types, Causes, Complications & Treatment Options

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What is an Impacted Tooth?

During the infancy years, primary (baby) teeth emerge through the gums. Around age 6, these teeth start to shed and adult teeth grow in.

In some cases, permanent teeth erupt abnormally, which can result in complications later on. For example, when a tooth does not emerge or only grows in partially, it is considered an impacted tooth.

Surgical removal or exposure of an impacted tooth is typically necessary to reduce the chance of dental crowding and other issues.

Impacted Tooth Causes

The primary cause of an impacted tooth is due to overcrowded teeth in the dental arch. If your jaw is too small, your teeth may grow in crooked and overlap because there is not enough room.

Other possible causes of an impacted tooth include:

  • Dental Trauma — a traumatic dental injury can delay eruption and eventually cause an impacted tooth. Incisors in the upper jaw are most commonly affected.
  • Over-Retained Baby Teeth — this condition refers to teeth that loosen, but then tighten back into the gums, preventing the eruption of permanent teeth. Dentists and oral surgeons typically extract these teeth to allow for the proper eruption of permanent teeth. If they are not removed, dental crowding commonly develops, which can result in impacted teeth.
  • Irregular Tooth Growth — sometimes, a tooth grows in at an angle, which can result in an impacted tooth. This most commonly affects wisdom teeth (third molars).
  • Supernumerary Teeth — this condition refers to people who have extra teeth. Having extra teeth can result in impacted maxillary incisors (the front teeth in the upper jaw).

Which Teeth Are Mostly Commonly Impacted?

Impaction most commonly affects the wisdom teeth (third molars) and canines in the upper jaw (maxillary canines).


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Wisdom Teeth (Third Molars)

Wisdom teeth, also referred to as third molars, erupt behind the 12-year-molars (second molars) about five to nine years later.

Between 16 and 20 years of age, most people undergo wisdom tooth removal surgery because the teeth do not grow in properly. Third molars can grow in at various angles, even horizontally, because jawbones usually aren't large enough for them to erupt normally.

If you have a small jaw, you are more likely to have impacted wisdom teeth. Serious oral infections and cysts can form if an impacted wisdom tooth is not removed.

Maxillary Canines (Upper Jaw)

Canines in the upper jaw are the second most common teeth to become impacted. These teeth are essential because they help you rip and tear food. Because of this, dentists do not typically extract them. Instead, they use treatments that help them erupt normally.

Symptoms of an Impacted Tooth

Many times, impacted teeth do not cause any obvious symptoms. However, the longer a tooth is impacted, the more likely these following symptoms will arise:

  • Bad breath (halitosis) that remains even after brushing your teeth
  • Bad taste in the mouth (typically near the tooth)
  • Tender, red, and swollen gums
  • Difficulty opening the mouth
  • Pain when opening or closing the jaw
  • Persistent headaches that come on suddenly
  • Occasionally, lymph nodes in the neck may swell
  • A gap between teeth where the tooth should emerge

Complications of Impacted Teeth

Serious complications are not likely if your dentist removes an impacted tooth. Although, if it isn't removed, serious dental infections, chronic mouth discomfort, plaque buildup, and nerve damage are possible. Other potential complications include:

Tooth Abscess

A tooth abscess forms due to a bacterial infection from the long-term buildup of pus inside the gums and teeth. Throbbing and pain near the affected tooth often accompany an abscess.

Malocclusion (Teeth Misalignment)

Malocclusion refers to the misalignment of teeth. Impacted teeth, teeth lost prematurely, and extra teeth can result in misalignment, such as dental crowding.

crossbite malocclusion scaled 1

Gingivitis or Periodontal Disease

Gingivitis is a mild form of gum disease that causes inflammation in the gingival tissues without bone loss. This form of gum disease is reversible and treated during professional teeth cleanings. If it is left untreated, periodontal disease can form, which is a nonreversible gum disease that causes permanent bone loss.

teeth with plaque and red gums from gingivitis

Treatment Options for Impacted Teeth

Treatment may not be necessary if an impacted tooth is not causing problems. Although, in most cases, a dentist or oral surgeon should remove impacted wisdom teeth by age 20 if they are not growing in properly.

If the impacted tooth is in the front of your mouth, you may benefit from orthodontic treatment. Braces, for example, can help move the tooth into the proper position.

An impacted back tooth will need to be surgically exposed. There are two types of oral surgery used to expose impacted teeth, including:

Open Eruption

During an open eruption procedure, your dentist or oral surgeon will surgically uncover the crown of the impacted tooth under the gums. The tooth is left exposed to the oral cavity and is surrounded by the soft tissue of the palate or labial mucosa (inside lining of the lips). From here, the dentist can directly visualize the tooth following exposure, allowing for proper eruption.

Closed Eruption

During a closed eruption procedure, your dentist or orthodontist will surgically expose the tooth under the gums. Then, they will place an orthodontic attachment and replace the overlying mucosa.

Lastly, a chain extends from the attachment through the mucosa, allowing the dentist to place traction on the tooth and simulate normal tooth eruption. This procedure is lengthy but may be necessary for impacted incisors and other front teeth.

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Resources

Cobourne, Martyn T., and Andrew T. DiBiase. Handbook of Orthodontics. Elsevier, 2016.

Gupta, Seema, and Nikhil Marwah. “Impacted Supernumerary Teeth-Early or Delayed Intervention: Decision Making Dilemma?” International Journal of Clinical Pediatric Dentistry, Jaypee Brothers Medical Publishers, Sept. 2012, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155876/.

“Impacted Tooth: MedlinePlus Medical Encyclopedia.” MedlinePlus, U.S. National Library of Medicine, https://medlineplus.gov/ency/article/001057.htm.

Updated on: September 10, 2020
Author
Alyssa Hill
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Medically Reviewed: November 15, 2019
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Lara Coseo
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