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Impacted Wisdom Teeth: Oral Surgery and Extraction

Evolution has rendered wisdom teeth unnecessary in humans, and about 85 percent of these third molars eventually require removal because of tooth crowding, according to the American Association of Oral and Maxillofacial Surgeons (AAOMS). Trapped in the gums, impacted wisdom teeth may lead to dental problems such as pain, infection or misalignment of other teeth.

Impacted third molars, or wisdom teeth, can be very painful.
Impacted third molars, or wisdom teeth, can be very painful.
Credit: Carlos Caetano | Shutterstock

Diagnosis

Wisdom teeth are the last to erupt and typically do so between the ages of 17 and 25. But according to the American Dental Association, they may grow sideways, emerge only partially or remain completely trapped under gum and bone, which either produces no symptoms or causes:

  • Pain
  • Swollen, red, tender or bleeding gums
  • Swelling around the jaw
  • Bad breath
  • An unpleasant taste in the mouth near the affected area
  • Headache or jaw ache
  • Occasional difficulty opening the mouth
  • Occasional swollen lymph nodes in the neck

To diagnose impacted wisdom teeth, dentists look for swollen gums or signs of infection such as tenderness, redness and drainage, according to the National Institutes of Health (NIH). They also inquire about symptoms and regular oral cleaning habits. A diagnosis can only be confirmed with dental x-rays, which may also indicate damage to other teeth or the jawbone.

Surgical options

Some impacted wisdom teeth don’t require removal, but symptomatic cases usually need surgical extraction by a dentist or oral surgeon in an outpatient setting. Local or general anesthesia may be used, depending on the severity of the condition. First, an incision in the gums is made and any bone blocking the impacted tooth is removed before the tooth itself, according to the Mayo Clinic. Afterward, the incision is stitched shut and the empty tooth socket is packed with gauze.

Surgery may be delayed if a wisdom tooth is already infected, in which case a dentist would likely prescribe antibiotics and wait a week to 10 days before proceeding.

After Surgery

Patients are sent home with instructions for diet modifications and other measures to help manage the expected post-surgical pain and swelling. Complications are unusual, but may include:

  • Infection of the tooth or gums due to bacteria or trapped food
  • Sinus damage near upper wisdom teeth
  • Dry tooth socket or bone exposure
  • Weakened lower jawbone
  • Nerve damage to the lower lip, chin or tongue

Patients who develop any post-surgical complications should contact their doctors immediately.

 

Risk on Non-Removal

Because bone is more flexible in people under 30, wisdom tooth removal may be simpler before then, according to the NIH. Some impacted wisdom teeth never need removal if they don’t cause dental problems, although AAOMS research indicates that even third molars that erupt in a normal, upright position may be as disease-prone as impacted ones.

Impacted teeth that are not removed may lead to serious complications, including:

  • Cyst development around the tooth that may gouge the jawbone and damage adjacent teeth
  • Infection of the tooth or gums
  • Chronic mouth discomfort
  • Misalignment of teeth
  • Plaque caught between teeth and gums

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