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What is an Impacted Tooth?

It is a tooth that is embedded in the bone and is blocked from coming into the mouth due to its incorrect position or lack of space available.  An impacted tooth can be partially exposed through the gum or completely submerged and only visible on X-rays.

What Causes Impacted Teeth?

The tooth may travel in the wrong direction during its eruption, or its progress may be blocked by and adjacent tooth.  The most commonly impacted teeth are the wisdom teeth (third molars).  Wisdom teeth are the last to erupt into the mouth and often fight for room because of limited space available to fit between the tooth in front and the jaw bone behind.

How Serious is an Impacted Tooth?

It is not normal for a tooth to remain beneath the surface beyond the age of 18 years.  The following difficulties may develop if it remains in the jaw:

1. Decay
Even if the impacted tooth is not fully visible in the mouth, saliva and bacteria can still reach the crown of an impacted tooth and cause decay. Your dentist has no way to fill such a cavity and if left untreated, severe pain and infection may result. Decay in an impacted tooth can also affect the roots of adjacent, fully erupted teeth.

2. Infection
Localized infection often occurs in a partially exposed impacted tooth, when food accumulates under the skin flap which covers part of the tooth, and is unable to be cleaned away.  This infection can spread to the surrounding tissues in the mouth.

3. Pressure
An impacted tooth can cause pressure on its healthy neighbours and this can lead to pain and damage to an otherwise healthy tooth.  Also, after orthodontic treatment pressure caused by submerged or partially erupted wisdom teeth can cause your teeth to move out of alignment.

4. Cyst Formation
A cyst may form around an impacted tooth and slowly grow in size, causing bone destruction and damage to adjacent teeth.  Removal of the tooth and cyst requires more extensive surgery.  Occasionally, tumours may develop within these cysts.

5. Orthodontic Problems
Orthodontists usually require the wisdom teeth to be removed before tooth straightening is deemed complete and stable.

Why should an Impacted Tooth be removed if it hasn't caused any trouble?

It is important to remember that problems can develop suddenly, unexpectedly and usually at inconvenient times.  The removal of impacted wisdom teeth in an older adult is not always as simple as in those who are young and the incidence of complications in older adults is somewhat higher.  If treatment has not been sought early and an infection has developed, it may require treatment before the tooth can be removed.  This often causes delays which can lead to increased risk, a need for further surgery and increased expense.

At present we have no accurate way to predict which wisdom teeth will cause problems in the future.  However, the vast majority of wisdom teeth, if left to develop, would go on to cause some trouble.

How are Impacted Teeth removed?

The removal of impacted teeth may take 30 - 45 minutes and is performed with great care and attention to being as gentle as possible when handling soft tissue and bone.  The procedure is performed using anaesthesia, sterile instruments, special lighting and will involve a surgeon and his assistant.  The surgeon will make an incision in the soft tissue overlying the impacted tooth to expose the tooth.  Some bone usually has to be removed and the tooth may have to be sectioned into several pieces to help its removal. The wound will be closed with dissolvable stitches which do not have to be removed at a post-operative visit.

What type of Anaesthesia will be used?

Surgery can be done using the following:

1. General Anaesthesia:
This is the most commonly used and requires a short period in hospital or a day clinic.

2.  Local Anaesthesia only:
Injections similar to those used by your dentist to numb your mouth.  Generally only suitable for minor surgical cases.
The choice of the most appropriate anaesthetic will be discussed at your pre operative consultation.

What Side Effects or Complications May Arise?

While some side effects are unavoidable, complications are rare and usually not serious.  The can include:

1. Swelling
Swelling will generally start to present itself on the evening of the operation and may last for several days.  Ice packs may help in limiting swelling and improving comfort.

2. Pain
Severe pain is usually not a significant problem.  Strong analgesics will be presecibed for you and, if taken correctly, should control any pain.  You should call the surgery if you notice any unusual pain as this can be treated with special dressings and pain medications.

3. Jaw Stiffness
Stiffness in the jaw muscles is common and may last for several days.

4. Bruising
Some people bruise more easily than others.  Discolouration often occurs around the face and neck.  This simply means that some of the blood has tracked into the soft tissue and discoloured the skin.  This does fade with time, although your skin may take on a yellow hue for a week or ten days after the operation.

5. Nerve Damage
A nerve runs in a canal just beneath the roots of impacted teeth in the lower jaw.  While all precautions will be taken not to damage this nerve, it may be stretched or bruised during the surgical procedure.  This could result in some numbness of the lower teeth, gum tissues, chin and lip on that side.  In nearly all cases feeling will return to those areas in time, as the inflammation resolves.  In very rare circumstances (approx 1 in 3000 cases) nerve damage may be permanent.  Also, the nerve that gives feeling to the side of the tongue may be involved during any procedure (even injections) around the lower jaw.  Again, any disturbance to sensations is usually temporary but in rare circumstances, may become permanent.

6. Sinus Opening
After an upper impacted tooth is removed you may notice a small amount of fluid in the nose, especially when you sneeze or drink. This is due to slight trauma to the maxillary sinus (antrum) on that side.  The blood in the nose will clear within a few days, usually without further problems.  However, occasionally sinus infections or an opening from the sinus into the mouth may develop.  An opening like this generally heals spontaneously but may require a second minor operation to close it.  It is emphasized that these compliations are most unusual.

7. Post Operative Infection
The mouth is normally full of bacteria and infection of the soft tissues and jaw can occasionally occur after removal of an impacted tooth. This is more likely to occur if infection has been present in the gum tissue overlying an impacted tooth prior to its removal.  Infections of this nature usually respond to antibiotics, local mouth washes and heat treatments.

8. Other Symptoms
There may be an elevation of temperature for the first 48 - 72 hours after surgery.   If the temperature feels feverish, please notify us.  The corners of your mouth may feel the effects of having been stretched during the operation and may dry out or crack.  Your lips should be kept moist with a suitable cream (chap-stik, vasoline, etc.) for several days after the operation. Adjacent areas may ache slightly or be tender upon hard chewing, a sore throat may develop or you may experience throbbing in the ear or temple.  These symptoms ususally last only a few days.

Post Operative Infection

A sheet of detailed post-operative instructions will be issued to you on the day of your surgery.  This sheet tells you all you need to know about diet, mouthwashes etc., in the days following your operation.

Following your surgery, it may be necessary to take some days off work (often up to one week).  We will be happy to give you a medical certificate for your employer.

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