Impacted Teeth and Wisdom Teeth

Third Molar Definition :: Types of Impacted Teeth :: Surgery :: Complications :: References :: Visuals

In time past (many eons ago) when we as humans did not cook our food, thus we needed a broad base to grind, mull and chew our food. As we evolved the need for this broad base has diminished. As mankind has refined eating habits, therefore, the posterior (the back surfaces of teeth) have shortened and thus the causal effect, the phenomenon of third molar impacted teeth.

The human jaw can accommodate 28 teeth. In rare circumstances, 32 teeth are an occlusion. The last four teeth that try to enter your mouth are called the wisdom teeth, i.e., third molars. In many instances they remain submerged in tissue or in bone and are called impacted teeth.

The third molars are now categorized as an extinct appendage, just as your appendix. It is a useless organ. As man has developed and our eating habits have changed, as have progressed in time, we all start losing not only third molars, but the upper first bicuspids and the lateral incisors, these other teeth that are next to the eye teeth looking forward.

Today we see many more children with loss of the lateral incisor teeth.

With respect to the evolving third molar, mankind is in a transitional stage, i.e. the lack of third molar presence is more common today than it was in the past. In the past, especially prior to antibiotic management, third molar problems arose and caused severe infections, disability and even death from infection.

Today under modem controls, proper diagnosis and effective therapies, third molar removal and therapy has become a routine portion of oral surgery. Based on the amount of surgical procedures done on any given day, the results have been of minimal consequence.


This is not to start that the procedure is a simple procedure and that there are not complications. As with any medical procedure, there are many complications that can happen.

Every person is different. Some of you will go through life without ever having had any problems by your third molars either by the eruption pattern or even by the presence of them. Some of you will not even have any third molars. However, the majority of people will have a problem with third molars, i.e. infection, pain, crowding of teeth, referred pain and in some cases, life threatening sepsis.

The following is a generalized program for you, the patient to understand some of the problems with third molars or impacted wisdom teeth.


An impacted tooth is one, which has not fully erupted into the oral cavity, usually due to a lack of space, poor positioning or the presence of associated pathology. ft is possible for any tooth to follow an aborted eruptive path and become impacted. In order of frequency, those teeth most commonly impacted include mandibular and maxillary third molars, maxillary canines, eye teeth, mandibular bicuspids and mandibular eye teeth.


Soft tissue impactions. There is jaw bone that is adequate enough to allow the wisdom tooth to erupt, but not enough to allow the gum tissue to recede for adequate tooth cleaning, i.e., the gum tissue is over the tooth with a small portion of the tooth showing which would lead to infection.

Partial bony impaction These are the most common types of impactions. There is enough space to allow the wisdom tooth to partially erupt. It cannot function. It just has erupted through the bone and there is no function in process of mastication and has a problem with infection and recurrent fetor oris. This partial bony impaction causes intermittent pain radiating along the jaw side and up to the ear. It is a source of harmful bacteria that will cause disease entities such as Vincentís infection which is acute necrotizing ulcerative gingival stomatitis, in essence old trenchmouth, i.e. gingivitis in acute form.

Complete bony Impaction There is no space for the tooth to erupt at all. It is covered in bone. It remains in the jawbone and usually is visible on x-ray causing crowding of teeth, causing destruction of the second molar.

The last type of impaction connotation is the unusually difficult complete bony impactions. The impacted tooth is an unusual and difficult position. very difficult to remove. The only reason these may be removed for cause is i.e. cystic destruction, mandibular nerve or sinus involvement.

The most common causes of removal of third molars for simplicity are as follows: infection i.e. the inability of the tooth to erupt into the mouth causing pockets, food pockets and bacterial growth pockets. This would then result in pain, swelling and chewing and swallowing difficulties.

The second most common is damage to the teeth, i.e. the third molar unbeknownst to the patient, will cause destruction of the second molar or cause destruction of the sinus causing pain and resulting in periodontal disease and bone loss and dental caries.

The third most common would be crowding, the wisdom teeth causing pressure and moving teeth forward and causing crowding of the anterior teeth.

The last is generalized disease causing cystic destruction, non-infectious disease causing cystic destruction around the tooth. This cystic destruction will eat bone and will dissolve roots of teeth and cause pain and paresthesia, i.e. numbness of the lip and will also lead to malignant and non-malignant types of tumors.

From the previous readings you have digested the optimal age is between 16 and 20 years
of age because of three reasons:
1) The patient will heal faster.
2) Quicker final healing.
3) Fewer complications.


First you will have made a decision to have what type of anesthesia. As described previously it would be local, IV sedation or general. It is commonly accepted that most people will have IV sedation, i.e. you are unaware of the experience and this will be discussed with you at your consultation session. The outpatient surgery is performed under strictest anesthesia guidelines to maximize your comfort. A surgical team will consist of one nurse that will be the surgical assistant, one nurse that will be the surgical instrument carrier and one will be the assistant as far as oxygenation and at the head of the patient, i.e. to stabilize the patientís head. Therefore, you have the doctor and a minimum of three nurses in the room. On the day of surgery you will have nothing to eat or drink as prescribed to you. The surgical procedure will take anywhere from one to two hours. You will stay in the office anywhere from one to two hours. Most surgical procedures take one hour and recovery is an hour.

In many cases, one hour before surgery an antibiotic will be prescribed to you and then postoperatively analgesics and antibiotics will be continued.

Intravenous sedation will be given via an IV that will be started by the doctor and to that one single IV, all medication is regulated by the doctor.

Postoperatively the sutures are usually dissolvable. However, in many cases we will place silk sutures that have to be removed in five to seven days.

Pain management maybe over-the-counter meds such as Advil (ibuprofen) 400 mg every 4-6 hours, or Tylenol every 4-6 hours. However, in many cases, a stronger narcotic will be prescribed for you. Postoperative instructions have been given to you and these are to be read very carefully and are found elsewhere in this web site.


For any procedure that any professional gives there are always complications. The most common complication is infection. Even though it is rigidly sterile procedures are enacted, antibiotics may or may not be used, it is every individual personís reaction to a surgical procedure that will cause an infection. Infections will be controlled by the appropriate surgical management. The second most common complication is an osteitis which in essence means a dry socket, no blood clot, i.e., after a period of four to seven days consistent pain usually means that the normal healing has not occurred and that for some extraordinary reason, i.e. smoking or sucking through a straw the clot has washed out and normal healing process has been disrupted, i.e. lysis of the clot. Therefore, the bony wall is exposed.

This complication will be dealt with by appropriate means, i.e. dressings until a wall of epithelial cells line the bony socket and pain is minimal.

Second problem in the upper wisdom teeth are sinus complications. This is a very rare complication. Upon removal of the wisdom tooth there may be a sinus communication. If this is evident at the time of surgery, the doctor will close that immediately to allow for non-communication of the sinus into the oral cavity. If he is not aware and it happens at a later date, then certain appropriate procedures will be accompanied.

Sinus considerations. If the sinus communication is foreseen, the following findings should happen. Do not blow your nose, do not play a wind instrument, do not use a straw and do not smoke. If a cough or sneeze is unavoidable, then open your mouth, turn your head towards the floor and direct the cough toward the floor through your open mouth. Gently rinse the surgical site as directed. Please take all medications as needed. You may use a nasal decongestant, Afrin nasal spray. Do not remove the stitches yourself. Some bleeding from the nose may follow surgery. You may blot the area but do not blow your nose. Following these directions will increase the chance of uneventful healing. Failing to follow these directions will increase the possibility of additional surgery. It is to be noted that it is common for the upper teeth, maxillary sinus is adjacent to them. In the process of removing wisdom teeth and/or roots, extending the sinus, and an opening between the sinus and the mouth may occur as the tooth is removed. This is like pulling a plug from a drain. In the healing of such communication, the quality of bone and gum tissue may complicate the healing process. In order to maximize the likelihood for favorable healing it is absolutely necessary that the previously mentioned directions be followed precisely.

The next complication is mandibular paresthesia, i.e. there is a nerve that runs along the lower jawbone that provides sensation to the lower lip. It is rare that this mandibular complication can happen. It also may happen with the lingual nerve providing sensation to the lingual nerve. Occasionally when teeth are removed, especially in an older individual, i.e. 20 and above, the roots have grown and become closer to the nerve itself. This surgical removal can irritate the nerve in the process of removal. You will experience a tingling and numb sensation or you may be completely numb. Should this occur, it is usually temporary and will resolve gradually in weeks, months or even a year.

Again, this is rarely. The sensation is that similar to the feeling of a Novocaine being worn off.

You will inform the doctor and the doctor will follow you through this, and if necessary, refer you to a microneuro-oral surgeon.

It is extremely rare that during the process of surgical removal of lower wisdom teeth the jaw may break. This is usually on when there is a large cystic destruction or there is a very thin friable mandible in the older person in their 60s and 70s. It is usually can be determined preoperatively. All necessary instrumentation and surgical skills will be employed preoperatively and to determine with your doctor if this is a possibility. If however, some unforeseen reason the jaw is broken, it will be wired immediately.

This process, i.e., infection, dry socket, fractured jaw is reversible, meaning that the doctor involved will treat and bring you back to a normal state. The complication that is the most worrisome is the irreversible complication, that of mandibular nerve. Again, it is to be noted that it is a rare complication.


The Management of Impacted Third Molar Teeth

"Should the Asymptomatic Impacted Third Molar Be Removed?"


View the slideshow below to see different types of Impacted Teeth:

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