What is an impacted tooth?
An impacted tooth is a tooth that is not able to erupt because its eruption process has been blocked in some way. Any tooth can be impacted and there are many different factors that can cause the impaction. Many people have impacted teeth and are not aware of that because now they do not cause any problems. Once the tooth starts causing symptoms, it might cause difficulties in eating, swallowing, pain, cosmetic issues and more.
Most common causes
Among the many causes of impaction, probably the most common one is not having enough space in the jaws for the tooth. If a patient has an overcrowded bite, the chances are some of his teeth that haven’t erupted yet might stay impacted. Another factor that might cause this condition is an ectopic position of the tooth bud. If the tooth bud is placed in a position where it is not supposed to be, or if it is angled at an inappropriate angle the tooth will not be able to erupt and most likely will be blocked by other teeth or a bone with very high density. Large cysts or tumors can also get in the way of erupting teeth. Other reasons include extra teeth that will block the pathway, ankylosis of primary or permanent teeth, prolonged retention of primary teeth, genetics, endocrinal deficiency, hereditary disorders and more.
Symptoms of an impacted tooth
Fully impacted teeth very often do not show any symptoms at all. That is why a lot of people do not even know that they have impacted teeth in their mouth. They usually get discovered accidently when the patient gets a panoramic x-ray done. Semi-impacted teeth are the ones that can cause a lot of symptoms and problems. Having bad breath and an unpleasant taste in the mouth occurs because of the food that might get trapped between the tooth and the soft tissue around it. The food combined with plaque can lead to inflammation of the gums. They will appear as red, swollen and tender. It is usually extremely hard to keep up with good oral hygiene in the area of semi-impacted teeth, especially the third molars which are most commonly impacted. The bacteria and the debris present under the soft tissues will intensify the inflammation leading to pericoronitis, which happens a lot with the third molars. The pericoronitis can appear as a chronic type that is accompanied with mild symptoms, or as an acute type with very severe symptoms. Those symptoms include intensive pain, redness, swelling, swollen lymph nodes, fever, headache, unpleasant taste, difficulty when opening the mouth (trismus), difficulty with swallowing, jaw and neck pain and more.
Which teeth can be impacted?
Any single tooth in the mouth can be impacted, but the first place in this group is taken by the mandibular third molar. It is followed by the maxillary third molar and the maxillary canine. The wisdom teeth, or third molars, are the ones that erupt between 17 and 25 years. Those are the teeth that appear the last in the mouth, so in most cases, there is not enough space for them in the jaws. Scientists think that with the process of evolution people nowadays have smaller jaws compared to our ancestors mostly because of the changes in the modern diet compared to then. Genetics plays a big part in tooth impaction. Wisdom teeth can also be misaligned or placed at a certain angle that will not allow them to erupt.
Canines also can be impacted, especially the maxillary one. Their time of eruption is between 11 and 13 years, and if they haven’t erupted during that age, impaction is a possible reason. A discrepancy between the size of the jaw and the teeth is once again a factor that can lead to an impacted canine. This tooth has the longest pathway of the eruption which makes it more difficult for the tooth to get to the dental arch. Other factors include prolonged retention of the primary canine, no permanent maxillary lateral incisor, early loss of the maxillary primary canine, ankylosis, trauma, ectopic position of the tooth bud, cysts or tumors, delayed resorption of the primary’s canine root, genetics and more.
Other teeth that can also be impacted are premolars and the central and lateral incisors, but the incidence for these teeth is very low.
The treatment mostly depends on the tooth that is impacted and if it is causing any problems.
If the impacted tooth is a canine, the best treatment option is a combination of surgery and orthodontics. This way, if it is possible the canine is exposed with a surgical procedure and with the help of orthodontics, it is brought into its place in the dental arch. But, if this type of treatment is not possible, then the way to go is to surgically remove the tooth. The canine has a great cosmetic and functional meaning, so the dentist should do everything in his power to preserve the tooth in the patient’s mouth.
With the third molars, the way to go is to surgically remove the tooth. If the tooth is not causing any problems, a lot of dentists choose not to take any measures. If the tooth is showing obvious signs and symptoms, then all those symptoms must be taken care of before the patient undergoes a surgery. Inflammation, especially if it is an acute pericoronitis, must be treated with antibiotics. Over-the-counter pain relievers are also very helpful.
The surgical procedure is performed by an oral surgeon or a maxillofacial surgeon and the duration depends on the individual case. It is one of the most common surgical procedures.
What are the consequences if the tooth is not removed?
If impacted teeth are not removed, they can cause different complications. Because of the insufficient oral hygiene and the plaque present, the impacted tooth can be affected by the periodontal disease. Dental caries can also be noticed very often with partially impacted teeth. Pericoronitis can become very dangerous, especially for people with a compromised immune system. The inflammation can lead to a pericoronal abscess that might spread to the cheek or even parts of the face and neck. This is a rare complication. Impacted teeth can cause root resorption to the second molars, especially if their position is angled towards the second molars. Other consequences include malocclusion of teeth, the neighboring teeth can also be affected by periodontal disease, impacted teeth can cause cysts and more.