Impacted Tooth: Causes, Problems and Treatment Options

An impacted tooth is a tooth that fails to erupt normally into the mouth within the expected time. It may remain completely covered by bone and gum, or it may erupt only partially. Wisdom teeth (third molars) are the most commonly affected, but canines, premolars and other teeth can also become impacted.

What Is an Impacted Tooth?

A tooth may fail to erupt because of several factors, including:

• Lack of space in the jaw

• Crowding of teeth

• Abnormal tooth position or angulation

• Extra teeth blocking the eruption pathway

• Cysts or other jaw lesions

• Delayed loss of baby teeth

• Certain developmental or genetic factors

In some cases, more than one factor may contribute to impaction.

What Problems Can an Impacted Tooth Cause?

Not every impacted tooth causes symptoms. However, leaving an impacted tooth without appropriate assessment may sometimes result in complications.

1. Infection

A partially erupted wisdom tooth can create a space where food debris and bacteria collect. This may cause pericoronitis, an infection and inflammation of the gum surrounding the tooth.

2. Pain and Swelling

Inflammation or infection may cause pain and gum swelling. In more severe cases, it can lead to facial swelling.

3. Tooth Decay

An impacted or partially erupted tooth is difficult to clean. Food trapping may increase the risk of decay in the impacted tooth or in the neighbouring tooth.

4. Damage to Nearby Teeth

An impacted tooth can sometimes press on an adjacent tooth. It may be associated with periodontal bone loss or root resorption of the neighbouring tooth.

5. Cyst or Other Pathology

Some impacted teeth may be associated with an odontogenic cyst or other jaw pathology. Although uncommon, these conditions may need further investigation and treatment.

6. Difficulty Opening the Mouth

Infection around a lower wisdom tooth can sometimes cause painful restriction of mouth opening, particularly when inflammation spreads into the surrounding tissues.

How Is an Impacted Tooth Diagnosed?

Diagnosis begins with a detailed clinical examination. Your dentist or Oral & Maxillofacial Surgeon may assess:

• The position of the tooth

• Gum condition

• Presence of pain or infection

• Adjacent teeth

• Mouth opening

• Signs of swelling or pathology

Dental X-ray

A panoramic or other dental X-ray helps determine the position and angulation of the impacted tooth and its relationship to surrounding structures.

CBCT Scan for an Impacted Tooth

In selected cases, a CBCT (Cone Beam Computed Tomography) scan may be recommended for a detailed three-dimensional assessment. It is particularly useful when an impacted tooth is close to important anatomical structures such as the inferior alveolar nerve, maxillary sinus or adjacent tooth roots.

What Are the Treatment Options for an Impacted Tooth?

Treatment depends on the type and position of the impacted tooth, symptoms, age, surrounding structures and the presence of pathology.

1. Observation

If an impacted tooth is completely symptom-free and there is no significant associated disease or damage, your dentist or surgeon may recommend periodic monitoring. Regular clinical and radiographic review can help detect changes early.

2. Surgical Removal

Removal may be considered when an impacted tooth is associated with:

• Recurrent infection

• Persistent pain

• Tooth decay

• Periodontal damage

• Damage to neighbouring teeth

• Cyst or other pathology

• Other clinically significant complications

The surgical approach depends on the tooth's position and its relationship with surrounding anatomical structures.

3. Save and Align the Tooth

An impacted canine, particularly in a younger patient, may sometimes be preserved rather than removed. A common approach is surgical exposure of the tooth, followed by orthodontic treatment to gradually guide it into its correct position.

Treatment Options at a Glance
Place this right after the three treatment options, as a quick summary.

• Observation: Used when the tooth is symptom-free and there is no significant disease or damage. It involves periodic clinical and radiographic review.

• Surgical removal: Considered for infection, pain, decay, periodontal damage, damage to neighbouring teeth, cyst or other complications. The approach depends on the tooth's position and nearby anatomy.

• Save and align: Used mainly for an impacted canine, particularly in a younger patient. It involves surgical exposure plus orthodontic treatment.

Don't Wait Until It Hurts: When to See a Specialist

An impacted tooth may remain unnoticed for a long time. The absence of pain does not always mean the absence of a problem.

An evaluation can help decide whether treatment or monitoring is appropriate if you have:

• An unerupted tooth

• Recurrent gum swelling

• Pain around a wisdom tooth

• Difficulty opening your mouth

• Unexplained swelling

Early Evaluation = Early Diagnosis + Appropriate Treatment

Pain • Swelling • Recurrent Infection • Unerupted Tooth?

Consult a Dentist or Oral & Maxillofacial Surgeon for a clinical and radiographic evaluation and an individualized treatment plan. Book an Appointment

"This article is for educational purposes and does not replace a clinical examination."