Impacted Tooth

Impaction is classified into three main types:

• Soft-tissue impaction: The tooth erupts through the jawbone but does not break through the gums.
• Partial bony impaction: The tooth partially erupts through the jawbone and does not break through the gums.
• Full bony impaction: The tooth remains completely trapped within the jawbone and does not erupt at all. 

The symptoms of impacted teeth may be intermittent or persistent. These include the following:

• Red, swollen, or bleeding gums
• Pain and stiffness in the jaw (difficulty in opening the mouth)
• Halitosis (bad breath) or dysgeusia (bad taste)
• Headaches
• Swollen lymph nodes in the neck

In some cases, impacted teeth may cause oral health complications like:

• Tooth decay (cavity formation)
• Tooth abscesses
• Gum disease
• Formation of cysts (fluid-filled sacs) under the gums
• Pericoronitis
• Malocclusion (bad bite)
• Mandibular nerve damage (a large nerve in the lower jaw that controls important functions such as mastication and swallowing)

The main causes of an impacted tooth include:

• Teeth erupting at an abnormal angle (twisted/sideways)
• Overcrowding due to limited jaw space.
• Small jaw size or the presence of extra (supernumerary) teeth

The diagnosis of an impacted tooth usually involves the following:

• Oral examination: The dentist checks the oral cavity for signs of inflammation, pericoronitis, swelling, or pus formation.
• Dental X-ray: X-ray imaging is done to determine the location of the impacted teeth.
• Cone beam CT: Sometimes used for determining the actual position of the impacted teeth and their proximity to vital nerves and vessels. 

Patients with impacted teeth may not always experience symptoms; moreover, treatment is not always needed. The severity and cause of the condition may reflect whether the symptoms will get better or worse; however, without proper care, complications may develop and pain can become persistent.

Based on the symptoms, presentation, and severity of the condition, dentists decide the course of the treatment, which includes :

• “Wait and watch” approach: If an impacted tooth is detected but no symptoms are present, dentists may recommend that the affected region be monitored without further action (unless required), i.e., the tooth is frequently examined during routine dental checkups or cleaning sessions to ensure that it is healthy and does not cause any complications.
• Impacted tooth removal: In cases where the impacted tooth causes oral health issues, such as pain, swelling, or infection, tooth extraction is recommended. This is an outpatient procedure performed under local anaesthesia or sedation.
• Eruption aids: When a tooth does not erupt on its own, an eruption aid is applied to accelerate eruption. This treatment is quite frequently performed among young patients (children and teenagers) with impacted canine teeth.

If patients notice sudden and unexplained pain in the teeth or gums, or difficulty opening the mouth, they are advised to schedule a dental consultation.

Although not all cases of impaction can be prevented, the following steps help reduce complications:

• Regular dental checkups to detect early signs of impaction
• Orthodontic evaluation in children and teenagers to identify space or alignment issues

For management of an impacted tooth, consult a:

• General dentist or Oral and maxillofacial surgeon: For diagnosis, monitoring, and removal of impacted teeth
• Orthodontist: If impacted teeth require guided eruption or alignment treatment