Impacted wisdom teeth fall into one of several categories. Mesioangular impaction is the most common form (44%), and means the tooth is angled forward, towards the front of the mouth. Vertical impaction (38%) occurs when the formed tooth does not erupt fully through the gum line. Distoangular impaction (6%) means the tooth is angled backward, towards the rear of the mouth. And finally, Horizontal impaction (3%) is the least common form, which occurs when the tooth is angled fully ninety degrees forward, growing into the roots of the second molar.
Typically distoangular impactions are the easiest to extract in the maxilla and most difficult to extract in the mandible, while mesioangular impactions are the most difficult to extract in the maxilla and easiest to extract in the mandible. Frequently, a fully erupted upper wisdom tooth requires bone removal if the tooth does not yield easily to forceps or elevators. Failure to remove distal or buccal bone while removing one of these teeth can cause the entire maxillary tuberosity to be fractured off and thereby the tearing out the floor of the maxillary sinus.
Impacted wisdom teeth may also be categorized on whether they are still completely encased in the jawbone. If it is completely encased in the jawbone, it is a bony impaction. If the wisdom tooth has erupted out of the jawbone but not through the gumline, it is called a soft tissue impaction. Sometimes the wisdom tooth fails to erupt completely through the gum bed and the gum at the back of the wisdom tooth extends over the biting surface, forming a soft tissue flap or lid around the tooth called an operculum. Teeth covered by an operculum can be difficult to clean with a toothbrush. Additional cleaning techniques can include using a needle-less plastic syringe to vigorously wash the tooth with moderately pressured water or to softly wash it with hydrogen peroxide.
However, debris and bacteria can easily accumulate under an operculum, which may cause pericoronitis, a common infection problem in young adults with partial impactions that is often exacerbated by occlusion with opposing 3rd or 2nd molars. Common symptoms include a swelling and redness of the gum around the eruption site, difficulty in opening the mouth, a bad odor or taste in the mouth, and pain in the general area which may also run down the entire lower jaw or possibly the neck. Untreated pericoronitis can progress to a much more severe infection.
If the operculum does not disappear, recommended treatment is extraction of the wisdom tooth. An alternative treatment involving removal of the operculum, called operculectomy, has been advocated. There is a high risk of permanent or temporary numbness of the tongue due to damage of the nerve with this treatment and it is no longer recommended as a standard treatment in oral surgery.
The oldest known impacted wisdom tooth belonged to a European woman of the Magdalenian period (18,000 - 10,000 BP). read full article
Why Should I Remove My Wisdom Teeth?
Wisdom teeth are the last teeth to erupt within the mouth, at approximately 18 years of age. Some adults get their wisdom teeth earlier or later. If they align properly and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this does not generally happen. The extraction of wisdom teeth is necessary when they are unable to properly erupt within the mouth.
Often times the wisdom teeth may grow sideways, or only partially emerge from the gum. It is very common that they remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to erupt successfully.
Poorly positioned impacted teeth can cause many problems, especially if they are left untreated for many years.
Partially erupted wisdom teeth create an opening around the tooth which can allow bacteria to grow. This bacteria growth will ultimately cause infection. This result will manifest itself into swelling, stiffness, pain and illness.
The erupting wisdom teeth may cause the other teeth to shift and disrupt the occlusion, requiring orthodontic care and realignment of teeth. This orthodontic care may have been avoided by simply removing the wisdom teeth at the early stages.
The most serious problems occur when tumors or cysts form around the impacted wisdom tooth. This may result in the deterioration or destruction of the jaw bone and healthy teeth. Removal of the offending impacted tooth or teeth usually resolves these serious problems. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.
Many studies have shown that early evaluation and treatment result in a superior outcome for the patient. Patients are generally first evaluated in the mid-teenage years by their dentist, orthodontist or by an oral and maxillofacial surgeon.
All out-patient surgery is performed under appropriate anesthesia right in our office, to maximize patient comfort and convenience. Dr. Arcan has the training, licensing and experience to provide various types of anesthesia to allow patients to select the best alternative. These services are provided in an environment of optimum safety, utilizing modern monitoring equipment and our well-trained staff is experienced in the latest anesthesia techniques and procedures.
