Information on Impacted Teeth What is an impacted tooth? It is a tooth that is embedded in the bone or under the gum tissue and is blocked from coming into the mouth due to its incorrect position or the lack of space in the mouth. Wisdom teeth are the most common impacted teeth because of their position in the back of the haws and the fact that they are the last to come into the mouth.
What problems can an impacted tooth cause? It is not normal for a tooth to remain under the gums beyond the age of about 21 years old. The following problems may develop:
Decay – Although the impacted tooth may not be visible in the mouth, food debris may reach the crown and cause decay. As this may not be visible in the mouth, there is no way for a dentist to fill such a cavity and severe pain could result.
Infection – When the impacted tooth is partially visible in the mouth, a gum flap usually covers the back part of the tooth. Food debris may then accumulate under this gum flap resulting in a local infection. This can result in severe pain and a swollen face due to an underlying abscess. This can spread to the surrounding tissues, eventually causing serious ill health.
Pressure – An impacted tooth can cause pressure on its healthy neighboring teeth which may result in pain, destruction of the adjacent teeth or crowding of the teeth.
Cyst Formation – A cyst may form around an impacted tooth which may slowly grow in size causing bone destruction and damage to adjacent teeth. Subsequent removal of the tooth and cyst require more extensive surgery with an increased chance of nerve damage and fracture of the jaw. Occasionally tumors may also develop within these cysts.
Why should an impacted tooth come out if it hasn’t caused any problems? There is no accurate way to predict which teeth will cause problems. The vast majority if left to develop would cause some trouble. This could obviously occur unexpectedly and at inconvenient times. The removal of impacted teeth in older patients is also more difficult than it is in your patients and the incidences of complications are higher.
How are impacted teeth removed? The surgery is done using either:
local anesthesia (freezing only)
local anesthesia with intravenous sedation (this is the most common method)
The method used in this office will be local anesthesia. After the local anesthesia take effect, the gums and bone overlying the impacted tooth are incised. The tooth is the exposed following which some bone may be removed and/or the tooth sectioned to facilitate its removal. The wound will then be closed with a suture(s) which will dissolve by itself and will not need removal.
Approximately 20 to 60 minutes may be required for the surgery depending on the difficulty of the procedure. Great care will be taken to be as gentle as possible in handling the soft tissues and bone.
What side effects or complications may arise?
Swelling – This is the most frequent side effect of surgery around the jaws. This will come on very soon after the operation and may last for up to a week. You will be advised to use ice packs and the prescribed medicine to limit this swelling. As every person reacts differently to surgery it is impossible to predict just how much swelling will develop. It usually takes 7 -10 days to resolve.
Pain – Severe pain is usually not a problem. Pain medication will be prescribed for you and if taken correctly should control most pain. Occasionally pain may develop several days after surgery and may radiate to the ear or chin. This is typically due what is called a “dry socket”, which is premature loss of the blood clot from the extraction socket. If this develops, you should immediately notify our office as this can be treated by special dressings and/or pain medication.
Jaw Stiffness – Commonly, some stiffness of the jaw muscles is present and may last several days. This may be helped by doing jaw opening exercises starting the day after the surgery.
Bruising – Occasionally some discoloration occurs around the face and neck. This is not an important complication and fades with time. Some people bruise more easily than others.
Nerve Damage – An impacted tooth in the lower jaw may be intimately related to the nerve which runs in a canal in the lower jaw. While all precautions will be taken, the nerve may be damaged during the removal of the impacted tooth. This could result in some numbness, pain, burning, or tingling of the lower teeth, gum tissue, chin and lip on that side. In most cases feeling will return to those areas within a few months as the nerve repairs itself. In some cases however, the nerve damage may be permanent with no recovery of sensation in the involved areas. Also, the nerve which gives feeling and taste to the side of the tongue may be damaged during the extraction of the impacted tooth and result in numbness, pain, burning, tingling, and loss of taste on that side of the tongue. This again may be temporary lasting only months but may also be permanent.
Sinus problems – As an upper impacted tooth is intimately associated with the sinus, you may notice a small amount of blood in the nose after the surgery. This is due to slight trauma to the maxillary sinus on that side. The blood in the nose will usually clear within a few days, usually without complications. However, occasionally after removal of upper teeth, sinus infections or openings from the sinus into the mouth may develop. An opening like this may persist and require a secondary operation to close it. It is emphasized that these complications are unusual.
Infection – The mouth is normally full of bacteria. Infection of the gums and jaw can occur after removal of an impacted tooth. Infections of this nature usually respond to antibiotics and local therapy. Occasionally an infection may develop to such an extent that it requires surgical drainage and hospitalization.
Recovery time following the surgery: This is difficult to predict as each person reacts differently to the surgery. A general rule is about 3 – 4 days for the maximum swelling to develop and this will then take about 3 – 4 days to resolve. You should plan to be able to have 4 – 5 days off work after the surgery if necessary. However, should you feel alright you may go back to work immediately afterwards. This is impossible to predict and will depend on the difficulty and reaction to the surgery.
If any additional questions arise or if you do not understand any of this information, please ask for assistance and we will be glad to answer them to the best of our abilities.