That partially erupted or malposed wisdom tooth that has no chance or hope of achieving a normal relationship within the arch or between the opposing arch. It could damage your healthy functioning second molar which is necessary for chewing and helps support your adjacent teeth and the posterior facial dimension. The impacted tooth has to be removed.
What is an impacted tooth?
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| Large cavity and periodontal pocket and 50% bone loss down the distal root on the second molar due to the impacted wisdom tooth |
| As the word implies “strongly pressed together” or “forcible contact” is when a tooth is not in a natural physiologic state and is being encroached on by adjacent bone, soft tissue or teeth. An impacted tooth can create a deleterious effect, or influence on adjacent structures. This image shows that there isn’t a passive relationship between these two teeth. Encroachment by the wisdom tooth upon the second molar makes it difficult to maintain and keep clean and becomes a food trap which eventually results in decay, periodontal (gum) disease, or both. |
Why should they be removed?
Looking at this image a large black cavitating lesion is visible on the distal (back portion) of the second molar. In many instances when an impacted wisdom tooth is malposed or partially impacted it is unmaintainable and dental caries or periodontal pocketing ensues. If this were in the anterior oral cavity, within the smile region it would be recognized earlier, but many times it isn’t because it’s behind the other teeth. I’ve seen far too many of these situations where patients lose a good second molar because they were afraid to have it looked at for fear it would need to be removed. Many were advised by their dentist that they should avoid surgery at all costs. That is bad advice because we know that this is a set-up waiting to become a more serious problem. Then we fast forward 30 years and the patient is now in their 50’s or 60’s and the risks for surgical complications increase with age, and the set-up for disease never went away, it’s still there.
Which impacted teeth should be removed?
I am referencing to assymptomatic impacted teeth. In my experience, those teeth that have completely formed roots and are not level with the occlusal plane, have inadequate circumferential attached gingiva and an unexposed crown that is within the alveolar bone, should be treated. These conditions predispose the oral cavity to disease, and this is what I call “watchful neglect”. With this in mind I am not advocating for the same treatment plan for a 70 year old. The patients age, medical conditions and the potential risks of treatment are some factors to consider. All circumstances including the potential risks involved with removal should be weighed against the benefits of surgery. We weigh the risks of removal of the tooth with the risks of the alternative treatments where one alternative is always no treatment at all, because this is the patients decision. Although in many situations if removal is the recommendation, no treatment is not the recommendation. Diseased states certainly need some form of treatment, wether it simply be with an antibiotic or removal of the tooth.
How do we know the impacted teeth won’t relate normally when the patient is 50 or older?
There is no definitive method to predict the position of an impacted tooth. It is not uncommon for impacted teeth to shift and move during ones lifetime. Once any portion of an impacted tooth is in contact with the cervical portion of another tooth, it has the potential to cause periodontal pocketing and caries. In addition, if any part of the impacted tooth is within the coronal alveolar bone, it can become exposed. I have seen many impacted teeth in an edentulous ridge become exposed and wreak havoc in 70 and 80 year old patients with removable prostheses. They usually develop a fulminant infection, osteomyelitis, and pathologic fracture which are debilitating diseases. Requiring extensive costly medical care leaving the patient with significant deformities or to the most serious extreme, death.
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| 46 year old panoramic and post extraction periapical radiograph |
Who is the best provider to seek for evaluation and care?
An Oral and maxillofacial surgeon (OMFS) is the best source, and are the premier provider to offer the proper recommendations for you. Their training which is another 4-6 years after dental school, gives them the honor of expert. OMFS’s are equipped with the knowledge and skill and experience, additionally their office is best set up for surgical procedures.
When should they be evaluated?
Teenagers bodies are growing but at some point they stop and some females have completed their growth. All teens, especially those that do not have 32 erupted teeth in their mouth. They should be evaluated with an examination that includes periodontal probing and panoramic radiograph. Dentists must use a periodontal probe, and if you are a patient then you should ask them why? It is an essential tool that I feel many dentists don’t utilize which means their examination is incomplete.
The GIrldoc😉
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