Impacted Tooth

An impacted tooth is one that cannot fully erupt into its normal position in the dental arch. It may be completely buried within the jawbone (fully impacted), partially through the gum (partially impacted), or angled in a way that prevents proper eruption. Wisdom teeth are by far the most commonly impacted, but canines, premolars, and other teeth can also be affected.

Impaction happens when there is not enough room in the jaw for the tooth to emerge, or when the tooth develops at an abnormal angle. The classification depends on the direction of the impaction. Mesioangular impactions tilt toward the front of the mouth, distoangular impactions angle toward the back, horizontal impactions lie sideways, and vertical impactions are upright but stuck below the gumline. Each type presents different surgical considerations. Partially impacted teeth are particularly problematic because the opening in the gum tissue creates a pocket where bacteria can accumulate, leading to pericoronitis (infection of the gum flap), decay on the impacted tooth or the adjacent tooth, and even cyst formation around the unerupted tooth. Fully impacted teeth may remain symptom-free for years, but monitoring with periodic x-rays is important to catch any developing pathology.

For your practice, impacted teeth are a common finding on panoramic radiographs, especially in teenage and young adult patients. Having a clear referral relationship with an oral surgeon streamlines the process. When discussing impacted wisdom teeth with patients or parents, focusing on the preventive rationale, removing them before they cause problems, tends to resonate better than waiting for symptoms to develop.