Short answer: An impacted tooth is a tooth that remains in the jawbone or gums past its normal eruption time and fails to take its place in the mouth. The teeth most often impacted are the lower and upper wisdom teeth and the upper canines (eye teeth). Pain, swelling, gum inflammation and damage to neighboring teeth may occur. Depending on the tooth's position, treatment is surgical removal, monitoring or guiding the tooth into place with orthodontic treatment.
Many people are surprised to learn from an X-ray taken at a dental check-up that a tooth not visible in the mouth is waiting inside the bone. This condition, called an impacted tooth, is quite common and does not always cause complaints; in some cases, however, it can lead to problems such as pain, inflammation or damage to neighboring teeth. Whether an impacted tooth should be removed, monitored or brought into place with orthodontic treatment depends on the type of tooth, its position and the person's age. In this article we explain what an impacted tooth is, which teeth are most often impacted, the symptoms and risks, the treatment options and recovery after surgery.
What is an impacted tooth?
An impacted tooth is a tooth that remains in the jawbone or gums even though its normal eruption time has passed and fails to take its place in the mouth. Teeth that have partly emerged into the mouth while the rest stays under the gums or bone are called "partially impacted." Impacted teeth can be upright, horizontal, angled or inverted.
The main reasons teeth become impacted are:
- Lack of space: The jaw not being wide enough to hold all the teeth is the most common cause. It is thought that the human jaw has become smaller over the course of evolution and that this is why wisdom teeth in particular are so often impacted.
- Blocked eruption path: Neighboring teeth, extra (supernumerary) teeth, cysts or thick gum tissue can prevent a tooth from erupting.
- Late loss of a baby tooth: A baby tooth staying in the mouth for a long time can divert the direction of the permanent tooth underneath.
- The tooth developing in the wrong position: The tooth bud developing at an abnormal angle.
- Genetic and systemic factors: Certain familial tendencies and rare syndromes.
Which teeth are most often impacted?
The teeth most often impacted are, in order, the lower and upper wisdom teeth (third molars) and the upper canines (eye teeth). In addition, lower premolars and extra teeth can also become impacted.
Wisdom teeth
Wisdom teeth, which are usually expected to erupt between ages 17 and 25, often do not find enough space because they are the last teeth to come in. Lower wisdom teeth often remain tilted forward or horizontal and can press against the neighboring second molar.
Canines (eye teeth)
The upper canines are an important part of the smile and the bite. They usually erupt around ages 11–13, and because they follow a long eruption path, their chance of becoming impacted is relatively high. An impacted canine is most often located on the palate side. Unlike wisdom teeth, canines are functionally and aesthetically valuable, so the aim is to preserve them and guide them into place whenever possible. That is why it is important to assess the position of the canines at an orthodontic check-up in children around ages 10–11; if noticed early, simple interventions such as removing the baby canine can increase the chance that the permanent tooth erupts on its own.
What are the symptoms and risks of an impacted tooth?
Impacted teeth that are fully inside the bone often cause no symptoms at all and are noticed by chance on routine X-rays. Partially impacted teeth cause complaints more often. Possible symptoms include:
- Pain, tenderness and swelling in the gums at the back of the mouth
- Inflammation of the gum over a partially impacted tooth (pericoronitis), which may be accompanied by difficulty opening the mouth and pain when swallowing
- A bad taste in the mouth and bad breath
- Pain spreading to the jaw and ear area
- A baby tooth not falling out when it should, or a permanent tooth erupting noticeably later than its counterpart on the other side
The possible risks of impacted teeth are:
- Decay and root resorption in the neighboring tooth: A tilted wisdom tooth can create a hard-to-clean area on the back surface of the tooth in front of it. An impacted canine can cause resorption of the roots of the neighboring incisors.
- Cysts and, rarely, tumors: The sac around an impacted tooth can enlarge over time and turn into a cyst in the bone.
- Recurrent infections: These are common, especially with partially impacted wisdom teeth.
- Gum and bone loss: Loss of supporting tissue around the neighboring tooth.
Whether impacted wisdom teeth cause crowding of the front teeth has long been debated; current evidence shows that wisdom teeth are not the only cause of crowding in the front teeth.
Impacted tooth treatment: surgery or orthodontic eruption?
Treatment of an impacted tooth is determined by the type of tooth, its position, the person's age and whether the tooth is causing problems. There are three basic approaches:
Monitoring
Some impacted teeth that cause no complaints, are fully inside the bone and show no pathological findings around them can be monitored with regular X-ray check-ups. International guidelines recommend different approaches on whether impacted wisdom teeth that cause no symptoms should be removed routinely; the decision is made individually by weighing the risks and benefits.
Surgical removal
When there is recurrent inflammation, damage to a neighboring tooth, a cyst or an orthodontic treatment plan that requires it, surgical removal of the impacted tooth is recommended. This is the most common treatment for wisdom teeth. When removal is done at a young age, before the roots have fully developed, healing is usually faster.
Orthodontic eruption
Especially for impacted canines, the goal is to bring the tooth into its natural place in the mouth. This treatment is carried out through collaboration between the surgeon and the orthodontist. First, orthodontic treatment opens up the space where the impacted tooth will go. Then the tooth is exposed with a minor surgical procedure, and a button or chain is bonded to it. Using orthodontic appliances, a light, continuous force is applied to this chain, slowly pulling the tooth into place. Depending on the difficulty of the case, this process can take from a few months to one or two years. If the tooth's position is very unfavorable or its root has fused to the bone (ankylosis), guiding it into place may not be possible; the tooth is then removed and the space is managed with other methods.
What do impacted tooth surgery and recovery involve?
Impacted tooth surgery is planned after a panoramic X-ray and, when needed, a three-dimensional CT scan are used to assess the tooth's position and its proximity to important structures such as nerves and the sinus. The procedure is usually done under local anesthesia; for people with high anxiety or in complex cases, sedation options may be considered. The gum is opened, some of the bone around the tooth is removed if needed, the tooth is sometimes sectioned into pieces for removal and the area is stitched.
Things to keep in mind during recovery:
- Applying cold compresses to the face at intervals during the first 24 hours helps reduce swelling.
- Not rinsing the mouth, spitting or using a straw on the first day is important so that the blood clot stays in place.
- Lukewarm, soft foods should be chosen instead of hot and hard foods.
- Smoking delays healing and increases the risk of dry socket.
- The medications recommended by the dentist should be used as directed.
- Swelling usually peaks on the 2nd or 3rd day and then decreases; stitches are usually removed after 7–10 days.
In situations such as increasing pain, fever, a bad smell or bleeding that does not stop, you should contact the clinic without delay. For other questions, you can check our frequently asked questions page.
When should you be examined in Ankara if you suspect an impacted tooth?
If you have recurring pain and swelling around your back teeth, if your child's baby canine has not fallen out even though they are past age 12–13, or if a tooth has not come in on one side even though the matching tooth on the other side has, an assessment is recommended. At our clinic in Oran, Çankaya, the position of the impacted tooth is examined with X-rays, and we assess together with you whether removal, monitoring or orthodontic eruption is the right option.
Frequently asked questions
Do impacted wisdom teeth always have to be removed?
No, not every impacted wisdom tooth needs to be removed. Removal is recommended if there are problems such as pain, recurrent inflammation, decay in a neighboring tooth or a cyst. Teeth that cause no symptoms can be monitored with regular X-ray check-ups; the decision is made individually.
Can an impacted canine be brought into place?
In most cases, yes; impacted canines can be guided into place with a combination of surgical and orthodontic treatment. The chance of success depends on the tooth's position and angle and the patient's age. Early diagnosis makes treatment easier.
How long does it take to recover from impacted tooth surgery?
Swelling and tenderness are usually noticeable in the first few days and largely subside within a week. Soft tissue healing takes a few weeks, and bone healing takes a few months. The time varies depending on the tooth's position and the extent of the procedure.
Does an impacted tooth cause crowding of the front teeth?
Crowding of the front teeth has many causes, and current evidence shows that wisdom teeth are not the only cause. However, some teeth, such as an impacted canine, can affect the position and roots of neighboring teeth. The assessment is made through an orthodontic examination.
