Impaction (Wisdom Tooth)

A wisdom tooth, is any of the usual four third molars. Wisdom teeth usually appear between the ages of 16 and 25. Most adults have four wisdom teeth, but it is possible to have fewer (hypodontia), or more, in which case they are called supernumerary teeth. Wisdom teeth commonly affect other teeth as they develop, becoming impacted or "coming in sideways." They are often extracted when this occurs. The oldest known impacted wisdom tooth belonged to a European woman of the Magdalenian period (18,000–10,000 BC). Panel Oral and Maxillofacial Surgeons at Delhi Dental Hub undertake all these specilized surgical procedures as an initiative towards providing best dental  care facilities to our patients and making it Painless for the patient.

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. 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 third or second 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. Chronic inflammation in the gingival tissue of the partially erupted third-molar, i.e. chronic pericoronitis, may be the etiology for the development of paradental cyst, an inflammatory odentogenic cyst.

Impacted wisdom teeth (those that have failed to erupt through the gum line) fall into one of several categories:
1) Mesioangular impaction is the most common form (44%), and means the tooth is angled forward, towards the front of the mouth.
2) Vertical impaction (38%) occurs when the formed tooth does not erupt fully through the gum line.
3) Distoangular impaction (6%) means the tooth is angled backward, towards the rear of the mouth.
4) Horizontal impaction (3%) is the least common form, which occurs when the tooth is angled fully 90 degrees sideways, growing into the roots of the second molar.

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. In a small portion of patients, cysts and tumors occur around impacted wisdom teeth, requiring surgical extraction. Estimates of the incidence of cysts around impacted teeth vary from 0.001% to 11%, with a higher incidence in older patients, suggesting that the chance of a cyst or tumor increases the longer an impaction exists. A retrospective review of approximately 10,000 impacted teeth, suggested that the incidence of malignant tumours was 0.02% (2 cases in 9,994 teeth).