In many instances, impacted wisdom teeth do not produce signs and symptoms. In cases when they do, it is primarily attributed to the onset of gum diseases and infection that has set in. Under such circumstances, the following signs and symptoms are experienced:

• Pain in the affected area
• Tender and swollen gums
• Gums may bleed and be painful
• Development of bad breath and unpleasant taste inside the mouth
• Headache
• Swelling around the jaw area

• Pain

  Misaligned wisdom teeth are often positioned horizontally or angled toward or away from the teeth and may cause damage to the surrounding teeth or jaw, resulting in pain. [houstonmethodist.org]

  Pain Medication Dreamstime Many patients who aren’t getting their wisdom teeth out right away, may want to deal with the pain at least temporarily, so dentists often recommend over-the-counter pain relief medication. [healthprep.com]

  […] to no pain or swelling. [chapinoralsurgery.com]

• Dentist

  When wisdom teeth emerge normally, a dentist is usually able to handle the extraction. But if you have impacted wisdom teeth, your dentist might refer you to an oral surgeon who is more skilled in removing teeth awkwardly positioned in the mouth. [healthprep.com]

  It's important to talk to your dentist about your concerns. Anxiety is common and nothing to be embarrassed about. Ask your dentist for suggestions on how to cope with your anxiety and discomfort. [drugs.com]

  A dentist will take periodic x-rays at your regular dental visits to be able to look at your teeth and know if something needs looked at relating to your wisdom teeth. Remember to tell your dentist if anything in your mouth has been bothering you. [eaglerockdentalcare.com]

  When To Call a Professional Call your dentist if you feel pain in your back teeth. If you visit your dentist regularly, he or she will keep track of your wisdom teeth and let you know if you need to have them taken out. [colgate.com]

  What to expect at the dentist The dentist will probably take an x-ray to see how the roots lie and how the tooth is growing. The removal may take place at a dentist's surgery or as an outpatient at the hospital. [medicalnewstoday.com]

• Swelling

  After surgery, some swelling or mild discomfort may occur, so your physician may recommend cold compresses to reduce swelling, pain medication and a modified diet. [houstonmethodist.org]

  Unlike the infected wisdom tooth, there is usually not any pain or swelling until it is quite large. Tumors: An un-erupted or impacted tooth has a follicle around the crown, which allows it to erupt normally in the mouth. [omaxsurgery.com]

  - Jessica O 5 out of 5 stars by Jessica O on 02/17/2016 Patient Review I had all four wisdom teeth removed the same day and expected swelling and pain after the procedure.....to my surprise, I had little to no pain or swelling. [chapinoralsurgery.com]

  They can cause inflammatory dental disease manifested by pain and swelling of infected teeth and may destroy adjacent teeth and bone. [ncbi.nlm.nih.gov]

• Inflammation

  /infection) and adverse effects associated with their removal (alveolar osteitis/postoperative infection, nerve injury, damage to adjacent teeth during surgery, bleeding, osteonecrosis related to medication/radiotherapy, inflammation/infection). [ncbi.nlm.nih.gov]

  […] effects associated with their removal (alveolar osteitis/ postoperative infection, nerve injury, damage to adjacent teeth during surgery, bleeding, osteonecrosis related to medication/radiotherapy, inflammation/infection). [cochrane.org]

• Surgical Procedure

  Extraction of wisdom teeth is one of the most commonly performed surgical procedures. Wisdom teeth typically emerge between the ages of 17 and 25. [houstonmethodist.org]

  In reality, this is an easier surgical procedure to perform than having to expose and bracket the impacted tooth. This will encourage some eruption to occur before the tooth becomes totally impacted (stuck). [oralfacialsurgeon.com]

  INTRODUCTION: Wisdom tooth removal is one of the most common oral surgical procedures performed across the world. The aim of this study was to gauge the teaching and training of impacted wisdom teeth in undergraduate dental programmes across the UK. [ncbi.nlm.nih.gov]

• Difficulty Opening the Mouth

  Symptoms of impacted wisdom teeth include: Bad breath Red gums Tender or bleeding gums Headache Jaw stiffness Unpleasant taste in mouth Difficulty opening the mouth If left untreated these symptoms can develop into worse problems such as: Damage to adjacent [familycedarrapidsdentist.com]

  In those who have symptoms, impacted teeth may cause: Redness and swelling of the gums around the impacted tooth Pain or tenderness of the gums or jaw bone Prolonged, unexplained headache or jaw ache Difficulty opening your mouth Unpleasant taste when [health.cvs.com]

  However, as they progress, they can cause problems such as: Jaw pain Swelling, particularly around the gums or around the jaw Bleeding gums (though be aware that bleeding gums is also a symptom of periodontal disease ) Bad breath Difficulty opening your [thedentalexpress.com]

  […] near the affected area Food to be trapped behind the tooth Headache or jaw ache Occasional difficulty opening the mouth Occasional swollen lymph nodes in the neck To diagnose impacted wisdom teeth, dentists look for swollen gums or signs of infection [livescience.com]

• Bleeding Gums

  However, as they progress, they can cause problems such as: Jaw pain Swelling, particularly around the gums or around the jaw Bleeding gums (though be aware that bleeding gums is also a symptom of periodontal disease ) Bad breath Difficulty opening your [thedentalexpress.com]

  Symptoms of impacted wisdom teeth include: Bad breath Red gums Tender or bleeding gums Headache Jaw stiffness Unpleasant taste in mouth Difficulty opening the mouth If left untreated these symptoms can develop into worse problems such as: Damage to adjacent [familycedarrapidsdentist.com]

  Tender, Red or Bleeding Gums [acfdga.com]

  Symptoms may include pain, swollen and bleeding gums, swelling around the jaw, bad breath, headache or jaw ache, and an unpleasant taste when eating. Some people experience stiffness of the jaw or swollen lymph nodes in the neck. [colgate.com]

  Symptom #2: Swollen, tender and bleeding gums Impacted wisdom teeth can cause serious gum issues. The gums may become swollen and tender to the touch. [dentalvibe.com]

• Jaw Pain

  Jaw Pain: Jaw pain is a common sign of impacted wisdom teeth. The pain radiates from the affected area down throughout the jaw and the jaw joint. [trapnellorthodontics.com]

  Pain from an impacted wisdom tooth (or teeth) is one of the most common causes of pain, and often the culprit of jaw pain or a toothache. [acfdga.com]

  Pain Pain, swelling and a stiff jaw are symptoms of an impacted wisdom tooth. Gum infections If the wisdom tooth has started to break through the gum line, bacteria can easily seep through this opening, setting the stage for a gum infection. [thedentalexpress.com]

  If you or your child has received a recommendation to undergo wisdom tooth extraction, or are bothered by symptoms like jaw pain and swelling, contact our practice to schedule an appointment today. [glennoms.com]

  Impacted Wisdom Teeth Pain: Wisdom teeth pain can be a sign of impacted wisdom teeth, which occurs when wisdom teeth are prevented from emerging by the jaw bone or other teeth. [crest.com]

• Toothache

  Pain from an impacted wisdom tooth (or teeth) is one of the most common causes of pain, and often the culprit of jaw pain or a toothache. [acfdga.com]

  He prescribed an aggressive regimen of Amoxicillin to begin combating the pain-causing infection, and the toothache disappeared in less than a day. [dentalfearcentral.org]

  Tip # 3 - OTC Oral Pain Relievers Orajel Instant Pain Relief for Severe Toothache is the only over-the-counter product that has actually worked for me, including other Orajel products. [healdove.com]

  An infection can lead to bad breath, earache, headache, a strange taste in the mouth, toothache, swollen gums which may be redder than usual, swollen jaw, and bleeding gums. [medicalnewstoday.com]

  This can cause toothache, earache pain, swelling and even infection, cysts and abscesses. If this is the case, then it could be necessary to have the wisdom teeth removed from your mouth. [patient.info]

• Tooth Loss

  Although dentists will use every measure to prevent tooth loss, there are still sometimes necessary occasions when a tooth may need to be extracted. [burnsdentalva.com]

  Bone loss, loosened teeth and eventually tooth loss. Pain, and possibly infection, if the tooth is left in the gums too long. [lowelloralsurgery.com]

  Lack of good dental hygiene led to extensive tooth loss. So when it came time for these third molars to emerge in the back of the mouth, there was plenty of room to welcome them. [thedentalexpress.com]

  Additionally, the harsh world of the caveman no doubt often led to the occurrence of broken teeth and tooth loss. Once a tooth (or a portion of it) is missing the teeth behind it have a tendency to shift forward. [animated-teeth.com]

• Eruptions

  Complete Bony Impaction: There is NO space for the tooth to erupt. [aomsnj.com]

• Erythema

  Epulis Pyogenic granuloma Congenital epulis Gingival enlargement Gingival cyst of the adult Gingival cyst of the newborn Gingivitis Desquamative Granulomatous Plasma cell Hereditary gingival fibromatosis Hypercementosis Hypocementosis Linear gingival erythema [en.wikipedia.org]

• Suggestibility

  It has been suggested that watchful monitoring of asymptomatic wisdom teeth may be an appropriate strategy. [ncbi.nlm.nih.gov]

  Another study, also at high risk of bias, found no evidence to suggest that removal of asymptomatic disease-free impacted wisdom teeth has an effect on crowding in the dental arch. [cochrane.org]

• Fear

  Brigham Burton is very gentle, understands people with fear of dental work, and works to make sure the patient experiences the least amount of pain possible. He recently did two crowns for me and I was amazed at his smooth technique. [edenutahdentist.com]

  If you are experiencing one or more of these warning signs and fear that you may have impacted wisdom teeth, you should contact your dentist right away. [dentalvibe.com]

  In cases, when there is complete impaction, there is significant fear of development of cysts or neoplasms in the affected area. Such a type of phenomenon is however uncommon. [symptoma.com]

  I have known since my teenage years that my wisdom teeth need to be taken out but have also had a consistant fear of ANY kind of dental work. I have literally put off the procedure for ten years. [dentalfearcentral.org]

  The fear most people have is pain during the treatment; however, the procedure itself is actually pain-free. [patient.info]

• Headache

  Symptom #5: Headaches Impacted wisdom teeth can cause headaches of the temporomandibular joint, which connects the jaw and skull. This pain may radiate to other areas of the head and face as well. [dentalvibe.com]

  Symptoms of impacted wisdom teeth include: Bad breath Red gums Tender or bleeding gums Headache Jaw stiffness Unpleasant taste in mouth Difficulty opening the mouth If left untreated these symptoms can develop into worse problems such as: Damage to adjacent [familycedarrapidsdentist.com]

  Symptoms may include pain, swollen and bleeding gums, swelling around the jaw, bad breath, headache or jaw ache, and an unpleasant taste when eating. Some people experience stiffness of the jaw or swollen lymph nodes in the neck. [colgate.com]

  Headaches: In many patients, impacted wisdom teeth can cause headaches at the temporomandibular joint, where the jaw connects to the skull, and this pain may expand to the rest of the face and head. [collaborative-dental.com]

  In those who have symptoms, impacted teeth may cause: Redness and swelling of the gums around the impacted tooth Pain or tenderness of the gums or jaw bone Prolonged, unexplained headache or jaw ache Difficulty opening your mouth Unpleasant taste when [health.cvs.com]

• Irritability

  Treatment You can sometimes relieve minor irritation by rinsing with warm salt water (1/2 teaspoon of salt in 8 ounces of water). Over-the-counter pain relievers also may help. [colgate.com]

  More serious infections include cellulitis in the cheek tongue or throat or gingivitis, the gum disease that results when plaque releases toxins that irritate the gums. [medicalnewstoday.com]

  It is advised that you avoid sharp food items like crackers and chips as they will irritate the surgical site if they jab the wound during initial healing. [olympicoralsurgery.com]

  Do not use commercial mouth rinses -- these can irritate the extraction site. Continued After 24 hours Facial swelling in the area of the tooth extraction should be treated with heat after the first 24 hours of ice. [webmd.com]

  If used for very long, it can cause irritation or burns to the tongue or other tissues, and the pain will return soon after removing the clove. Saltwater: Saltwater has a cleansing effect that battles bacterial infections. [medicinenet.com]

• Feeling of Relaxation

  Hairr was also very friendly, and made me feel very relaxed and comfortable about the procedure. He was able to extract the tooth and everything went well. [chapinoralsurgery.com]

  Soon, the doctor came in and by this point I began feeling really relaxed from the gas. He put some kind of cooling agent on my hand and put in the IV, it didn't even hurt. [dentalfearcentral.org]

Impacted wisdom teeth can be clinically diagnosed in patients who have partial eruption and the teeth is visible during examination so that the angulation and depth of the impaction can be determined. Such a kind of analysis is also possible if the patients are too young for further eruption of the wisdom tooth. It has been known that, wisdom teeth continues to grow even during adulthood and significantly contribute to the development of periodontal disease [6].

When clinical diagnosis does not provide useful information about the condition, then dental X-ray examination or cone beam CT scan are used for diagnosing the condition of impacted wisdom teeth [7].

In conditions, when the impacted wisdom teeth are causing problem, surgical removal is the best option. Complications resulting from surgical extraction of tooth are rare and therefore it is considered as the best method which is done by the socket-shield technique [8] [9].

Impacted wisdom teeth that do not cause any problems are generally considered as asymptomatic. However, there is no evidence suggesting that such teeth would not be a significant source of problem later in life too. Therefore, keeping this in mind, there have been several controversies surrounding the surgical removal of such impacted teeth. Scientists argue that, the asymptomatic impacted wisdom teeth cannot be disease free and therefore, extraction is the best method to avoid onset of future complications.

The prognosis of the condition gravely depends on the severity of impaction. In cases, when there is complete impaction, there is significant fear of development of cysts or neoplasms in the affected area. Such a type of phenomenon is however uncommon. In individuals with partial impaction, the chances of development of signs and symptoms usually increase with age. Studies have reported that, about 30 to 60% of individuals with impacted wisdom teeth, who were asymptomatic in the past, experienced symptoms of gums disease almost 2 to 4 years after the first examination was carried out [5].

The major cause of wisdom teeth to get impacted is that they do not get enough space to appropriately erupt. In other conditions, the mouth is overcrowded, which does not allow enough space for the third molars to develop at a normal pace. In such situations, the third molars get trapped and thereby become impacted. Impacted wisdom tooth can either be partially impacted, wherein the crown is visible or they are completely impacted, where they do not break out from the gums [2]. There are certain pieces of evidence suggesting a genetic predisposition for development of wisdom teeth impaction [3].

A large scale study carried out in New Zealand revealed that 95.6% had at least one wisdom tooth which had an eruption rate of 15% in the maxilla and 20% in the mandible. In yet another study, which was done on 5000 army recruits, showed 10,767 impacted wisdom teeth.

Wisdom teeth can either be partially or fully impacted. In both the cases, the teeth grow in the following directions:

• It may grow at an angle in the direction of second molar
• It may grow at the back of the mouth
• It my grow in a direction that forms a right angle with the other tooth; giving an appearance as if the wisdom tooth lies within the jaw bone
• Grows straight as any other teeth, but may be trapped inside the jaw bone

In individuals with partially impacted wisdom teeth, the most common reason for tooth removal are development of pericoronitis, or any other infection of the gums [4]. Statistics has revealed that, about 15% of individuals with impacted wisdom teeth suffer from cavities either on the surface of the impacted tooth or in the neighboring second molars.

The occurrence of impacted wisdom teeth cannot be prevented. However, onset of complications can certainly be kept at bay if the condition is promptly treated by either extraction of tooth or local methods to treat gum infections. Maintaining proper dental hygiene can help in preventing the onset of gum cavities and infection [10].

Impacted wisdom teeth are also known as impacted third molars. Impacted wisdom teeth can cause damage to the teeth which are adjacent to it. In many instances however, the wisdom teeth may not cause any problems. Such teeth may be difficult to clean and therefore can be susceptible to tooth decay and onset of gum diseases [1].

• Definition: Impacted wisdom teeth is a condition, wherein the wisdom tooth does not fully erupt due to various factors. Such a type of condition can be a cause of great discomfort for individuals who develop pain and other associated symptoms due to tooth impaction.
• Cause: Various factors that prevent or obstruct the complete eruption of wisdom teeth give rise to impacted wisdom teeth. The major cause is when the mouth gets overcrowded with other teeth, leaving little room for the wisdom teeth to sufficiently grow.
• Symptoms: In many cases, individuals do not experience symptoms. However, when impacted wisdom teeth favors the development of cysts or gum disease, affected individuals suffer from pain, tenderness, swelling along with redness, bad breath and unpleasant taste in mouth.
• Diagnosis: Clinical examination is often enough for diagnosing impacted wisdom teeth. However, when this does not provide useful insight, then dental radiographs and core beam CT scan may also have to be employed.
• Treatment: Treatment of impacted wisdom teeth depends on whether or not the condition is causing any symptoms. In case of development of gum disease or infections, surgical extraction of the teeth is recommended. Treatment of asymptomatic impacted wisdom teeth is controversial, whether or not to be surgically removed.

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2. Linde A, Goldberg M. Dentinogenesis. Crit Rev Oral Biol Med 1993; 4:679.
3. Marks SC Jr. The basic and applied biology of tooth eruption. Connect Tissue Res 1995; 32:149.
4. Delaney JE, Keels MA. Pediatric oral pathology. Soft tissue and periodontal conditions. Pediatr Clin North Am. Oct 2000;47(5):1125-47
5. Ramos-Jorge J, Pordeus IA, Ramos-Jorge ML, Paiva SM. Prospective longitudinal study of signs and symptoms associated with primary tooth eruption. Pediatrics 2011; 128:471.
6. Gart C, Zamanian K. Title Global trends in dental imaging: the rise of digital. 
7. Dölekoğlu S, Fişekçioğlu E, İlgüy M, İlgüy D. The usage of digital radiography and cone beam computed tomography among Turkish dentists. Dentomaxillofac Radiol. 2011/09;40(6):379-84).
8. Hürzeler MB, Zuhr O, Schupbach P, Rebele SF, Emmanouilidis N, Fickl S. The socket-shield technique: a proof-of-principle report. J Clin Periodontol. Sep 2010;37(9):855-62.
9. Shakibaie-M B. Comparison of the effectiveness of two different bone substitute materials for socket preservation after tooth extraction: a controlled clinical study. Int J Periodontics Restorative Dent. Mar 2013;33(2):223-8.
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