An impacted tooth is a tooth that has not fully erupted into the mouth and has remained partly or completely within the bone or under the gum tissue. Wisdom teeth are the teeth most often found in this position, although canines and other teeth may also be affected. Whether a surgical procedure is indicated is decided by the dentist after examination and radiographic evaluation.
Why a tooth remains impacted
A tooth may not erupt when there is insufficient space in the dental arch, when it is angled in a direction that prevents it from emerging, or when the surrounding bone or soft tissue lies in its path. The position and angulation are established on a radiograph.
Findings that are assessed
Some patients have no complaints and the tooth is noticed on a radiograph taken for another reason. Others describe pain or pressure at the back of the jaw, swelling or tenderness of the gum over the area, difficulty opening the mouth, or repeated inflammation around a partly erupted tooth. Each of these findings is assessed at examination; none of them determines the plan on its own.
How the decision is made
The dentist examines the mouth and reviews a radiograph, usually a panoramic view, to establish the position of the tooth, its relationship to the neighbouring roots and to the anatomical structures nearby. Your medical history and any medication you take are also reviewed. Where the tooth is not causing findings and the assessment does not indicate removal, the dentist may recommend that it be followed up at routine examinations instead.
How the procedure proceeds
- Preparation. The plan is explained, questions are answered, and the area is numbed with local anaesthesia.
- Access. Where the tooth lies under gum tissue or bone, the tissue over it is reflected so that the tooth can be reached.
- Removal. The tooth is removed; depending on its position it may be divided into sections so that it can be taken out through a smaller opening.
- Cleaning of the site. The socket is cleaned and irrigated.
- Closure. The tissue is repositioned and sutured where this is considered necessary.
- Review. A follow-up appointment is arranged, at which sutures are removed if non-resorbable sutures were used.
How long the procedure takes depends on the position of the tooth and is discussed with you beforehand.
After the procedure
Swelling, limited mouth opening and discomfort in the first days are commonly reported, and their extent differs from person to person. Your dentist gives instructions specific to your procedure. These usually cover biting on the gauze for the period stated, avoiding rinsing and spitting on the first day, applying cold to the outside of the face as directed, choosing soft and lukewarm foods, refraining from smoking, and taking any prescribed medication as instructed. If bleeding, swelling or pain continues beyond what your dentist described, you are asked to contact the clinic.
Points that are discussed beforehand
Because the roots of impacted teeth may lie close to nerves and to the maxillary sinus, the dentist explains the findings on the radiograph and the points relevant to your own case before the procedure. Any regular medication, particularly blood thinners, and any general health condition should be reported at this stage. Where a tooth in a different part of the mouth is missing, the plan may also include a discussion of dental implants or of root canal treatment where a tooth can be retained.
Impacted teeth other than wisdom teeth
Wisdom teeth are the most common impacted teeth, but they are not the only ones. Upper canines are the next most frequent, and premolars and other teeth can also fail to come through. The approach here is often different: rather than removal, the tooth may be uncovered surgically and guided into position with orthodontic traction, because a canine has a structural role in the bite. Whether a tooth is removed or brought into the arch is decided from radiographs together with the orthodontic plan.
Dry socket and how it is managed
After an extraction a blood clot forms in the socket and protects the underlying bone while healing begins. If that clot is lost early, the site becomes painful, typically from the second or third day, and the pain can radiate towards the ear. Rinsing vigorously, smoking and using a straw in the first days are the situations most often associated with it. The condition is managed at the clinic by cleaning and dressing the socket; it is not resolved by painkillers alone, so an appointment should be arranged rather than waiting.
The nerve canal and temporary numbness
In the lower jaw a nerve canal runs close to the roots of the back teeth. Three-dimensional imaging is used when the relationship between root and canal needs to be seen clearly, and the surgical approach is planned accordingly. Altered sensation in the lip or chin after a lower extraction is uncommon and in most reported cases temporary, but it is discussed before the procedure rather than afterwards so that the patient knows what to report. Any persistent numbness should be reported to the clinic.
Upper teeth and the sinus
The roots of upper back teeth can lie close to the floor of the maxillary sinus, and in some cases extend into it. This is assessed on the radiograph before the procedure and affects how the tooth is removed. After such an extraction, blowing the nose forcefully and sneezing with a closed mouth are usually avoided for a period, and the dentist explains for how long. If air or fluid passes between the mouth and nose after an extraction, the clinic should be contacted.
Eating and cleaning in the first week
Soft, lukewarm food on the opposite side is the usual advice for the first days, moving back to a normal diet as comfort allows. Very hot food and drink, hard and crumbly items and alcohol are avoided early on. Brushing continues on the rest of the mouth from the first day, while the extraction site itself is kept clean in the way the dentist describes rather than brushed directly. Any rinsing regimen is started at the time the dentist specifies, not immediately.
Timing around travel, work and other treatment
Swelling and discomfort are usually most noticeable in the first two to three days, so the procedure is often planned before a period without heavy commitments. Long flights soon after a surgical extraction are generally discussed with the dentist beforehand. Where other dental treatment is planned in the same area, the sequence matters, and it is set out at the examination so that healing and the rest of the plan do not conflict.
Frequently asked questions
Does every impacted tooth have to be removed?
No. Whether removal is indicated is decided case by case, after examination and radiographic evaluation. In some cases the tooth is followed up at routine appointments.
Will I feel anything during the procedure?
The area is numbed with local anaesthesia. What is felt during and after the procedure differs from person to person, and your dentist discusses this with you beforehand.
If you have a question about this subject, you can reach our clinic.
How long does recovery take?
This varies according to the position of the tooth and the individual. Your dentist tells you what to expect for your own case and arranges a review appointment.
Can two impacted teeth be removed in one appointment?
This is a clinical decision. Your dentist decides after assessing the position of the teeth and your general health.
When should I return to the clinic?
At the review appointment arranged for you, and sooner if you notice anything that differs from what your dentist described. You can reach us through the contact page.
The information on this page is for general information purposes only and does not replace an examination by a dentist. Diagnosis and treatment planning are carried out by the dentist following an intraoral examination and, where considered necessary, radiographic evaluation.
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Related pages
- Our dental treatments — an overview of the treatments carried out at our clinic.
- Our dentists — the dentists working at our clinic.
- Contact us — appointment and directions.
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