Impacted wisdom teeth
| Impacted wisdom teeth | |
|---|---|
 |
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| 3D CT of an impacted wisdom tooth adjacent the inferior alveolar nerve prior to removal of wisdom tooth | |
| Classification and external resources | |
| Specialty | dentistry |
| ICD-10 | K01.1 |
| ICD-9-CM | 520.6 |
| OMIM | 189490 |
| DiseasesDB | 32003 |
| MedlinePlus | 001057 |
| MeSH | C07.793.846 |
Impacted wisdom teeth (or impacted third molars) are wisdom teeth which do not fully erupt into the mouth because of blockage from other teeth (impaction). If the wisdom teeth do not have an open connection to the mouth, pain can develop with the onset of inflammation or infection or damage to the adjacent teeth. Common accepted hypothesis that determine eruption is the angle at which the 3rd molars sit, the stage of root formation of 3rd molars at the point of screening, depth of impaction, how much room there is for eruption as well as the size of the 3rd molar.
Wisdom teeth likely become impacted because of a mismatch between the size of the teeth and the size of the jaw. Impacted wisdom teeth are classified by their direction of impaction, their depth compared to the biting surface of adjacent teeth and the amount of the tooth's crown that extends through gum tissue or bone. Impacted wisdom teeth can also be classified by the presence or absence of symptoms and disease. Screening for the presence of wisdom teeth often begins in late adolescence when a partially developed tooth may become impacted. Screening commonly includes clinical examination as well as x-rays such as panoramic radiographs.
Infection resulting from impacted wisdom teeth can be initially treated with antibiotics, local debridement or soft tissue surgery of the gum tissue overlying the tooth. Over time, most of these treatments tend to fail and patients develop recurrent symptoms. The most common treatment is wisdom tooth removal. The risks of wisdom tooth removal are roughly proportional to the difficulty of the extraction. Sometimes, when there is a high risk to the inferior alveolar nerve, only the crown of the tooth will be removed (intentionally leaving the roots) in a procedure called a coronectomy. The long-term risk of coronectomy is that chronic infection can persist from the tooth remnants. The prognosis for the second molar is good following the wisdom teeth removal with the likelihood of bone loss after surgery increased when the extractions are completed in people who are 25 years of age or older. A treatment controversy exists about the need for and timing of the removal of disease-free impacted wisdom teeth that are not causing problems. Supporters of early removal cite the increasing risks for extraction over time and the costs of monitoring the wisdom teeth that are not removed. Supporters for retaining wisdom teeth cite the risk and cost of unnecessary surgery.
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