Impacted Tooth Extraction

What is impacted tooth extraction?

An impacted tooth extraction is a surgical dental procedure whereby the tooth that is impacted or has not erupted (emerged) completely through the gums or is lodged below the gums or jaw bone. This is usually when wisdom teeth (the third molars) come in but can happen with canines and other teeth.

Impacted tooth extraction is not a routine tooth extraction and instead a dentist or oral and maxillofacial surgeon will have to make a cut in the gum of the patient and in some instances, remove a little bone surrounding the tooth. The tooth may also be divided into smaller segments which may make the extraction easier and less traumatic to the adjacent tissues.

What Causes Tooth Impaction?

There are a number of reasons why a tooth can become impacted:

• Not enough space in jawbones.
• Tooth malposition 
• Overcrowding from neighbouring teeth.
• Thick gums or hard jaw bones
• Delayed tooth eruption
• Genetic factors

Types of Impacted Teeth

The degree of impaction depends upon the position of the tooth:

• Soft Tissue Impaction – Gum tissue partially covers the tooth.
• Partial Bony Impaction – A portion of the tooth is in the jawbone.
• Complete Bony Impaction – Tooth is totally surrounded by the jawbone.
• Horizontal, Vertical, Mesioangular, Distoangular Impactions – These refer to the angle of the tooth.

When Is Impacted Tooth Extraction Needed?

Your dentist may suggest an extraction if it affects tooth function in any of the following ways:

• Recurring pain/discomfort
• Gums that is swollen or infected.
• Infection around the tooth (pericoronitis)
• Dental caries that is no longer repairable.
• Damage to adjacent teeth.
• Pain or stiffness in the jaw!
• Gums that form cysts or tumors around the affected tooth.
• Cleaning problems
• Orthodontic treatment planning

Surgical extraction of impacted tooth

The extraction of an impacted tooth is a dental procedure that is performed to remove a tooth that has not been able to grow out of the gums or into the jawbone properly. This is not a routine extraction but instead involves a small incision made in the gum line and may even necessitate cuts made in the bone surrounding the tooth or division of the tooth into smaller sections for removal. Wisdom teeth (third molars) are the most common teeth to be impacted but can also include canines, premolars and other permanent teeth.

Types of Impacted Teeth

Tooth that has been impacted may be distinguished by its location:

Soft Tissue Impaction

• The tooth is partially exposed, but remains partially hidden in the gums.

Partial Bony Impaction

• A portion of the tooth is encased in the jaw bone.

Complete Bony Impaction

• The whole tooth is embedded in the jaw bones.

Angular Impactions

These are used to indicate the direction of the tooth:

• Mesioangular (tilted towards the front)
• Distangular (slope backwards)
• Horizontal (lying sideways)
• Vertical (upright but unable to erupt)

Surgical Extraction Procedure

Typical steps of the procedure are as follows:

Step 1: Diagnostic assessment and imaging

• Dentist views the tooth and takes X-rays or a CBCT scan to see just how and where the tooth is located in relation to nearby nerves and sinuses.

Step 2: Anaesthesia

Depending on the complexity, the procedure can be done under:

• Local anaesthesia
• IV sedation
• Conscious sedation
• General anaesthesia

Step 3: Gum Incision

• A small cut is made in the gum to reveal the impacted tooth.

Step 4: Bone Removal

• A minimal amount of bone overlying the tooth is gently removed, if needed.

Step 5: Tooth Sectioning

• If the tooth is too large or deeply affected, it is sometimes necessary to split it up into smaller pieces so it can be removed without too much trauma.

Step 6: Tooth Removal

• Specialist surgical tools are used to carefully remove fragments of the tooth.

Step 7: Complete the cleanup of the site

• Any debris and infected tissue are removed from the extraction socket.

Step 8: Suturing

• The gum is moved back and is securely closed using either dissolvable or removable stitches.

Step 9: Gauze Placement

• Gauze is applied over the extraction site to help the bleeding to stop and blood clotting to form.

Impacted wisdom tooth extraction

The wisdom tooth is the third molar that is partially or fully stuck under the gums or under the bones of the mouth. It can grow sideways, stay in the bone, or grow just part way into the mouth.

Common impactions are:

• Mesioangular impaction: Tooth is rotated towards the front of the mouth.
• Distoangular impaction: The tooth is angled towards the back of the mouth.
• Horizontal impaction: Tooth is tilted sideways to the adjacent tooth.
• Vertical impaction: Tooth is facing up but it is not able to fully erupt.

Why extracting impacted wisdom tooth?

Your dentist or oral surgeon may suggest the removal of an impacted wisdom tooth if it causes any of the following:

• Tooth, jaw pain that lasts longer than 3 months.
• Gingivitis, or swollen, red, or bleeding gums
• Multiple gum infections (pericoronitis)
• Tooth decay
• Gum disease
• Damage to adjacent teeth.
• Cysts in the area of the affected tooth.
• Overcrowding of neighbouring teeth
• Cleaning challenge due to difficulty
• Orthodontic treatment planning

In some instances, affected wisdom teeth are removed prior to issues developing, to avoid future issues.

How is an impacted wisdom tooth extracted?

Step-by-Step Procedure:

Initial Examination

Prior to the procedure, the dentist will:

• Check your health and dental record.
• Examine your mouth.
• Perform dental x-rays or a 3D CBCT scan to evaluate the position of the tooth, the shape of its roots and the relationship of the tooth to the nerves and sinus cavity nearby.
• This assessment can help decide on the best extraction method.

Administration of Anaesthesia

To make you feel comfortable, you can use one of the following:

• Local anaesthesia: Anesthetizes the area that's being extracted with no loss of consciousness.
• Sedation: This will relax you and possibly make you sleepy during the procedure.
• General anaesthesia: This will sedate you and is only used for complex procedures or multiple teeth.

Making an Incision

• If the tooth is covered by gum tissue, the surgeon makes a small incision in the gums to open the area of the tooth and bone.

If necessary, remove Bone

• When the wisdom tooth is stuck in the jaw, a small amount of bone that surrounds the tooth is gently removed with special surgical tools. Just enough bone is taken out to allow for the maximum implant placement.

Sectioning the Tooth

If the wisdom tooth is large and/or is already impacted, it may be divided into smaller sections.

This technique:

• Makes removal easier.
• Minimises pressure on the jawbone.
• Reduces the risk of damaging neighbouring tissues.
• Helps preserve nearby teeth and bone.

Removing the Tooth

• Dental elevators and forceps are used to gently loosen and remove each section of the tooth.
• Surgeon verifies that all fragments have been removed.

The Extraction Site is cleaned

Once the tooth has been extracted, the socket is thoroughly cleaned to ensure that all the following are removed:

• Tooth fragments
• Bone debris
• Damaged tissue
• Bacteria

This is a great way to help minimize the chances of infection.

Closing the Surgical Site

• The tissue of the gums is pulled back and stitched.

With each type of suture:

• Absorbable stitches will dissolve on their own in 1-2 weeks.
• The stitches are not dissolving and will be removed during a follow up visit.

Controlling Bleeding

• After the tooth is removed, a sterile gauze pad is put over the extraction area.
• You will have to gently bite on the gauze for 30-60 minutes to promote the blood clotting process that is required for healing.

Recovery from impacted wisdom tooth extraction

The process of recovering from an impacted wisdom tooth extraction is gradual and usually takes 1-2 weeks for the gums to heal and 3-6 months for the jawbone to completely heal. Most patients have mild pain, swelling, and stiffness in the first few days that gradually improve as they take care of the injury.

Recovery Timeline

First 24 Hours

On the first day, a blood clot will form in the extraction socket which will protect the nerves and bone underneath.

You may experience:

• Light bleeding/blood-stained saliva
• Swelling of facial skin around the cheek area.
• May feel numb until the anaesthetic fades
• Some minor pain or discomfort

What to do:

• Bite gently on the gauze for 30–60 minutes.
• Apply an ice pack for 15–20 minutes at a time.
• Don't strain the head and neck, and keep your head up.
• Only take soft cool food.
• Consume lots of water.
• Use pain medicine according to instructions.

Days 2–3

This is when swelling is at its greatest.

Common symptoms include:

• Facial swelling
• Jaw stiffness
• Mild bruising
• Has trouble opening mouth wide enough for the dental mirror.

Care tips:

• Keep taking medicines as directed.
• Use warm compresses as recommended by your dentist after 24-48 hours.
• After the first 24 hours, start to gently rinse with warm salt water.
• Carefully brush teeth around the extraction site, but not within.

Days 4–7

Patients start to feel much better most of the time.

You may notice:

• Reduced swelling
• Less pain
• Improved mouth opening
• Improved chewing of soft food.
• Normal daily activities can be resumed as your mood allows.

Week 2

By the second week:

• Gum tissue is mostly reattached.
• All dissolving stitches might start to fade away.
• There has been little swelling and discomfort.
• Food comes easily.
• Your dentist might take out non-dissolvable stitches during a subsequent visit.

Complete Healing

• Although you may feel normal within two weeks, the bone beneath the gums continues to heal.
• Soft tissue healing: 7–14 days
• Bone healing: 3–6 months
• At this time, new bone will form in the extraction socket over time.

Pain Management

The pain is typically most intense on days 1-3.

Relief measures include:

• Prescribed pain medication (if given)
• Your dentist will recommend pain relievers that you can purchase over the counter.
• Ice packs first 24 hours.
• Adequate rest
• Staying hydrated
• Pain should gradually decrease each day.

Oral Health in Recovery

• Maintain cleanliness of the mouth to prevent infection.
• Brush your teeth twice a day, but brush them gently.
• Do not brush immediately over the extraction site.
• Gently wash with warm salt water after eating, starting 24 hours after surgery.
• Don't rinse your mouth too vigorously on the first day.

Conclusion

Impacted tooth extraction is a surgical procedure which safely and effectively removes a tooth that is stuck under the gums or jawbones and cannot come up. It can help avoid pain, infections, the loss of adjacent teeth and the development of cysts and gum disease if a tooth is affected whether it is a wisdom tooth, canine or another permanent tooth. The procedure is typically painless and with today's technology in dentistry, dental imaging, advanced surgical techniques and effective dental anaesthesia, most patients recover within 1-2 weeks. Adhering to post-surgical recommendations by your dentist, practicing good oral hygiene and following-up with appointments are essential to a smooth recovery and maintaining long-term oral health.

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FAQ

Is impacted tooth extraction painful?

• No. You will not feel pain during the surgery as it is performed under local anaesthetic, sedation or general anaesthetic. After the surgery, there is usually some pain, swelling and discomfort which can be managed with either prescribed or over-the-counter pain medication.

How long does an impacted tooth extraction take?

• This usually takes 20-60 minutes, depending on tooth position, depth of impaction and if one tooth or a number of teeth are being extracted.

What is dry socket and how can it be prevented?

• Dry socket is a painful condition that develops when the blood clot that forms over the tooth extraction site dislodges prior to healing. Smoking, drinking with a straw, strenuous rinsing, spitting and activities during the first few days after surgery increase the risk of infection; avoid these to reduce the risk.

Should impacted teeth always be extracted?

• Not always. If your tooth is not damaged and experiencing no symptoms, then your dentist may choose to monitor instead of have it extracted. But, in most cases, the removal is recommended when the tooth is aching, infected, decayed causing gum disease or other complications.