Impacted wisdom teeth: types and removal
19 Jun 2020
Wisdom teeth, otherwise known as third molars, erupt in the back four corners of the mouth, usually between the young adult ages of 17 to 21.
There can be complications with wisdom teeth, where some can fail to fully come through the gum, causing the teeth to become impacted or create other problems with alignment.
Getting wisdom teeth removed early can be a wise move indeed - with persistent pain, teeth alignment issues, damage to gums and the potential of infection just some reasons as to why people may need to have their wisdom teeth removed.
Wisdom teeth, also knows as third molars, and they erupt in the mouth in behind the 2nd molars, provided there is enough room in the person’s jaw to accommodate them.
A person generally has four wisdom teeth, one in each corner of the mouth. When all four of the “third molars” develop normally alongside the rest of your teeth and they are perfectly healthy, they are considered an asset to your mouth. However, wisdom teeth usually either fail to erupt into their expected position or they erupt at an awkward angle and become impacted.
Impacted Wisdom Teeth – Diagnosis
At your initial consultation, your dentist will likely recommend taking a full mouth radiograph known as an Orthopantomograph or an OPG. This radiograph (x-ray) will show the degree and direction of the impaction.
Types of impaction
Direction of the impaction
- In terms of “direction”, they use specific terms to indicate the positioning of the impaction. The Mesial Impaction, (also known as Angular Impaction), refers to the wisdom tooth angled in a forward position. The Mesial Impaction is the most common, accounting for 44% of cases.
- When the wisdom tooth is angled towards the throat, it is known as Distal Impaction.
- Vertical impaction occurs when the tooth is angled towards the roof of the mouth while Horizontal Impaction indicates “sideways” angulation. This is the least common type of impaction, occurring in only 3% of cases.
Degree of the impaction
- The impaction can also be described by the degree to which the tooth remains encased within the jawbone or below the gum line. This type of impaction is further sub-divided into two groups – whether a "bony" impaction or "soft tissue" impaction.
- A soft tissue impaction indicates the tooth has penetrated the bone but not the gums. A bony impaction, on the other hand, describes means they are still encased in the jaw's bone.
Soft Tissue Impaction
If the wisdom tooth has erupted out of the jawbone but still covered by the gum, it is known as a Soft Tissue Impaction. If the tooth has partially erupted out of the jawbone below the gum line, it is called a Partial Bony Impaction. A Complete Bony Impaction refers to a wisdom tooth that is totally covered by the jawbone and gum.
Although it is possible to retain one’s wisdom teeth – especially for people with larger jaws that provide enough room for the teeth to erupt properly in the mouth, it is uncommon for most people.
What are the risks?
If your wisdom teeth are causing issues, delay or postponement of a wisdom teeth removal can sometimes cause further problems. Wisdom teeth removal at an older age could also cause bigger problems as not only would the third molars become more difficult to extract, a longer healing period could be necessary.
The degree and direction of the impaction of the wisdom teeth, and the proximity to the mandibular nerve may mean that we will refer you to see a specialist oral maxilla facial surgeon.
The Wisdom Teeth Removal Procedure
A dentist or oral and maxillofacial surgeon will determine which wisdom teeth need to be removed using x-rays. This will also indicate which ones will also be functional. A dentist may need to only remove some soft tissue to allow the tooth to erupt properly, allowing the wisdom tooth to be functional.
If the wisdom tooth needs to be extracted, some surrounding bone may need to be removed, and if the tooth extracted was large, the socket may need stitches to help with the healing.
Anxious Patients and Sedation ‘Sleep’ Dentistry
Many people have a fear of the dentist, especially when it comes to tooth extraction. This is where sedation dentistry can be useful for some patients.
At Bond Street Dental, we offer a range of sedation dentistry from light ‘nitrous oxide sedation’ right through to a General Anaesthetic in our very own purpose-built facility in our dental clinic in South Yarra. With a visiting specialist anaesthetist, registered nurse and surgeons we will be able to take care of your personal preference and sedation needs right here at our practice.
It is not uncommon for patients to opt for sedation dentistry when going for a wisdom teeth removal, particularly for multiple extractions.
Some of the sedation options available at our clinic include;
Laughing Gas or Nitrous Oxide Sedation
Better known as “happy gas”, laughing gas induces feelings of relaxation when inhaled via a comfortable mask. A great benefit of this type of sedation is that the sedation effects stop upon removal of the mask, and the patient can leave shortly after the procedure.
The patient would take a prescribed anti-anxiety drug approximately an hour prior to the procedure. The patient will need to be escorted to and from the practice by a family member or a friend. Whilst the patient remains conscious, and able to communicate with the dentist, the patient is in a relaxed and comfortable state, free of anxiety during the procedure.
This intravenously administered sedation by a qualified professional, puts the patient in a “dream-like” state. Like oral sedation, the patient remains conscious and anxiety-free during treatment and again the patient will need to be escorted home after the procedure.
This is only recommended for more complex wisdom teeth extractions or where multiple procedures are prescribed in a single appointment. Available in our state of the art, purpose built facility at our clinic in Bond Street South Yarra. We offer our patients the option of a General Anaesthetic if needed.
Wisdom tooth removal costs
The fee for the removal of the wisdom tooth depends on the level and complexity of the impaction. The cost per wisdom tooth ranges from $300-$550 plus any sedation costs (if you choose sedation dentistry). We will provide you with a treatment plan and estimate of treatment costs at the time of your consultation.
If you have private health insurance, you may be able to claim a rebate for this treatment depending on your level of insurance cover.
We are pleased to offer a range of flexible payment options, including Afterpay and Zip.