Impacted Tooth: Symptoms, Types, Causes and Treatment

Impacted teeth are a common dental problem that can affect people of all ages, often causing discomfort, complications, and requiring specialized care. Whether triggered by local or systemic factors, tooth impaction can lead to a variety of symptoms and may involve different teeth, most notably the third molars (wisdom teeth) and canines. Understanding the symptoms, types, underlying causes, and treatment options is essential for effective management and prevention of long-term dental issues. This article provides a comprehensive overview, synthesizing the latest research findings on this important topic.

Symptoms of Impacted Tooth

Impacted teeth may not always announce their presence, but when symptoms do arise, they can range from mild to severe. Early identification of these signs is crucial to avoid complications and ensure timely intervention. While pain is often the most recognized symptom, others like infection, headaches, or even systemic issues can be linked to tooth impaction.

Symptom	Description	Age/Context	Source(s)
Pain	Aching or sharp discomfort	Most common, all ages	1 3 12
Caries	Tooth decay in or near impaction	Younger patients	1 9 12
Gingivitis	Gum inflammation	Older adults	1 12
Oral Infection	Swelling, pus, bad taste	All ages, acute cases	1 9 12
Headache	Generalized or localized pain	Often with molars	2 3
Limited Mouth Opening	Difficulty opening jaw	Severe impaction	3
Systemic Symptoms	Fatigue, vertigo, nausea	Rare, asymptomatic cases	2

Table 1: Key Symptoms of Impacted Teeth

Common and Localized Symptoms

Pain is the hallmark of impacted teeth, especially when infection or pressure is present. It often leads patients to seek dental care. Associated with this can be swelling, redness, and tenderness in the gums overlying the impacted tooth 1 3.

Dental caries (tooth decay) can develop on the impacted tooth or adjacent teeth due to difficulty cleaning the area, especially in younger patients under 30 1 9. Gingivitis and more severe periodontal problems, like periodontal bone loss, are common in older adults, as inflammation spreads from the impacted tooth to surrounding gums 1 9 12.

Infection may present as swelling, pus drainage, or even a bad taste in the mouth. In more serious cases, this can lead to oral abscesses or spread to the throat 1 9.

Systemic and Rare Symptoms

Some individuals, even without obvious local symptoms, may experience systemic issues such as headaches, vertigo, fatigue, blurred vision, nausea, tension, and irritability. These rare symptoms have been linked to asymptomatic, unerupted impacted teeth and may resolve after the tooth is treated 2.

Limited mouth opening (trismus) can occur if the impacted tooth is severely inflamed, making it difficult to eat or speak 3.

Complications from Untreated Symptoms

If left untreated, impacted teeth can lead to:

• Periodontitis (advanced gum disease)
• Root resorption of adjacent teeth
• Cysts or tumors
• Distal caries on neighboring teeth
• Persistent or recurrent infections 9 12 13

Types of Impacted Tooth

Impaction can affect various teeth and can occur in different patterns or orientations. Recognizing these types is essential for diagnosis and planning effective treatment.

Type	Orientation/Tooth Affected	Prevalence/Pattern	Source(s)
Mesioangular	Tooth tilts toward front	Most common in molars	1 3 10
Horizontal	Tooth lies sideways	Second most common	1 3
Vertical	Tooth upright but blocked	Less common	1 3
Distoangular	Tooth tilts backward	Least common in molars	1 3
Canine	Often maxillary, various	Most common non-molar type	4 5 7 10
Premolar	Second premolar, various	Less frequent	4 5 7
Supernumerary	Extra teeth, various	Rare, may cause impaction	4 5 7 10

Table 2: Main Types of Impacted Teeth

Orientation-Based Types

Mesioangular impaction is the most frequent, especially for lower third molars (wisdom teeth). In this orientation, the tooth tilts forward towards the front of the mouth, often pressing against the adjacent molar 1 3 10.

Horizontal impaction occurs when the tooth is lying on its side, parallel to the gum line, and is more difficult to remove surgically 1 3.

Vertical impaction means the tooth is correctly aligned but unable to erupt due to lack of space or obstruction 1 3.

Distoangular impaction is when the tooth tilts away from the front of the mouth, a less common but more complex orientation 1 3.

Tooth-Specific Patterns

Third molars (wisdom teeth) are the most commonly impacted, especially in the lower jaw, due to space limitations 1 3 10.

Maxillary canines are the most frequently impacted non-molar teeth. Their complex eruption path and arch length discrepancies often lead to impaction, sometimes on the palate or within the dental arch 4 5 7 10.

Premolars (especially mandibular second premolars) and supernumerary teeth (extra teeth not part of the normal set) can also be impacted, though less frequently 4 5 7 10.

Classification Systems

Several classification systems exist for impacted canines and molars, often based on the tooth’s angulation, depth, and relation to adjacent teeth or anatomical structures 5 14. For canines, up to seven subtypes may be used, reflecting the complexity of their impaction 5.

Causes of Impacted Tooth

Understanding why teeth become impacted is critical for prevention and effective management. Causes can be localized (related to the mouth itself) or systemic (related to overall body health and development).

Factor Type	Example Causes	Impacted Teeth Affected	Source(s)
Local	Lack of space, crowding, cysts	Molars, canines	10 12
Local	Retained baby teeth, trauma	Incisors, canines	11 12
Systemic	Hereditary, syndromes	Multiple teeth	12 8
Systemic	Endocrine, nutritional disorders	Generalized	12

Table 3: Main Causes of Tooth Impaction

Local Causes

• Lack of space in the dental arch is the most common reason for impaction, especially for wisdom teeth and canines 10 12.
• Crowding due to misaligned or oversized teeth blocks normal eruption 10 12.
• Obstructions such as cysts, tumors, or supernumerary (extra) teeth can prevent eruption of the normal tooth 11 12.
• Retained deciduous (baby) teeth or premature loss can alter the eruption path of permanent teeth, leading to impaction 11 12.
• Trauma to the jaw or teeth during development may displace the tooth follicle and hinder eruption 12.

Systemic Causes

• Genetic factors: Some individuals inherit a tendency for tooth impaction, particularly in certain syndromes like cleidocranial dysplasia 12 8.
• Endocrine or nutritional disorders: Conditions such as rickets, anemia, congenital syphilis, and malnutrition can affect normal tooth development and eruption 12.
• Developmental abnormalities: Disorders affecting jaw growth or tooth size can predispose to impaction 12.

Risk Factors Influencing Severity

• Age: Delayed treatment is associated with more severe impactions 8.
• Gender: Females may experience more severe angular impactions, particularly with maxillary canines 8.
• Retained primary teeth: When baby teeth don't fall out on time, they may make permanent tooth eruption more difficult 8.

Why Early Detection Matters

Identifying risk factors and causes early—often with panoramic radiographs—can help prevent complications such as tooth malalignment, cyst formation, or damage to adjacent teeth 7 9 12.

Treatment of Impacted Tooth

Treatment of impacted teeth depends on several factors, including the tooth involved, its position, the patient’s age, and the presence of symptoms or complications. Approaches range from observation to surgical removal or orthodontic intervention.

Option	Indications	Complications/Risks	Source(s)
Observation	Asymptomatic, no pathology	May require future action	13 15
Surgical Removal	Symptomatic, pathology	Pain, infection, nerve injury	6 13 15
Orthodontic Exposure	Favorable position	Longer treatment duration	6 14 16
Extraction	Non-restorable, supernumerary	Bone loss, root resorption	15

Table 4: Main Treatment Options for Impacted Teeth

Observation (Watchful Waiting)

For asymptomatic, disease-free impacted teeth (especially wisdom teeth), observation with regular monitoring is a viable option. Evidence is insufficient to recommend removal in all cases, but long-term follow-up is essential to detect emerging problems 13 15.

Surgical Removal

Surgical extraction is the most common treatment for symptomatic or pathologically involved impacted teeth, especially for wisdom teeth causing pain, infection, or damaging adjacent teeth 6 13 15. Surgical techniques may vary:

• Simple extraction for teeth that are partially erupted or easy to access
• Surgical exposure and removal for deeply impacted or horizontally oriented teeth, requiring bone removal and sectioning 6

Risks include pain, swelling, infection, nerve injury, and postoperative complications, particularly in older patients 13.

Orthodontic Management

When the impacted tooth is valuable for function or aesthetics (such as canines or incisors), surgical exposure followed by orthodontic traction may be performed to bring the tooth into alignment. Success rates are high, but treatment may take several months or longer, especially for teeth impacted high in the bone or with unusual root shapes (dilaceration) 6 14 16.

Orthodontic approaches are tailored to each case, considering factors such as the tooth's position, patient's age, and underlying cause of impaction 14 17.

Extraction of Supernumerary or Severely Affected Teeth

Teeth that are supernumerary (extra), severely malformed, or non-restorable are usually extracted to prevent complications for adjacent teeth and the dental arch 15.

Multidisciplinary Approach

Sometimes, a multidisciplinary team (oral surgeons, orthodontists, periodontists) is needed, especially for complex cases involving multiple teeth, syndromes, or significant jaw abnormalities 6 14 17.

Imaging and Planning

Accurate diagnosis and planning using panoramic radiographs, CBCT scans, or MRI are vital for determining the position, orientation, and risks associated with each impacted tooth 12 11 14.

Patient-Centered Decision Making

Given the variability in presentation, shared decision-making between clinician and patient is essential, especially when balancing the risks and benefits of removal versus retention in asymptomatic cases 13.

Conclusion

Impacted teeth are a significant dental issue, affecting both oral health and overall quality of life. Early recognition, understanding the type and cause, and choosing the right treatment are key to preventing serious complications. Here’s a summary of the main points covered:

• Symptoms: Pain, infection, gum problems, headaches, and in rare cases, systemic symptoms are common presentations.
• Types: Most commonly affect wisdom teeth and canines, with mesioangular impaction being the most frequent orientation.
• Causes: Local (crowding, retained baby teeth, cysts) and systemic (genetic, developmental, nutritional) factors contribute.
• Treatment: Ranges from observation for asymptomatic cases to surgical or orthodontic intervention for symptomatic or valuable teeth; decision-making should be individualized and evidence-based.

Maintaining regular dental check-ups and early imaging is crucial for the timely detection and management of impacted teeth, ensuring both oral health and overall well-being.