Pain or discomfort at the back of your mouth may be a sign of an impacted wisdom tooth. Depending on how the tooth is positioned, it can affect the surrounding gums and nearby teeth in different ways.

At Restoration Dental OC in Orange, CA, we explain the different types of impacted wisdom teeth to help you recognize them and understand how they can be appropriately managed.

Common types of impacted wisdom teeth and the problems they may cause

1. Mesial impaction

A mesially impacted wisdom tooth tilts forward toward the second molar. This is one of the common positions seen with impacted wisdom teeth.

Depending on the angle and available space, only part of the wisdom tooth may emerge through the gum. The area between the wisdom tooth and second molar can then become difficult to brush and floss effectively.

Food and bacteria trapped in this space may contribute to gum inflammation or decay. The neighboring second molar also needs to be evaluated because problems can develop where the two teeth meet.

2. Distal impaction

A distally impacted wisdom tooth tilts toward the back of the mouth, away from the second molar.

Although it does not lean directly into the neighboring tooth, its position at the very back of the mouth can still make cleaning difficult. If the tooth only partially erupts, bacteria and food debris may collect around the surrounding gum tissue.

Whether a distally impacted wisdom tooth needs to be removed depends on how much room it has, whether it can erupt into a functional position, and whether the surrounding tissues remain healthy.

3. Buccal or lingual impaction

Some wisdom teeth do not simply tilt forward or backward. They may angle toward the cheek, known as a buccal position, or toward the tongue, known as a lingual position.

When part of the tooth erupts at an unfavorable angle, it can make the area uncomfortable and difficult to keep clean. Depending on its position, the tooth may also irritate nearby soft tissues during chewing.

A dental examination and imaging can show the direction of the tooth and whether its position is likely to interfere with normal function or oral hygiene.

4. Horizontal impaction

A horizontally impacted wisdom tooth lies sideways in the jaw instead of growing upward into the mouth.

The crown may point directly toward the second molar. Because the tooth is unlikely to erupt into a normal functional position, the area between the impacted tooth and neighboring molar can be difficult to maintain.

Depending on its exact location, a horizontal wisdom tooth may contribute to problems affecting the second molar or the surrounding gum and bone. Dental imaging is important for seeing how close the tooth is to neighboring structures before deciding whether removal is appropriate.

5. Soft tissue impaction

A soft tissue impaction occurs when the wisdom tooth has moved through the bone but remains partly or completely covered by gum tissue.

When only part of the crown is exposed, a flap of gum may remain over the tooth. Food and bacteria can collect beneath this tissue, making the area difficult to clean.

This can contribute to inflammation around the wisdom tooth. Some people may experience tenderness, swelling, or discomfort toward the back of the mouth, particularly when the area becomes irritated or infected.

6. Bony impaction

A bony impaction occurs when part or all of the wisdom tooth remains trapped within the jawbone.

Because the tooth may not be visible inside the mouth, dental imaging is needed to determine its position, depth, root shape, and relationship to nearby structures.

A completely bone-covered wisdom tooth does not automatically need to be removed. The dentist considers whether there are signs of disease or damage and whether monitoring the tooth remains a reasonable option.

When does an impacted wisdom tooth need to be removed?

Not every impacted wisdom tooth requires extraction. A tooth that is not causing disease or damaging surrounding structures may sometimes be monitored.

Tooth extraction may be considered when the impacted wisdom tooth is contributing to problems such as:

• Repeated pain or inflammation: Ongoing swelling, tenderness, or discomfort around the wisdom tooth.
• Infection: Bacteria around a partially erupted tooth can lead to recurring gum infections.
• Tooth decay: A difficult-to-clean wisdom tooth may develop decay or contribute to decay in the neighboring second molar.
• Damage to the neighboring tooth: An impacted tooth may affect the health of the second molar next to it.
• Gum or bone problems: Impacted wisdom teeth can contribute to periodontal problems around the back teeth.
• Cysts or other changes: Abnormal changes may develop in the tissues surrounding an impacted wisdom tooth.

Whether removal is necessary depends on the tooth’s position, symptoms, and the health of the surrounding teeth and tissues.

Wisdom tooth removal process at Restoration Dental OC

The wisdom tooth removal process at Restoration Dental OC generally involves four main steps:

Step 1: Examine and evaluate your wisdom tooth

We begin by examining your overall oral health, the wisdom tooth that needs to be removed, and the surrounding tissues. Digital X-rays help us evaluate the position of the tooth, the shape of its roots, and the surrounding bone.

For more complex cases, we may use 3D CBCT imaging to get a more detailed view of the tooth and nearby structures. This helps us assess the complexity of the extraction and plan the appropriate approach.

Step 2: Clean the treatment area

Before the extraction, we clean the treatment area to prepare for the procedure and reduce bacteria around the tooth being removed.

Step 3: Numb the area

Before we begin, we numb the area around the wisdom tooth to help minimize pain and keep you comfortable throughout the procedure.

The appropriate type of anesthesia will depend on the condition of your tooth and the complexity of the extraction.

Step 4: Remove the wisdom tooth

Once the area is numb, we carefully remove the wisdom tooth using appropriate sterilized dental instruments. Impacted or more complex wisdom teeth may require a surgical extraction.

Get your wisdom teeth evaluated in Orange, CA

Impacted wisdom teeth can be difficult to assess based on symptoms alone. An exam and dental imaging can show how your wisdom teeth are positioned and whether they are affecting the surrounding teeth or tissues.

At Restoration Dental OC, we provide gentle, personalized care to help you understand whether your wisdom teeth can be monitored or if removal may be appropriate.

Schedule a consultation with us to have your wisdom teeth evaluated and discuss your treatment options.

Frequently asked questions

What is the most common type of impacted wisdom tooth?

Mesial impaction, where the wisdom tooth tilts forward toward the second molar, is a commonly seen position. Wisdom teeth can also be distal, horizontal, angled toward the cheek or tongue, or trapped beneath gum or bone.

Is a horizontal wisdom tooth more likely to need removal?

A horizontal wisdom tooth cannot usually erupt into a normal upright position and may sit against the neighboring second molar. Whether it needs removal still depends on its exact position, surrounding tissues, and whether it is causing or likely to cause oral health problems.

Can an impacted wisdom tooth damage the tooth next to it?

Yes. Depending on its position, an impacted wisdom tooth can create areas that are difficult to clean and may contribute to decay or periodontal problems around the neighboring second molar.

Can a wisdom tooth stay under the gum without causing problems?

Sometimes. A wisdom tooth that remains impacted but shows no signs of disease or damage may be monitored. Dental exams and imaging help check for changes that may not be noticeable from symptoms alone.

Does a wisdom tooth need to be removed if it does not hurt?

Not necessarily. Pain is only one factor. A wisdom tooth may be monitored if it remains healthy, while removal may be considered when examination or imaging shows disease or damage even if the tooth is not currently painful.