When wisdom teeth communicate with the mouth, the most common symptom is localized pain, swelling and bleeding of the tissue overlying the tooth. This disorder is called pericoronitis which means inflammation around the crown of the tooth.  Low grade chronic periodontitis commonly occurs on either the wisdom tooth or the second molar, causing less obvious symptoms such as bleeding from the gums and bad breath. The teeth can also remain asymptomatic (pain free), even with disease.  As the teeth near the mouth during normal development, people sometimes report mild pressure of other symptoms similar to teething.

The term asymptomatic means that the person has no symptoms. The term asymptomatic should not be equated with absence of disease. Most diseases have no symptoms early in the disease process. A pain free or asymptomatic tooth can still be infected for many years before pain symptoms develop.

Causes

Wisdom teeth become impacted when there is not enough room in the jaws to allow for all of the teeth to erupt into the mouth.  Because the wisdom teeth are the last to erupt, due to insufficient room in the jaws to accommodate more teeth, the wisdom teeth become stuck in the jaws, (impacted).  Some believe that the decrease in jaw size is due to softer diets.

Screening

Visiting your dentist often will reduce your risk of potential problems with your teeth.  Yearly your dentist should be monitoring your teeth and gums through xrays.  Below is an example of what an impacted wisdom tooth will look like on an xray.  If you notice on the below xray the last teeth on both the upper and lower arch that are not fully erupted are impacted wisdom teeth.

Treatment

Wisdom teeth removal, (extraction) is the most common treatment for impacted wisdom teeth. The absolute indications for removal are either the presence of disease or symptoms around the tooth.  The procedure, depending on the depth of the impaction and angle of the tooth, is to create an incision in the mucosa of the mouth, section the tooth and extract it in pieces. This can be completed under local anaesthetic, sedation or general anaesthetic.

Recovery

Most patients will experience pain and swelling (worst on the first post-operative day) then return to work after 2 to 3 days with the rate of discomfort decreased to about 25% by post-operative day 7 unless affected by dry socket: a disorder of wound healing that prolongs post-operative pain. It can be 4 to 6 weeks before patients are fully recovered with a full range of jaw movements.