Impacted teeth generally feel uncomfortable and hurtful while growing. However, as one gets older the pain diminishes although some people may still find them quite unpleasant.

Epimak Kayiranga, a dentist at the University Teaching Hospital (CHUK) of Kigali, explains that impacted teeth, also known as wisdom teeth, come about as a result of a tooth failing to come out or emerging only partially.

"This mostly happens with the third set of molars. They are the last teeth to emerge and thus erupt and after other teeth have already grown. They, therefore, become either complete or semi impacted. This is common with people who have small or constricted jaws,” he says.

Frank Rwema, a dentist at Rwanda Military Hospital, further explains that wisdom teeth usually come between the age of 17 and 21.

Are they harmful?

Impacted teeth are very common and are often painless when they have fully erupted. However, when some impacted teeth emerge, they exert pressure (push) on the tooth next to them.

This eventually causes misalignment of the teeth that bring about oral problems. They are often blamed, among other things, for causing tooth movement by exerting pressure on other teeth when trying to erupt. This results into dental crowding.

"Impacted teeth may cause carious lesions (demineralisation of enamel) on the neighbouring tooth. They may cause inflammation of the gum overlying the crown. They may be associated with some lesions such as cystic lesions and tumours,” says Kayiranga.

Dr Rwema also explains that because they emerge only partially or remain completely trapped under gum or bone (pericoronitis), this area is hard to see and clean, and can become a magnet for bacteria that cause gum disease and oral infections.

"A partially emerged tooth can trap food, plaque and other debris in the soft tissue around it, which can lead to inflammation and tenderness of the gums and unpleasant mouth odour. The retained debris may also lead to the decay on the wisdom tooth or the neighbouring tooth,” he says.

Extraction of impacted teeth

Removal of the tooth (extraction) is the ideal treatment for an impacted tooth. Professionals, however, advise that the procedure should be done by an oral surgeon.

Dr Rwema advises that impacted wisdom teeth should not necessarily be removed if they are correctly positioned in the mouth and do not cause any pain or dental problems.

"Not all impacted wisdom teeth need to be removed. It may be necessary if, for example, those teeth interfere with the normal eruption of another molar or prevent the movement of teeth towards the back of the mouth. If they are impacted or cause crowding in your teeth, an oral surgeon ought to remove them,” he says.

Dr Rwema also advises that if wisdom teeth need to be removed, it is better to remove them early when you are young rather than waiting until periodontal (gum) disease has set on.

"Removing the wisdom teeth before the age of 25 often has better results. This is because the roots are not fully developed, which allows for an easier removal and better healing.

"As a person ages, the roots become longer and curved. Bone becomes more rigid and complications can develop. As you age, it will take longer to recover from the surgery,” he explans.

The prior existence of a periodontal defect, your age and your level of oral hygiene may serve as predictors of undesirable outcomes. As individuals age, the effects of retained and impacted wisdom teeth can be more consequential. Periodontal defects tend to get worse in the presence of retained third molars, and so do caries (tooth decay).

According to Dr Kayiranga, although they tend to appear as misaligned bites, dental braces do not help with the treatment of impacted teeth as many tend to believe.

He rather advises that people who require braces should have their impacted removed prior to their placement.

He also notes that adequate safety measures should be taken when removing impacted teeth and requires a professional dentist.

"The removal depends on how difficult the procedure is after analysing the dental x-ray (opg). Removal requires surgical disimpaction by removing a little of bone all around to be able to remove it fully. The complications often include bleeding of the gum, trauma of the nerve, bone fracture, infection post operative, trauma or removal of the neighbouring tooth,” he says.

Dr Rwema also advises that certain considerations should be made before an impacted tooth is extracted.

The patient should be informed about the procedure and possible complications, and should also do a general health check-up. Immunity suppressed individuals, diabetics and elderly people often have bigger complications,” he says.

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