When either the space available for the eruption of the wisdom teeth is not enough, or when the third molars erupt into the wrong position pushing the adjacent teeth a high pressure builds up within the jawbone and the gums. This inner pressure building up around the impacted tooth will compress the nerves and sensitize them causing severe pain in the back of the jaw.

You might be curious whether you or your child has silent impacted teeth in the mouth. While some impacted wisdom teeth are innocent and do nothing disturbing, the ones which try to erupt will give you some hard time. If you are experiencing one or a few of the following symptoms you might have impacted molars in your mouth.

1. Constant throbbing pain in the back of your mouth: since the third molars are located at the most back of your jaws, you may experience a severe constant throbbing pain in the back of your mouth without any obvious reason such as tooth decay or fracture.
2. Changes in the gums in the back of your mouth: the effort to erupt the mouth will lacerate the above and surrounding soft and hard tissues making the gums reddish, swollen, and bleeding.
3. Swelling in the back of the face: continuous pressure maygive rise to swelling in the face in relation to the molar region. You will notice a little facial asymmetry and sometimes the swelling may be tender to touch.
4. Tender lymph nodes: tender lymph nodes are one of the signs that an infection. if the tooth gets infected due to bacterial activity around the tooth, the lymph nodes under the lower border of the lower jaw will be palpable and painful to touch.
5. Bad smell and bad taste: the bacteria and their byproducts will give rise to smell and taste disturbances.
6. Difficulty in opening the mouth:if an impacted wisdom tooth is kept untreated the infection and subsequent swelling will progress making it difficult to open your mouth.

You can confirm whether your wisdom teeth are fully erupted or impacted when you visit your dentist. If you are someone between 17-25 years and if you are concerned, you can ask your dentist for confirmation. He will examine you thoroughly and may order an X-ray of your mouth, and an OPG to check the condition of the wisdom teeth.

An OPG is a type of X-ray which shows your complete mouth and by looking at the X-ray, a dentist can tell you,

• Whether you have wisdom teeth or not
• When are they going to erupt?
• Will they be problematic?
• Should they be removed or kept under observation?
• If they ought to be removed what will be the treatment plan? 

No, not always. If your wisdom teeth are erupting in the proper place and are not problematic due to impaction they can be kept as it is. When the future of the teeth is not clear, your dentist may recommend keeping the teeth under observation.

In simple words, the wisdom teeth should be removed only when they are not innocent and keep disturbing you.

The type of wisdom teeth impaction will determine the complexity of the impaction and the extraction procedure. There are four types of wisdom teeth impaction.

• Mesial
• Distal
• Vertical
• Horizontal

Sometimes vertically or distally impacted teeth need not be removed. If they are indicated for removal it will be easier to remove them than the horizontally or mesially impacted teeth because they might damage the adjacent front tooth.  However, only an experienced dentist can decide on the best way to remove the tooth according to the type of impaction.

Not necessarily. Wisdom teeth are the most back teeth in the arch. Thus wisdom teeth are not essential to maintain either aesthetics or functional efficiency, there’s no need to replace wisdom teeth. Rarely, your dentist may suggest replacing the tooth If there’s a risk of the opposing tooth over erupting in the absence of the wisdom tooth.

• First, your dentist will do a thorough examination of your mouth to come up with the best treatment plan suited for your condition.
• Then the doctor will give you an anaesthetic injection to numb the area so that you will not feel any pain or discomfort during the procedure.
• If it seems not complex, the tooth will be extracted in the dental chair itself as any other normal tooth removal.
• If there is not enough room in the mouth for the removal of the tooth chair-side, a simple surgery will be carried out in a separate minor oral surgery unit. You might need a simple incision.
• After incising the overlying gum, the dental surgeon may take the tooth out in whole, or he may section the tooth into pieces and will take them out gradually piece by piece. Sectioning of the tooth will ensure minimal damage to the adjacent teeth and the soft tissues.
• The dentist may then suture the area to secure the wound to ensure complete and fast healing of the wound.
• Sometimes, when more than one nuisance wisdom tooth should be removed at once, you may have to undergo a more complex surgery in the operating theatre under general anaesthesia where the surgery team will anaesthetize your whole body for a few hours.