Wisdom teeth, or third molars, are the last teeth to develop and appear in the mouth. They are called “wisdom teeth” because they usually appear during a person’s late teens or early twenties, which has been called the “age of wisdom”. Many times the jaws are not large enough to accommodate the four wisdom teeth. This is why wisdom teeth cause more problems than any other teeth in the mouth. In fact, for nine out of ten people at least one wisdom tooth remains underneath the gum due to lack of space in the mouth.

There are 4 possible ways in which wisdom teeth may cause problems:-

• Gum disease: Most people are aware of the pain experienced during the eruption of these teeth. This generally happens because these partly erupted teeth are difficult to keep clean, and the accumulated food particles cause the gums around the tooth to get infected. Such an infection is felt as swelling and pain around the area. Sometimes the tooth is trying to erupt, but has not yet broken through the gums. When the upper tooth bites down onto this gum, pain can be caused.
• Impacted: It sometimes happens that there is not enough space in the mouth for these teeth to erupt. In such cases they may try to erupt in an abnormal direction, or may get locked into the jaw. This locking is known as impaction.
• Decay: A wisdom tooth may decay unnoticed, as they are the most difficult teeth to keep clean, being so far back into the mouth. Also, the 2^nd molar in front of the wisdom tooth may be decayed due to lodgment of food between the 2^nd molar and the 3^rd molar (wisdom teeth).
• Crowding: An impacted or erupting wisdom tooth can push on adjacent teeth, causing them to become crooked or even damaging them structurally.
• Cyst: If the sac that holds the crown of the wisdom tooth remains in the bone, it can fill with fluid, forming a cyst that can destroy surrounding bone.

The picture above shows an impacted wisdom tooth. The swollen gums are depicted in red, while the decayed portions are shown in black. The position of the wisdom tooth also makes it difficult to keep that area clean, leading to decay and gum infection.

Your dental evaluation will consist of oral examination and x-rays. Your oral surgeon may also need to know your medical history, as extraction of an impacted tooth usually is a minor surgical procedure. But the surgery is a minor one and the patient is back to work in a day or two. The x-rays show the type of impaction and thus help the oral surgeon plan your treatment.

Positions of Impaction:

Due to unavailability of space in the jaws, the impacted wisdom teeth grow in many different directions, commonly at an angle. The complexity of surgery depends on the type of impaction, as explained below.

	A wisdom tooth may grow at an angle towards your other teeth. This type of impaction is called as a Mesio-angular impaction.(44%)
	A wisdom tooth which erupts at an angle away from your other teeth is said to be Disto-angularly impacted.(6%)
	A wisdom tooth facing your other teeth horizontally is said to be Horizontally impacted.(3%)
	A tooth which is in normal direction but still unable to erupt due to lack of space is said to be Vertically impacted.(38%)