What is a Wisdom Tooth

 A wisdom tooth is a molar that grows in the very back of your jaw and is the last tooth to erupt into the mouth. Many people do not have sufficient space in their jaw to accommodate these large molars, causing several problems for the patient. This can be discomfort/pain, gum disease, bone loss, cavities, damage to the other teeth, infections, and cysts/tumors. These issues don’t always cause symptoms, so it is important to have your wisdom teeth checked every year by your dentist or an oral and maxillofacial surgeon to prevent damage from occurring.
The ideal time to have a wisdom tooth extracted is between the ages of 15-25 years old to reduce chances of postop complications, but this varies between individuals based on dental development. The only way to know if you need your wisdom teeth removed, is to make an appointment with us so you can be evaluated. 

What is an impacted tooth?

A tooth is impacted When inadequate space exists in the jaw bone that prevents the teeth from erupting into the proper position. This can affect the patient’s ability to chew, appropriately care for the teeth, and can have significant consequences for the patient down the road.  

Typically, people develop four wisdom teeth but some people have less and very rarely, some individuals have more. These teeth typically  try to erupt into the mouth between 17-25 years old.  



If you do not have enough room in your mouth for your third molars to fully erupt, a number of problems can happen. Impacted wisdom teeth should be removed before their root structure is fully developed. In some patients it is as early as 12 or 13, and in others it may not be until the early twenties. Problems tend to occur with increasing frequency after the age of 30. For more information about wisdom teeth removal, click here.

Some of the possible problems related to not removing your wisdom teeth include:

A representation of a pericoronitis infection on a wisdom tooth


The most frequent clinical problem we see is pericoronitis, (a localized gum infection). Without enough room for total eruption, the gum tissue around the wisdom tooth can become irritated and infected, resulting in recurrent pain, swelling, and problems with chewing and/or swallowing.

An example of a cyst formation on a wisdom tooth

Cyst Formation:

Non-infectious diseases may also arise in association with an impacted wisdom tooth. Cysts are fluid-filled “balloons” inside the jaw bone that develop as a result of impacted teeth and slowly expand destroying adjacent jaw bone and occasionally teeth. They can be very difficult to treat if your wisdom teeth are not removed in your teenage years. Although rare, tumors can be associated with the delayed removal of wisdom teeth.

An illustration of teeth crowding causes by a wisdom tooth

Possible Crowding:

Impacted wisdom teeth may contribute to crowding of your teeth. This is most noticeable with the front teeth, primarily the lower front teeth and is most commonly seen after a patient has had braces. There are a number of factors that cause teeth to crowd after braces or in early adulthood. Retained, impacted wisdom teeth may be a contributing factor. Unless you have an active problem when you see the oral surgeon, the reason for removal is primarily to prevent long-term damage to your teeth, gums and jaw bone.

A visual of a wisdom tooth damaging an adjacent tooth

Damage to Adjacent Teeth:

If there is inadequate room to clean around the wisdom tooth, the tooth directly in front, the second molar, can be adversely affected resulting in gum disease, bone loss around the tooth, and/or decay.



As wisdom teeth develop, the roots become longer and the jaw bone more dense. When it is necessary to remove impacted wisdom teeth in your thirties, forties or beyond, the post-operative course can be prolonged and there is a higher complication rate. Treating these complications is often more difficult and less predictable than with a younger patient. Healing may be slower and the chance of infection can be increased. If your impacted wisdom teeth are not removed in your teenage years or early in your twenties and they are completely impacted in bone, it may be advisable to wait until a localized problem (such as cyst formation or localized gum disease and bone loss) develops. In general, you will heal faster, more predictably, and have fewer complications if treated in your teens or early twenties.


We will need to see you for a consultation to determine if you will benefit from wisdom tooth removal. A special x-ray (panoramic radiograph) of your mouth and jaws will be taken to determine if your wisdom teeth are impacted, if there is room for them to erupt, and how difficult it will be to have them removed.

Dr Pashkowsky will do an examination, review your panoramic radiograph with you, and review a treatment plan. Most patients elect to have impacted wisdom teeth removed with IV general anesthesia so that they can be completely comfortable and sleep through the procedure. Other options include local anesthesia (numbing medicine) only or nitrous oxide (laughing gas). Dr. Pashkowsky will review these anesthesia options with you to decide which is best.

Types Of Impactions

  • Soft Tissue Impaction: There is not enough room to allow the gum tissue to retract for adequate cleaning of the tooth.
  • Partial Bony Impaction: There is enough space to allow the wisdom tooth to partially erupt. However, the tooth cannot function properly in the chewing process, and creates cleaning problems, among others.
  • Complete Bony Impaction: There is NO space for the tooth to erupt. It remains embedded in the jaw bone or if even partially visible requires complex surgical techniques for removal.The impacted wisdom tooth may also be in an unusual position and difficult to remove. This situation can also arise when the shape or size of the jaw bone and other facial structures make removal of this tooth significantly more complex.
A representation of a wisdom tooth impacted by soft tissueSoft Tissue
An example of a wisdom tooth with a partial bony impactionPartial Bony
An illustration of a wisdom tooth completely impacted by boneComplete Bony