Wisdom Teeth

- What are they? | What's it mean when they're impacted? | Impaction classifications.

Links to page: Images | Animations | Slideshows
Link to 3rd molar slideshow.
Link to types of impactions animation.
Link to 3rd molar x-rays slideshow.

1) What are they?

"Wisdom teeth" are a type of molar. Molars are the large chewing teeth found furthest in the back of the mouth.

Most people have 1st, 2nd and 3rd molars. A person's third molars are their wisdom teeth. (See our graphic below.)

a) When do they come in?

For most people, the eruption process takes place during their late teens or early twenties (usually ages 18 to 24 years), although eruption outside of this age range is not uncommon.

If there is not enough room for the teeth, or they are not aligned properly, they may never fully erupt. (See "Impacted Teeth" below.)

An x-ray showing a person's upper and lower teeth on their right side.

Details about which teeth are a person' wisdom teeth.

b) How many wisdom teeth does a person have?

People usually have four: upper left, upper right, lower left, and lower right.

If they don't, it's due to their genetic makeup. It's been estimated that about 25% of people are lacking one or more. (Faculty, 1997)


An x-ray showing different classifications of tooth impactions.

Examples of different classifications of impacted teeth.

2) What are "impacted" wisdom teeth?

In dental terminology, an "impacted" tooth refers to one that has failed to fully emerge into its expected position. (Our slideshow and the animations below provide examples.)

This failure to erupt properly might occur because there is not enough room in the person's jaw to accommodate the tooth, the tooth's eruption path is obstructed by other teeth or because the angulation of the tooth is improper.


3) Types of impactions (classifications).

Dentists use a number of terms, in combination, to describe the positioning of impacted teeth. They are mesial, distal, horizontal, vertical, soft-tissue and bony.

a) Mesial, vertical, horizontal and distal.

These terms are used to refer to the general angulation (positioning) of the tooth.

Graphic showing mesial, distal, vertical and horizontal impaction types.

Mesial, distal, vertical and horizontal tooth impactions.

  • The term "mesial" means that the tooth is angled forward, toward the front of the mouth. This is the most common type of wisdom tooth impaction.
  • The other types of impactions, in order of frequency of occurrence, are the vertical, horizontal, and distal types.
  • A distal impaction has an angulation that is generally directed towards the rear of the mouth.
  • Horizontal impactions have an alignment where the tooth is lying on its side.
  • Vertical impactions have a relatively normal orientation.

Graphic illustrating soft tissue and bony impaction types.

Full-bony, partial-bony and soft-tissue impactions.

b) Soft-tissue and bony wisdom tooth impactions.

In combination with the classifications above, wisdom teeth are also categorized as soft tissue or bony impactions.

  • A "soft tissue" impaction is one where the upper portion of a wisdom tooth (the tooth's crown) has penetrated through the bone but has not yet fully erupted through the gum tissue.
  • The term "bony" or "hard tissue" impaction indicates that the tooth still lies primarily within the jawbone. A full-bony impaction is entirely encased by bone tissue, whereas a partial-bony one has erupted through it somewhat.

With in this group, soft-tissue extractions are typically the easiest and full-bony the most difficult to perform. Related to this, the cost of a wisdom tooth extraction is typically based on its classification: soft-tissue, parital-bony or bony.

c) How likely is it that your wisdom teeth will be impacted?

Studies suggest that the incidence of having at least one that's impacted runs on the order of 65 to 72%. (Faculty, 1997)


4) What causes wisdom tooth impaction?

The reason why some wisdom teeth are impacted is not an easy question to answer. A primary cause simply seems to be a condition of inadequate jawbone space behind a person's second molar.

Why this lack of space exists is not fully understood. There does, however, seem to be a correlation between large tooth size and/or the presence of generalized tooth crowding and having impacted wisdom teeth.

Graphic illustrating how a lack of jawbone space can lead to problems.

Inadequate jawbone space leads to impaction.

The human diet has changed.

The dietary changes adopted by modern man have been theorized as playing a role in the incidence of 3rd molar impaction.

The coarse nature of stone-age man's diet had the effect of producing extensive tooth wear (not just on the chewing surface of the teeth but also in between, where neighboring teeth touch against each other).

When this type of wear takes place, it tends to reduce the "length" of the teeth (as a set), thus creating additional jawbone space to accommodate the wisdom teeth by the time they erupt. In comparison, the diet of modern man does not usually cause a significant amount of this type of wear.

It has also been argued that the coarse nature of stone-age man's diet, as compared to modern man's relatively soft diet, probably required more chewing muscle activity. This activity could have stimulated greater jawbone growth, thus providing more space for wisdom teeth.

Additionally, the harsh world of the caveman no doubt often lead to the occurrence of broken teeth and tooth loss. Once a tooth (or a portion of it) is missing the teeth behind it have a tendency to shift forward. This type of movement would make more jawbone space available for wisdom teeth. In comparison, with the advent of modern dentistry there are relatively few reasons why a tooth should remain unrepaired or be lost.

 

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