Impacted teeth – causes and treatment is

Last updated on: 3 Sep, 2026

Among the various dental problems, impacted teeth present a particular challenge that requires timely diagnosis and professional treatment. This problem affects thousands of people and can lead to serious complications if not treated promptly. 

What is a retained tooth?

The term ‘impacted’ derives from the Latin ‘retentio’, meaning ‘retention’. Impacted teeth are teeth that remain trapped within the jawbone itself and fail to erupt normally to align with the rest of the teeth. Instead of growing into their natural position, they remain hidden beneath the gums, occupying various abnormal positions relative to the surrounding teeth.

Most often, wisdom teeth and impacted teeth are mentioned together, as it is wisdom teeth that are most prone to impaction. Apart from these, canine teeth (especially the upper ones) and premolars (the small molars) can also remain trapped in the bone. Retention of incisors or other teeth is rarely observed. 

The problem most often arises because these teeth are the last to erupt – the canines around the age of 13, and the wisdom teeth after the age of 18, by which time the jaws have already formed and there is often insufficient space in the dental arch for their correct positioning.

Although they remain impacted, impacted teeth retain their biological potential for growth and attempt to erupt. This movement, however minimal, exerts pressure on the bone tissue and neighbouring teeth, leading to various complications.

Symptoms of an impacted tooth

Impacted teeth may remain asymptomatic for a long time, but when they start causing problems, the symptoms are clearly evident and require immediate attention.

Pain and discomfort

Pain is one of the main symptoms of an impacted tooth. It may be constant and localised in the area of the impacted tooth, or it may spread to the neighbouring teeth and the jawbone. 

Gum inflammation

Inflammation of the gums around the impacted tooth is another characteristic symptom. The gums become red, swollen and sensitive to touch. This condition, known as pericoronitis, occurs when a partially erupted tooth creates a ‘pocket’ between the gum and the tooth, where food debris and bacteria accumulate.

Difficulty opening the mouth

Some impacted teeth can affect the chewing muscles, leading to difficulty opening and closing the mouth. Swallowing may also become painful, particularly when there is an active infection in the impacted teeth.

Unpleasant taste and smell

The presence of an infection is often accompanied by an unpleasant taste in the mouth and bad breath, due to the build-up of bacteria in the affected area. In rarer cases, a raised body temperature, swollen lymph nodes in the neck and a headache may be observed.

Causes

The occurrence of impacted teeth can be due to various causes.

Lack of space in the jaw

One of the most common causes of impacted teeth is insufficient space in the jaw. Over the course of evolution, human jaws have decreased in size, but the number of teeth has remained the same. When the very anatomy of the jaw does not allow sufficient space, particularly for teeth that erupt late, they remain impacted.

Genetic factors

Heredity plays an important role. The size and shape of the jaw, as well as a predisposition to delayed tooth eruption, are often passed on from parents to children. If there are cases of impacted teeth in the family, the risk for children is higher.

Abnormal positioning of tooth buds

Sometimes a tooth bud develops in the wrong position – at an angle or horizontally – which prevents it from erupting normally and leads to impaction. This is often seen with canine teeth in the upper jaw.

Delayed resorption of milk teeth

Delayed tooth eruption may be associated with delayed resorption (dissolution) of the roots of the deciduous teeth. When a deciduous tooth does not fall out on time, the permanent tooth has no path for normal eruption and remains impacted. This problem is particularly common with the small molars.

Pathological processes

The presence of follicular cysts, tumours or other pathological growths in the bone tissue can physically block a tooth from erupting. Jaw trauma in early childhood can also disrupt normal tooth development and eruption.

Crowded teeth

When teeth are too tightly packed in the dental arch, there is not enough space for subsequent teeth to erupt, particularly for those that come through later.

How is the diagnosis made?

The diagnosis of impacted teeth begins with a visit to a dental clinic, where an experienced specialist carries out a comprehensive examination of the oral cavity. The initial clinical examination involves an assessment of the teeth and gums, during which the dentist evaluates the symptoms and looks for signs of inflammation, swelling or misalignment of the teeth.

When diagnosing impacted teeth, an X-ray of the teeth is taken. This may include a panoramic X-ray, which visualises the entire jaw, or a specialised 3D computed tomography (CBCT), which provides detailed information on the exact position of the impacted tooth, its orientation relative to neighbouring structures, proximity to nerve canals and blood vessels, as well as the condition of the surrounding bone tissue.

How does the preparation for treatment proceed?

Once the diagnosis has been established and the treatment plan determined, the preparation for treatment begins. Preparation includes a detailed consultation during which the nature of the problem, possible treatment methods, expected results and potential risks are explained to the patient.

When planning the extraction of an impacted tooth or other surgical procedure, the patient is given instructions for pre-operative preparation. This may include a course of antibiotics starting two days before the operation to minimise the risk of infection. 

An important part of the preparation is assessing the patient’s general health. The dentist asks questions about any underlying medical conditions, allergies to medicines, current medication and previous experience with dental procedures.

Treatment methods

The treatment of impacted teeth depends on a number of factors, including the type of tooth, its position, the presence of symptoms, and the patient’s age.

Monitoring and observation

In cases of asymptomatic impacted teeth that do not cause discomfort or lead to complications, immediate intervention may not be necessary. In such cases, regular monitoring with periodic check-ups is recommended to track any changes.

Orthodontic treatment

Orthodontic treatment is the conservative method for managing impacted teeth. This approach involves exposing the crown of the impacted tooth, fitting an orthodontic brace system, and gradually moving the tooth into its correct position in the dental arch. The process can take from several months to over two years, but it allows the tooth to be preserved and its aesthetics and function to be restored.

Surgical extraction

When a tooth causes problems, leads to complications or cannot be moved orthodontically, extraction (removal of the tooth) becomes necessary. This surgical procedure is a complex operation performed by an experienced surgeon.

Coronectomy

In cases where there is a high risk of damage to the mandibular nerve during the complete removal of an impacted tooth, a procedure called a coronectomy may be performed. In this procedure, only the crown of the tooth is removed, whilst the roots are left in the bone to avoid damage to nerve structures.

Risks and potential complications

Risks are possible during the surgical treatment of impacted teeth and the extraction of an impacted tooth. Complications with impacted teeth can arise both from the problem itself and as a result of the treatment.

Complications are avoided through precise diagnosis, careful treatment planning, competent performance of the surgical procedure, and strict adherence to post-operative instructions by the patient.

Post-operative care and recovery period

The recovery process following surgery to remove an impacted tooth is important and requires adherence to the dentist’s recommendations. The first 24–48 hours after the procedure are the most critical. 

The course of antibiotics started before the operation continues for several days afterwards to prevent any post-operative infection. Swelling and pain following extraction are managed with the medication prescribed by the dentist.

Full recovery of the bone and soft tissues may take several weeks to months, depending on the complexity of the case. If the patient experiences unusually severe pain, significant swelling after the third day, prolonged bleeding, a high temperature or other worrying symptoms, they should contact their dentist immediately.  

Conclusion

Early prevention of impacted teeth involves regular dental check-ups, particularly during childhood and adolescence when permanent teeth are erupting. The diagnosis of impacted teeth allows for the planning of preventive measures or timely intervention.

At Dentatime Clinic, led by Dr Radoslav Simeonov with over 25 years’ experience in oral surgery and implantology, we offer a comprehensive approach to the treatment of impacted teeth. Our team of specialists, state-of-the-art equipment and personalised approach to each patient ensure high-quality treatment and minimise complications associated with impacted teeth. 

Accurate diagnosis, expert treatment and careful post-operative care ensure a successful outcome and help you stay healthy.

Frequently asked questions

Is surgery always necessary for an impacted tooth?

Not always. Asymptomatic impacted teeth without complications can be monitored with regular check-ups. Surgery is necessary in cases of pain, inflammation, risk of damage to adjacent teeth, or when planning orthodontic treatment.

Can a retained tooth cause problems if it doesn’t hurt?

Yes, asymptomatic impacted teeth can gradually damage the roots of neighbouring teeth, cause tooth displacement, gum disease, cyst formation or chronic inflammation, which is often discovered incidentally during a routine X-ray.

What is the difference between an impacted and a partially impacted tooth?

A retained tooth is completely trapped within the bone and is not visible in the mouth. A partially retained tooth has erupted partially, with a small part of the crown visible above the gum line, but the tooth cannot fully erupt into the correct position.