The third molars, commonly known as wisdom teeth, are the final set of teeth to develop, typically emerging between the ages of 17 and 25. For many people, the jaw is too small to accommodate these late arrivals, leading to impaction. An impacted tooth is unable to fully erupt due to obstruction from the jawbone, gum tissue, or another tooth. A diagnosis of a “sideways” wisdom tooth indicates a specific and potentially serious type of impaction requiring professional attention. The primary concern is the angle of growth and the damage it may cause to surrounding oral structures.
Defining Sideways Wisdom Tooth Impaction
The term “sideways” refers to an impaction where the tooth is angled significantly off the vertical path of eruption. This improper growth results from insufficient space in the jaw, a common evolutionary change. Dentists classify these sideways orientations into two main types based on the angle of the third molar relative to the second molar, the tooth directly in front of it.
The most frequent type is mesioangular impaction, where the wisdom tooth is tilted forward (mesially) toward the front of the mouth. This angled position means the crown is pressing against the root structure of the adjacent second molar. The second, often more problematic, form is horizontal impaction, where the wisdom tooth lies completely on its side at a nearly 90-degree angle. In this case, the tooth is essentially parallel to the jawbone and often fully embedded deep within the bone tissue.
Both mesioangular and horizontal impactions are characterized by the third molar being trapped beneath the gums, sometimes partially or fully encased in bone. This prevents the tooth from aligning correctly with the rest of the bite. The specific angle determines the unique challenges for oral health and the surgical removal process.
Potential Risks to Oral Health
A sideways wisdom tooth poses several distinct threats due to the pressure it exerts and the difficult-to-clean spaces it creates. The most immediate concern is damage to the adjacent second molar. Constant pressure can lead to the erosion of the second molar’s root surface (root resorption) or create decay where the two teeth meet. This damage may be severe enough that the second molar requires extensive dental work, such as a root canal or extraction.
The sideways positioning also makes the area highly susceptible to infection, a condition termed pericoronitis. This occurs when the crown of a partially erupted wisdom tooth is covered by a flap of gum tissue, called an operculum. This small pocket traps debris, plaque, and bacteria, leading to localized inflammation, pain, and swelling. The infection can cause an unpleasant taste, bad breath, and difficulty opening the jaw.
Another serious, less common, risk is the development of a fluid-filled sac called a cyst around the crown of the impacted tooth. Wisdom teeth develop within a protective sac in the jawbone; if this sac fills with fluid, it forms a cyst that grows over time. As the cyst expands, it can erode the surrounding jawbone structure, the roots of nearby teeth, and damage associated nerves. Rarely, this process involves the development of a noncancerous tumor, requiring complex surgical intervention to remove the tissue and bone.
Management and Extraction Process
For a sideways, impacted wisdom tooth causing symptoms or deemed high-risk, the definitive management is surgical extraction. This procedure differs significantly from a simple tooth removal because the tooth is trapped below the gum line and often embedded in bone. The surgery typically begins with a specialist oral surgeon creating an incision in the gum tissue to access the underlying tooth and bone.
To remove the tooth safely without damaging adjacent structures, the surgeon often carefully removes some bone tissue blocking the tooth’s path. A sideways tooth, especially a horizontal impaction, frequently requires sectioning, where the tooth is divided into two or more smaller pieces. Removing the tooth in fragments reduces the force needed and minimizes the incision size, protecting the bone and soft tissues. Anesthesia options range from local anesthetic to moderate or general sedation, depending on the case complexity and patient comfort.
Post-operative care is crucial for healing and preventing the most common complication: a dry socket (alveolar osteitis). A dry socket occurs when the protective blood clot in the extraction site dissolves or is dislodged prematurely, exposing the underlying bone and nerves. To prevent this painful condition, patients must avoid any activity that creates suction in the mouth, such as using a straw, spitting forcefully, or smoking, for at least a week.
For the first 24 hours, only soft, non-chewy foods like yogurt and mashed potatoes are recommended, and the patient should avoid rinsing the mouth. After the initial day, gentle rinsing with a warm saltwater solution can begin to keep the area clean and reduce infection risk. Swelling can be managed by applying an ice pack to the cheek near the surgical site for 20 minutes on and 20 minutes off during the first 24 to 48 hours. Strenuous physical activity should be limited for several days to ensure the blood clot remains stable and healing is not disrupted.