If a dentist has told you one of your wisdom teeth is “impacted”, you’ve probably got a few questions. What does that actually mean? Does it have to come out? Is it going to cause problems if I leave it? Here’s a straight answer to each of those, from someone who removes these every week.

What “impacted” really means

A wisdom tooth is impacted when it can’t fully come through into its normal position. Usually that’s because one of three things is going on:

  • The angle is wrong — the tooth is tilted forward, backward, or sideways instead of growing straight up.
  • There isn’t enough room at the back of your jaw — the tooth is trying to erupt into a space that doesn’t exist.
  • The gum or bone is blocking it — either the tooth is covered by a flap of gum (soft-tissue impaction) or it’s buried partly or fully in the jawbone (bony impaction).

Healthdirect describes impaction simply as wisdom teeth that “come through at an angle and put pressure on the next tooth or the gums” (Healthdirect — Wisdom Teeth). That’s the plain-language version. The clinical version has a few more layers.

The types of impaction

Dentists classify impactions two ways: by the direction the tooth is angled, and by how deeply it’s buried.

By angle

  • Mesial impaction — the tooth is tilted forward, toward the molar in front of it. This is the most common type we see in practice.
  • Distal impaction — the tooth is tilted backward, away from the molar in front. Less common, often harder to remove.
  • Horizontal impaction — the tooth is lying on its side, pushing directly into the root of the next tooth. These need to come out.
  • Vertical impaction — the tooth is pointing in the right direction but just can’t erupt, usually because there’s no room. Some of these come through eventually; others stay stuck forever.

By depth

  • Soft-tissue impaction — the tooth has broken through the bone but is still covered (fully or partly) by gum. These often cause pericoronitis because food and bacteria get trapped under the gum flap.
  • Partial bony impaction — part of the tooth has cleared the bone; part is still embedded.
  • Full bony impaction — the tooth is entirely buried in the jawbone. Removal here is the most surgical of the bunch, but not always the most painful afterwards — the gum around it is often less irritated than a partial impaction.

If you want a broader overview of why wisdom teeth cause trouble in the first place, read our full wisdom teeth guide.

Symptoms — what an impacted wisdom tooth feels like

Some impactions are completely silent. You find out about them because they show up on a routine x-ray, and there’s no pain, no swelling, nothing. Others make themselves very well known. Common symptoms include:

  • A dull ache at the back of the jaw that comes and goes
  • Sharp pain when biting down or chewing on that side
  • Swollen, red, or tender gum over the tooth
  • Bad taste or smell from that corner of the mouth (often a sign of pericoronitis)
  • Jaw stiffness or difficulty opening wide
  • Swelling of the cheek or the side of the face
  • Occasional headaches or earaches on the affected side

The pattern we see most often in Murwillumbah: a partially erupted lower wisdom tooth, a flap of gum over it, food trapping, a flare-up of pain and swelling every few months that settles with warm salt-water rinses or a course of antibiotics — until the next one. That cycle is what we call recurrent pericoronitis, and it’s one of the clearest indications that the tooth needs to come out.

How we diagnose impaction

Diagnosis is usually straightforward. The steps look like this:

  1. Clinical exam — we look at the tooth, check for swelling, tenderness, bite issues, decay on the wisdom tooth or the molar next to it.
  2. OPG (panoramic x-ray) — this is the big wide x-ray that shows all your teeth in one image. It tells us the angle, the depth, the root shape, and how close the tooth is to other structures.
  3. CBCT (3D scan) — we only order this for complex cases, especially lower wisdom teeth that sit close to the inferior alveolar nerve (the nerve that supplies feeling to your lower lip and chin). A CBCT helps us plan the surgery and reduce the risk of nerve injury.

You don’t always need a CBCT. For a straightforward upper wisdom tooth, an OPG is usually plenty.

The risks of leaving an impacted tooth alone

This is the part most patients want a straight answer on. Here’s the honest version: not every impacted wisdom tooth causes problems, but the ones that do tend to cause the same handful of problems repeatedly.

  • Recurrent pericoronitis — inflammation and infection of the gum flap over a partially erupted tooth. It settles, comes back, settles, comes back. Each flare-up is unpleasant and occasionally requires antibiotics.
  • Decay — impacted teeth are hard to clean. Decay can develop on the wisdom tooth itself, or — more seriously — on the back surface of the second molar (the tooth in front). Decay on that second molar is often hidden, tricky to restore, and sometimes costs you that tooth too.
  • Gum disease — the deep pocket around a partially erupted tooth is a breeding ground for bacteria and bone loss.
  • Cysts — fluid-filled sacs can form around the crown of a buried tooth. These are uncommon but not vanishingly rare, and when they do form they can quietly destroy bone in the jaw before you know they’re there. This is the main reason we still x-ray asymptomatic impactions every few years.
  • Crowding or damage to the tooth in front — a horizontally impacted tooth pushing directly into the root of the second molar can cause resorption (the root slowly dissolving). Once that happens, the second molar is usually lost as well.

Healthdirect lists the same cluster of concerns — decay, gum infection, cysts — as the main reasons wisdom teeth are removed (Healthdirect).

None of this is a certainty. Plenty of impactions sit quietly for decades and never cause a problem. The question isn’t “will this tooth definitely cause trouble?” — it’s “what’s the risk, and is it worth waiting to find out?”

If you’re weighing that question and want a proper assessment, you’re welcome to book a consult with me at Biltoft Dental — bring any recent x-rays you have and we’ll talk through your specific situation.

When removal is the right call

I’ll recommend removing an impacted wisdom tooth when one or more of these is true:

  • It’s causing symptoms (pain, swelling, recurrent infection)
  • There’s decay in the wisdom tooth or the tooth in front of it
  • There’s obvious gum disease or bone loss around it
  • It’s damaging the root of the neighbouring molar
  • There’s a cyst on imaging
  • The tooth is unlikely to ever erupt into a useful position, and the risk of future problems outweighs the risk of surgery

And I’ll recommend leaving it alone and monitoring when none of those apply. Surgery isn’t free of risk. If a tooth isn’t causing trouble, isn’t likely to, and is in a position where removal would be difficult — sometimes the sensible call is to watch it.

If you’re earlier in the decision process, our article on signs your wisdom teeth need removal walks through the common red flags in more detail.

What the surgery actually looks like

Straight answer: most impacted wisdom tooth removals at Biltoft Dental take 20 to 45 minutes, under local anaesthetic, in the chair. Here’s what happens:

  1. Numbing — local anaesthetic injection around the tooth. You’ll feel the pinch, then nothing.
  2. Access — for a bony or soft-tissue impaction, we lift a small flap of gum so we can see the tooth. For a tooth that’s already partly erupted, often no flap is needed.
  3. Bone removal (if needed) — for bony impactions, we remove a small amount of bone around the tooth with a surgical handpiece.
  4. Sectioning (if needed) — for difficult angles, it’s often easier and less traumatic to split the tooth into two or three pieces and remove them separately, rather than trying to lever out the whole tooth.
  5. Cleaning and closing — we clean the socket, place stitches (usually dissolvable), give you a gauze pack to bite on, and run you through the aftercare instructions.

We do these under local anaesthetic only. We don’t offer IV sedation or general anaesthetic in-house. For the majority of patients, local is enough — but if you’d rather be asleep for it, or your case is genuinely complex (deep bony impaction close to the nerve, unusual root anatomy, medical factors), we’ll refer you to a specialist oral surgeon. That’s not a weakness — it’s us knowing where our lane is and where it isn’t.

Cost at Biltoft is $500 to $650 per tooth. The upper end of that range reflects surgical complexity — a horizontal bony impaction takes more time and more skill than a straight soft-tissue eruption, and we price accordingly.

Recovery is usually a few days of swelling, some tenderness, and a soft-food diet for a week. For a day-by-day breakdown of what to expect afterwards, have a look at wisdom teeth recovery day by day.

When we refer out

I’ll refer you to a specialist oral and maxillofacial surgeon when:

  • The tooth sits very close to the inferior alveolar nerve on CBCT
  • There’s a large cyst or bony lesion that needs specialist handling
  • You have significant medical complexities (bleeding disorders, bisphosphonate history, immunosuppression)
  • You want or need IV sedation or general anaesthetic

We have a couple of excellent oral surgeons on the Gold Coast and in Brisbane we send patients to. Referral isn’t a hassle — it’s the right call for the right patient.

The bottom line

An impacted wisdom tooth isn’t automatically a problem, and it isn’t automatically something that needs to come out. But it is worth getting a proper assessment — clinical exam, an OPG, and an honest conversation about what’s likely to happen if you leave it versus remove it. Individual results vary, and the right answer depends on your tooth, your symptoms, and your risk tolerance.

If you’re in Murwillumbah or anywhere across the Tweed or Northern Rivers and you’d like an assessment, you can book a consult at Biltoft Dental online or call us on (02) 6672 1980. Bring any recent x-rays you’ve had taken — we’ll review them with you and give you a straight answer on where your impaction sits on the spectrum from “leave it alone” to “let’s get it out.”

— Dr Daniel Johnston

Frequently asked questions

What does 'impacted wisdom tooth' actually mean? +

Impacted means the tooth can't fully come through into its normal position — usually because it's angled wrong, there isn't enough room at the back of the jaw, or it's blocked by gum or bone. Some impactions are partial (part of the tooth visible), others are fully buried. Impaction isn't a disease in itself, but it often leads to problems.

Does an impacted wisdom tooth always have to come out? +

No. If it's not causing symptoms, there's no decay, no infection, no cyst, and it's not damaging the tooth in front, it's often reasonable to leave it and monitor with periodic check-ups and x-rays. Removal is recommended when the impaction is causing (or likely to cause) problems. It's a judgement call, and we'll walk you through it honestly.

What are the risks of leaving an impacted wisdom tooth alone? +

The main ones are recurrent pericoronitis (gum inflammation around a partially erupted tooth), decay in the wisdom tooth or the molar in front of it, gum disease in that area, and — less commonly — cysts forming around the buried crown. None of these are guaranteed, but the risk rises the longer a problematic impaction sits there.

How do you diagnose an impacted wisdom tooth? +

A clinical exam plus an OPG (panoramic x-ray) is usually enough to see the angle, depth, and position of the tooth. For complex cases — especially where the tooth sits close to the nerve in the lower jaw — we may recommend a CBCT (3D scan) before surgery to plan the removal safely.

Can you remove an impacted wisdom tooth under local anaesthetic only? +

Most of the time, yes. At Biltoft Dental we do wisdom tooth surgery under local anaesthetic. If a case is particularly complex — deep bony impaction, close nerve proximity, or you simply want to be asleep — we refer to a specialist oral surgeon who offers IV sedation or general anaesthetic.

How much does removing an impacted wisdom tooth cost at Biltoft? +

Our wisdom tooth removal fee is $500 to $650 per tooth, depending on how complex the extraction is. Simple, straight eruptions sit at the lower end; surgical removal of a deeply impacted tooth sits at the upper end. We quote you directly after reviewing your x-ray so there are no surprises.