（#wisdomteeth #thirdmolar #extraction）“Wisdom teeth” in unusual places. “Impacted wisdom teeth” that are difficult to extract due to their location
Wisdom teeth are the backmost molars.
They are the “wisdom teeth” located furthest back in the mouth.
In medical terminology, they are called “wisdom teeth.”
They are called “wisdom teeth” in English because they erupt around the time people reach adulthood—in their late teens to early twenties—when they gain wisdom and the ability to judge matters wisely.
This timing also coincides with the milestone of graduating from school and starting a career.
So, you’re about to make your debut in the working world.
At such an important milestone, you might unexpectedly hit a snag—thinking, “Wait a minute, my wisdom tooth hurts.”
Speaking of these “wisdom teeth,”
there are rare cases where they don’t erupt normally,
or where they are located in unusual places.
In dental terminology, these abnormal “wisdom teeth”
are referred to as “impacted wisdom teeth” or “horizontally impacted wisdom teeth”.
The official anatomical name is “third molar”.
Occasionally, some people have difficult “wisdom teeth” located in unusual places.
Although it requires advanced technical skill, just as with the extraction of a normal “wisdom tooth,”
we hope that even difficult “wisdom teeth” can be successfully extracted.
A Report on “Difficult Wisdom Teeth”
“Difficult wisdom teeth” refer to wisdom teeth that are positioned in a way that deviates from the typical location of wisdom teeth.
Even oral surgeons rarely encounter them, so the extraction of difficult wisdom teeth requires extremely advanced technical skills.
Typical Wisdom Tooth Positions
For most people, wisdom teeth—if present—are located one tooth back from the molars.
Even if they are slightly impacted, they are usually only partially covered by the gums.
The very fact that you have an “impacted wisdom tooth” means it is “not normal.”
Difficult Wisdom Tooth Positions
As you can see by comparing the images, this difficult “wisdom tooth” is located quite deep.
Because it is located at this depth,
extracting this “wisdom tooth” involves challenges that are incomparable to those of a typical “wisdom tooth.”
A deep and extensive incision must be made through the gums and oral muscles,
bone must be removed since the tooth is embedded in the bone,
significant bleeding is inevitable,
and the severing and removal of nerves—a difficult decision to make—must also be considered.
How do the positions compare, and what are the differences?
When you compare the two, the difference in depth is clearly evident.
Although the image points appear to be close in position,
given that this difference exists within the human face and the oral cavity—where small teeth are closely packed—it can be said that their positions are quite different.
Why “difficult wisdom teeth” are such a challenge: The major difference from typical “wisdom teeth”
It comes down to whether or not the tooth is in contact with a nerve.
While typical “wisdom teeth” are completely separated from nerves, difficult “wisdom teeth” are positioned in a way that they touch (or overlap) a nerve.
This is one cause of pain and is also a factor in why the surgical removal of difficult “wisdom teeth” is considered challenging.
What kind of pain is it?
The cause—an “impacted wisdom tooth”—is located inside the mouth, so
although it isn’t visible from the outside,
it causes pain.
There’s no bleeding, and no bones are broken.
However, it’s just as “severe” a condition.
| Type of Pain | Symptoms & Experiences |
|---|---|
| Constantly hurts naturally | Unable to settle down |
| Hurts no matter what you are doing | Induces mistakes at work and elsewhere |
| Accompanied by an indescribable sense of irritation | |
| Unable to concentrate on anything | |
| Prescription pain relievers do not work | They provide slight comfort at best |
| Intense pain upon waking up in the morning | Makes you feel depressed from the morning |
| Mind-numbing pain | Feels like having a perpetual "hangnail" deep inside where your hands cannot reach |
| You sometimes want to drive a blade into it and scoop it out yourself, though you don't have the courage | |
| At its worst, you feel a writhing agony | |
| Makes you want to call an ambulance | |
| No effect on tooth brushing | Applying the toothbrush firmly does not resonate as pain |
| Pain sometimes subsides irregularly | Sometimes feels more like a painful sense of discomfort |
| The pain happens to subside only during the consultation with the doctor | |
| There is a frustration of feeling pain normally yet being unable to convey it | |
| Pain that cannot be expressed in onomatopoeia | Throbbing, pounding, stinging, creaking, sharp, burning, prickling |
| None of them feel quite right or wrong, just a dull throbbing | |
| Eventually, the reverberation from the nerves feels like a definitive pain sensation | Pain sometimes radiates from the jaw, passing near the jawline, up to the temples |
| The radiating path also matches the lines where human facial nerves run | |
| Pain that acts directly on the nerves, delivering pain signals to the brain, comes with a different quality of pain | |
| Constant pain during eating and chewing | Not being able to enjoy meals is stressful |
| Drinks and soups cause no vibration pain | |
| When it comes to solids like vegetables, the chewing vibration hurts too much to bite | |
| Every single bite of fried chicken spreads the pain | |
| The impact of breaking a single potato chip once transmitted an incredible pain vibration | |
| It doesn't feel like you've eaten, and urges for binge eating appear | |
| Above all, food stops tasting good | |
| Looking back at the diagnosis, it can also be interpreted as pain of unknown origin | Even if it is pain with a sense of uncertainty, it brings weariness and discomfort |
| Living with the pain for life is not impossible, but if possible, you'd want to get rid of it |
Why Do “Impacted Wisdom Teeth” Hurt?
First, an “impacted wisdom tooth” is positioned in such a way that it presses against a nerve.
Furthermore, “wisdom teeth” naturally tend to push their way out of the mouth.
It’s the same principle as hair or fingernails growing.
Even without conscious effort, there is a constant, subtle force at work within the body,
and for the nerves adjacent to the “impacted wisdom tooth,” this force is constantly interpreted as a pain signal.
Even if a “wisdom tooth” is buried in the bone, it may simply have a stubborn nature that drives it to push its way out no matter what.
Each individual tooth has its own nerve.
When you chew food, a slight vibration occurs.
You may not be aware of it while chewing, but
the chewing motion involves more than just a simple up-and-down movement of the teeth; it involves complex twisting and grinding in multiple directions.
The oral muscles also act as a cushion to absorb the impact of chewing.
The oral muscles located beneath the teeth primarily serve as this cushion, but
there is an impacted wisdom tooth right in that spot.
The crucial cushioning layer has become very thin,
so the vibrations and impact from chewing are transmitted directly to the “impacted wisdom tooth,”
and from there to the nerves, which interpret this as pain.
Can you tell from the image that the oral muscle cushion has become very thin?
The tendency of “wisdom teeth” to try to break through the gum,
a pain sensation distinct from that experienced during chewing,
when combined, are the cause of constant, chronic pain.
This is the true nature of the pain caused by “impacted wisdom teeth.”
Even for an oral surgeon who performs many tooth extractions, it is rare to encounter an “impacted wisdom tooth” located at this depth.
The mere presence of an “impacted wisdom tooth” is already abnormal,
and extracting one that is buried even deeper than expected requires extremely advanced technical skills.
Is there any swelling associated with the pain?
When pain occurs in the human body, swelling often appears—as is clearly seen in cases such as sprains.
In this patient’s case, there does not appear to be any visible swelling associated with the pain.
Since the affected area is very small and deep,
even if swelling occurs, it may not become large enough to be visible from the outside.
Since “impacted wisdom teeth” are located near the jawline,
it’s possible that, for people with prominent jawlines, the swelling might be hidden by the jaw itself.
Even if there is pain, not everyone will necessarily experience swelling at the affected site.
Why Is Surgery to Remove an “Impacted Wisdom Tooth” So Difficult?
Generally, even when an oral surgeon extracts a “wisdom tooth,” the nerve is not removed, and
in most cases, the nerve is not involved.
This is because, as shown in the image, even when a “wisdom tooth” is impacted, it is usually only partially buried, typically just above the gum line.
On the other hand,
“impacted wisdom teeth” are located deep within the gums, and the position of the nerves is a significant factor.
Not only oral surgeons but all physicians performing surgery are required to avoid removing nerves in the human body as much as possible.
| The foundational rule as a doctor that nerves must not be removed |
| A situation where symptoms cannot be resolved unless the nerve is removed |
These are contradictory and conflicting matters.
Whether to think of a way to eliminate the pain and wisdom tooth while complying with the doctor's fundamental rule not to remove the nerve, or
whether to remove the pain along with the nerve even if it goes against that rule
is a matter where judgments vary depending on the doctor.
Either way, a deep and large incision in the gums remains necessary.
Major blood vessels also run near the jawline, and a significant amount of bleeding is expected.
The amount of bleeding could potentially approach a fatal level,
and in some cases, blood transfusions may even be necessary, placing a heavy physical burden on the patient.
difficult surgery that places a heavy burden on both the doctor and the patient—that is the "impacted wisdom tooth" extraction procedure.
Inflammation Around an “Impacted Wisdom Tooth”?
It’s also possible that the pain is simply due to inflammation of the oral muscles, unrelated to the troublesome wisdom tooth.
Indeed, when traced back to its source, the “pain a person feels” is a sensation caused by “inflammation.”
What Is Inflammation?
It is a defensive reaction triggered by the body when it detects damage caused by trauma, burns, bacteria, drugs, radiation, or other factors.
As part of this defensive reaction, symptoms such as redness, swelling, fever, and pain occur.
Even though they are called “impacted wisdom teeth,” depending on the perspective, they can appear to be neatly embedded within the bone.
In such cases, if only the inflamed oral tissue is removed,
the pain should subside as the area heals naturally.
If the source of the pain is truly an “impacted wisdom tooth” or pain originating directly from the nerve itself,
and if the nerve is indeed the cause of the pain,
it must be removed at all costs; otherwise, the underlying pain will not subside.
However, it is, after all, in a difficult location.
The Complexity of “Impacted Wisdom Teeth” and Nerve Conditions
If the nerve is indeed the cause of the pain,
the pain will not subside at its root unless the tooth is removed at all costs.
While X-rays may show that the tooth overlaps the nerve,
they cannot reveal the exact position or condition of the nerve inside the body.
Unless the gum is actually incised to expose the nerve,
the true relationship between the “impacted wisdom tooth” and the nerve cannot be determined.
Nevertheless, given that the “impacted wisdom tooth” is located near the nerve
and that you are experiencing pain,
two possible scenarios can be considered.
1. The nerve is entangled with the tooth
When nerves are entangled throughout an “impacted wisdom tooth,” it is extremely difficult—if not nearly impossible—to remove only the “impacted wisdom tooth” while avoiding the nerves.
To use an analogy, it’s like a tangerine wrapped in a mesh net that covers every inch of it.
How do you remove the mandarin orange inside?
First, you have to tear open the sealed mesh—that is, the tangled nerves—
or you won’t be able to remove the mandarin orange or the “impacted wisdom tooth” inside.
2. The case where a troublesome wisdom tooth is pulling on the nerves
“Wisdom teeth” naturally tend to try to erupt.
Even “impacted wisdom teeth” have this instinctive tendency to try to erupt.
And what if the tip of an “impacted wisdom tooth” is pressing against a nerve...?
To put it another way, would it be easier to visualize this by imagining someone pulling on a rope?
If a nerve is caught at the base,
every time the “wisdom tooth” exerts force to push outward, that force is transmitted to the nerve as pain.
Since it is an “impacted wisdom tooth,” even though it tries to emerge, it is blocked by thick bone and the base of the gums and cannot break through into the oral cavity, but
the force trying to push it out is still present.
Even if it is a source of only the slightest force, the nerve that receives this signal directly interprets it as pain.
How to Remove It?
-
1.Precision Drilling from Inside and Outside the Mouth
- 2.Drastic Incision
1. Precision Drilling from Inside and Outside the Mouth
Precision drills are inserted from both inside the mouth and the jawline area, boring holes toward the troublesome wisdom tooth.
The approach aims to avoid the nerve as much as possible, though
(since it is an unnecessary nerve that was causing the pain, one might think it's a nerve that could be removed without hesitation)
the idea is to pulverize and remove only the troublesome wisdom tooth into small pieces.
Since a large portion of the oral muscles is removed, it takes time for them to recover through natural healing alone.
For this reason, muscle from the patient’s own buttocks is used as a substitute.
It takes about three months of follow-up treatment for the oral muscles and the buttock muscles to heal and integrate, leading to a fully recovered state.
During that time, the patient will be unable to eat much.
Additionally, since tissue is also removed from the buttocks, there is concern that the patient may experience pain during activities such as desk work.
It is considered preferable to harvest the buttock tissue used as a substitute from the lateral area,
a part of the buttocks that is rarely used in daily life.
2. Radical Incision
This method involves making a bold incision from the jawline to excise and remove the problematic wisdom tooth along with the nerve.
Since the incision may be even larger than in “1. Precision Drilling,” a significant amount of bleeding is to be expected.
However, since the surrounding nerves are removed along with the “impacted wisdom tooth,”
you can expect the pain to disappear completely once you’ve recovered from surgery.
This may no longer be just about dentistry—it might even border on plastic surgery.
Even if the surgery is a complete success, a large scar will remain from the jawline to the cheek.
If you think of it as a badge of honor, that’s not so bad, right?
As a patient burdened with troublesome “impacted wisdom teeth,”
you’ll likely want to eliminate the source of the pain completely, even if it means leaving a scar.
Society of Oral and Maxillofacial Surgery
The website features a section listing
the names of “Board-Certified Oral and Maxillofacial Surgeons” recognized by the Society of Oral and Maxillofacial Surgery.
It is said that becoming a board-certified oral and maxillofacial surgeon requires passing a series of challenging exams.
If a doctor is certified by the Society of Oral and Maxillofacial Surgery,
and the hospital has the necessary facilities and equipment to support the required techniques,
it may be possible to perform surgery to extract “impacted wisdom teeth.”
