Wisdom teeth are the last set of molars to develop, usually emerging in your late teens or early twenties. For some people, they come in without issue. For others, they grow at the wrong angle — including completely sideways. When this happens, they’re known as horizontal wisdom teeth.

If you’ve been told you have a horizontal wisdom tooth or you’re experiencing pain in the back of your mouth, it’s important to understand what this means and what your options are. Left untreated, horizontally impacted wisdom teeth can cause significant discomfort and long-term dental complications.

This guide explains what horizontal wisdom teeth are, why they happen, the symptoms to watch for, and when removal becomes necessary.

What Are Horizontal Wisdom Teeth?

A horizontal wisdom tooth is a third molar that grows at a 90-degree angle instead of upright. Instead of pushing up through the gum like a normal tooth, it grows sideways toward the neighboring molar.

Because there isn’t enough space in most adult jaws to accommodate wisdom teeth, they often become impacted. “Impacted” means the tooth cannot fully erupt through the gums. Horizontal impaction is one of the more severe types.

Types of Wisdom Tooth Impaction

Dentists generally classify impacted wisdom teeth into four categories:

Vertical impaction – tooth is upright but stuck under the gum
Mesial impaction – tooth angles forward toward the front of the mouth
Distal impaction – tooth angles toward the back
Horizontal impaction – tooth lies completely sideways

Horizontal impaction tends to create more pressure on the adjacent molar, increasing the risk of damage.

Why Do Wisdom Teeth Grow Sideways?

There are several reasons horizontal wisdom teeth develop.

Lack of Jaw Space

Modern jaws are often too small to fit third molars. When there isn’t enough room, the tooth may shift direction as it attempts to erupt.

Genetics

If your parents had impacted wisdom teeth, there’s a higher chance you will as well. Jaw size and tooth alignment are often inherited traits.

Late Eruption Timing

Wisdom teeth erupt last, after the other permanent teeth are already in place. By that time, space in the jaw is usually limited.

Symptoms of a Horizontal Wisdom Tooth

Some people don’t realize they have a horizontal wisdom tooth until an X-ray reveals it. Others experience noticeable symptoms.

Jaw Pain and Pressure

A sideways tooth can press against the adjacent molar, causing constant pressure or aching in the back of the jaw.

Swollen or Tender Gums

If the tooth partially erupts, bacteria can collect under the gum flap. This often leads to inflammation and tenderness.

Headaches or Ear Pain

The pressure from an impacted wisdom tooth may radiate through the jaw, causing discomfort that feels like headaches or ear pain.

Difficulty Opening Your Mouth

Severe impaction can cause stiffness or limited jaw movement, especially if infection develops.

If you’re experiencing any of these symptoms, early evaluation is key to preventing complications.

Are Horizontal Wisdom Teeth Dangerous?

Not every impacted tooth causes immediate problems, but horizontal wisdom teeth have a higher risk of complications compared to other types.

Damage to Adjacent Teeth

A sideways wisdom tooth pushes directly into the second molar. Over time, this pressure can:

Cause tooth decay
Damage the root structure
Lead to bone loss around the neighboring tooth

Infection (Pericoronitis)

When a wisdom tooth partially erupts, bacteria can become trapped. This infection, known as pericoronitis, can cause swelling, pain, and difficulty swallowing.

Cysts or Jaw Damage

In rare cases, impacted wisdom teeth can form cysts around the tooth sac. These cysts may damage surrounding bone and teeth if not treated.

How Dentists Diagnose Horizontal Wisdom Teeth

Diagnosis typically involves a clinical exam and digital X-rays. Panoramic imaging allows the dentist or oral surgeon to see:

The exact angle of the tooth
Proximity to nearby nerves
Pressure on adjacent teeth
Bone involvement

If imaging confirms horizontal impaction, your provider will discuss whether removal is recommended.

Learn more about wisdom teeth removal procedure to understand how treatment is performed.

Do Horizontal Wisdom Teeth Need to Be Removed?

In most cases, yes. Horizontal impactions rarely resolve on their own.

When Removal Is Recommended

Extraction is usually advised if:

The tooth is causing pain
There is infection or swelling
The adjacent molar is at risk
A cyst is forming
Orthodontic stability is compromised

Even if you aren’t currently in pain, preventative removal may be recommended to avoid future complications.

What to Expect During Removal

Horizontal wisdom tooth extraction is typically performed by an oral and maxillofacial surgeon.

Step 1: Sedation and Comfort

Depending on your needs, options may include local anesthesia, IV sedation, or general anesthesia.

Step 2: Surgical Access

Because the tooth is fully or partially trapped in bone, a small incision is made in the gum. The surgeon may remove a small amount of bone to access the tooth.

Step 3: Sectioning the Tooth

Horizontally impacted teeth are often divided into smaller sections for safer removal.

Step 4: Suturing and Healing

Once removed, the area is cleaned and sutured. Dissolvable stitches are commonly used.

Recovery Timeline After Horizontal Wisdom Tooth Removal

Healing varies by patient, but most follow a similar timeline.

First 24–48 Hours

Swelling peaks
Mild bleeding may occur
Soft foods are recommended

Days 3–5

Swelling gradually decreases
Bruising may appear
Discomfort significantly improves

One to Two Weeks

Stitches dissolve
Gum tissue continues healing
Normal activity resumes

Following post-operative instructions carefully reduces the risk of dry socket and infection.

What Happens If You Delay Treatment?

Delaying removal can increase surgical complexity later. As you age:

Bone becomes denser
Roots become more developed
Healing may take longer

Additionally, ongoing pressure can permanently damage the neighboring molar, potentially leading to root canal treatment or extraction.

Early evaluation often makes the procedure simpler and recovery smoother.

When to Seek Immediate Care

Call your provider immediately if you experience:

Severe swelling
Fever
Difficulty swallowing
Pus or foul taste
Persistent numbness

If symptoms escalate quickly, it’s best to call us directly at 305-552-1193 to speak with a team member who can guide you on next steps.

For non-emergency consultations, you can schedule an evaluation to determine the right treatment plan.

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Preventing Complications Before They Start

Routine dental exams and early X-rays in the teenage years allow providers to monitor wisdom tooth development. If horizontal positioning is identified early, removal can often be planned before pain or infection begins.

Proactive treatment typically results in:

Shorter recovery
Lower complication risk
Less discomfort overall

Final Thoughts

Horizontal wisdom teeth are more than just an inconvenience. Because they grow sideways and press directly into adjacent teeth, they pose a higher risk for infection, decay, and long-term damage.

The good news is that modern oral surgery techniques make removal safe, efficient, and highly predictable. If you’ve been diagnosed with a horizontal impaction or are experiencing symptoms, early evaluation can protect your oral health and prevent more serious complications down the road.

Horizontal Wisdom Teeth: What It Means and Treatment Options