Background: Impaction has been defined as a tooth which is prevented from completely erupting into a normal functional position within the expected time, due to lack of space, obstruction by another tooth or an abnormal eruption path ^[5], inadequate bony length and insufficient development of the retromolar space with the tooth either partly visible/in communication with the oral cavity or completely invisible. Objectives: To investigate the prevalence of impacted teeth and associated pathologies in Al Ahsa, Saudi population. Materials and Methods: this is a retrospective study. The total record of 1985 patients were examined found 537 patients with impacted teeth and 130 patients have panoramic x-ray, digital camera was used with plastic box on x-ray viewer to stabilize the magnification. Results: 27.1% of Saudi patients in Al Ahsa presented with at least one impacted tooth. Among the 355 impacted teeth, the mandibular third molars were the most common impacted tooth (62.3%), followed by the maxillary third molars (30.7%), and the least was the maxillary canine (1.7%).   The results of this study indicated that caries was associated with 23.1% of the impacted third molars and 11.5% of the distal surfaces of adjacent second molars. The results of this study indicated that pericoronitis was associated with 61.5% of impacted third molars. Caries was associated with 23.1% of the impacted third molars and 11.5% of the distal surfaces of adjacent second molars. Root resorption was associated with 3% of the second molars that was adjacent to the impacted third molars. Dentigerous cyst was associated with one of impacted tooth. Conclusion: The prevalence of impacted teeth was high, and there was a predominant for impaction of the mandibular third molars in this study of Al Ahsa Saudi population. Pericoronitis associated with impacted mandibular third molar were related to the erupted maxillary third molars created potential trauma of the pericoronal tissues of the partially erupted mandibular third molars. Caries and periodontal disease were commonly associated with the impacted third molars, whereas root resorption and cystic pathology were rarely observed.