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Wisdom teeth

Introduction

The Georgia Rule actress – Lindsay Logan – was seen in June 2010 wearing a bandage around her face after leaving a medical office in Los Angeles, California. It was reported that she looked a bit groggy after having her wisdom teeth removed by her local dentist. In the previous evening she tweeted – ” night night… before i am bed ridden from getting my wisdom teeth out tomorrow – wish me luck – i’m scared 🙁 xx”.

She is not the only one who is scared; there are many people who find wisdom teeth as a matter of annoyance and has to be removed and thrown away. You might wonder about wisdom teeth and why people are afraid of it. This FAQ gives an insight into the wisdom teeth.

What are Wisdom Teeth?

The third and final set of molars that a person gets is known as Wisdom teeth and they are the last set of teeth that erupt in your mouth. These teeth normally erupt between the ages of 17 and 25 which are considered as the “Age of Wisdom.” If these teeth are healthy and have proper alignment they could be useful; however, in many cases they are not aligned properly and hence require removal.

Why do problems occur in Wisdom Teeth?

Anthropologists have found that the rough diet followed by human beings in the earlier days has resulted in excessive tooth wear. In order to compensate for this tooth wear drifting of the teeth occur and this has ensured the availability of space for most wisdom teeth that erupt during adolescence.

On the other hand the diet in the current days is very soft that causes lesser tooth wear and drifting; further the Orthodontic tooth straightening procedures provide a fuller dental arch. Both these things leave hardly any room for the eruption of wisdom teeth. This causes problems when the final four molars enter the mouth.

What is an Impacted Tooth?

If there is insufficient space in the dental arch the growth and eruption of a tooth is prevented by overlying gum, bone or another tooth and this tooth is called as impacted. The impacted tooth can either be partial or total. A tooth is said to be partially impacted when a portion of it has broken through the gum; on the other hand a totally impacted cannot break through the gum.

What are the different types of Impaction?

The impacted tooth falls under any one of the following categories.
Mesioangular impaction – this is the most common form of impaction and forms 44% of the cases; in this the tooth is angled forward, towards the front of the mouth.
Vertical impaction – occurs in 38% of the case; in this the tooth formed does not erupt fully through the gum line.
Distoangular impaction – occurs in 6% of the cases; in this the tooth is

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angled backward, towards the rear of the mouth.
Horizontal impaction – occurs only in 3% of the cases and is the least commonly occurring impaction; in this the tooth is angled fully ninety degrees forward, growing into the roots of the second molar.
Another method of categorizing impaction is based on the extent of encasing in the jawbone. If the tooth is completely encased in the jawbone, it is known as a bony impaction. On the other hand if the wisdom tooth has erupted out of the jawbone and not through the gum line, it is called a soft tissue impaction.

What are the problems that are likely to occur because of an Impacted Tooth?

The following problems are likely to be faced by a patient because of impacted tooth.
Impacted teeth that are either partial or total might be painful and could lead to infection.
These teeth might crowd or damage adjacent teeth or roots.
If the wisdom tooth fails to erupt completely through the gum bed and the gum at the back of the wisdom tooth extends over the biting surface, a soft tissue flap or lid around the tooth called an operculum is formed. Teeth covered by an operculum are difficult to clean with a toothbrush. You might have to use needle-less plastic syringe to wash the tooth vigorously with moderately pressured water or to softly wash it with hydrogen peroxide. In spite of all these precautions debris and bacteria can still accumulate under an operculum and this in turn results in pericoronitis which is a common infection problem faced by young adults with partial impactions that is often exacerbated by occlusion with opposing 3rd or 2nd molars.
It is possible that operculum does not disappear and this condition necessitates extraction of the wisdom teeth.
Operculectomy is an alternative treatment which involves the surgical removal of the operculum and this was being advocated. However it has been found that the risk of permanent or temporary numbness of the tongue due to damage of the nerve with this treatment is high and it is no longer recommended as a standard treatment in oral surgery.
The problem could become serious if the sac surrounding the impacted tooth gets filled with fluid and enlarges to form a cyst. As the cyst becomes big it might hollow out the jaw and permanently damage adjacent teeth, the surrounding nerves and bone. If the cyst is left untreated, a tumor might develop from its walls which could necessitate a more serious surgical procedure to remove it.

What are the common symptoms of pericoronitis?

Swelling and redness of the gum around the eruption site
Difficulty in opening the mouth
A bad odor or taste in the mouth
Pain in the general area might get transferred to the entire lower jaw or the neck.
The pericoronitis, if left untreated, might result in a much more severe infection.
Is it necessary to extract the Wisdom Tooth if it does not give any problems?
You must understand that third molar problems are neither visible nor painful in all cases. You might find that the damage takes place without your being aware of it. It is difficult to remove wisdom teeth whose roots get longer over a period of time; this might result in complications. Total or partial impaction might cause more problems for the patient when he grows old.

Is it possible to predict the time when Wisdom Tooth should be removed?

It is difficult to predict when the complications of third molars occur and the damage would have been done by the time one comes to know about it; it will be very painful and difficult to treat at this time. In practice it has been found that 85% of third molars require extraction at sometime or other.

What happens before and during surgery?

Prior to getting the surgery you must discuss with your oral and maxillofacial surgeon regarding the details of surgery, what you could expect from this surgery and also the risk factors. Ask as many questions as you want regarding the surgery to understand the details. You must be frank during your discussions with the doctor and explain to him about any existing illnesses that you have and also the medications that you are taking.
Extent of difficulty that can be faced during the removal of the wisdom tooth depends on factors such as position of the tooth, root development etc. The surgical procedure to remove partially or totally impacted wisdom teeth is relatively more complicated.
The dental surgeon might administer local anesthesia, intravenous sedation or general anesthesia for performing wisdom tooth extractions; these are normally done in the Dental office. You could discuss with your oral and maxillofacial surgeon on the anesthetic option suitable for you.

What are the side effects that you are likely to face after surgery?

You might have swelling and discomfort after the surgery and these are part of normal healing process. Swelling can be reduced by applying cold compresses may and medications prescribed by your surgeon will be useful in managing the discomfort. It is quite likely that you may be have to modify your diets after the surgery and revert

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back to normal diet once healing is complete.

What are the post extraction complications?

Bleeding and oozing
Swelling
Nerve injury
Dry Socket
Some of these problems are natural and unavoidable whereas others are under the control of the patient.