WISDOM TEETH

Impacted Teeth

Wisdom Teeth Extraction
The wisdom teeth or third molars as they are also known are the last teeth to develop and appear in the mouth at ages 17 and 25, a period of life called the “Age of Wisdom.” Sometimes these teeth can be a valuable asset to the mouth, but when healthy and properly aligned. Most often, they are not aligned and affect the adjacent teeth, nerves or the bone jaws. In these cases, removal of the wisdom teeth – impacted, semi-impacted or not – is required.
There is also the possibility that the wisdom teeth do not erupt at all and remain as saying inmates through the gum and / or jaw or erupt partially (semi-impacted).
Most patients avoid visiting the dentist or the Oral and Maxillo Facial Surgeon as they fear that such a procedure is painful.

Impacted Wisdom Teeth
The wisdom teeth are facing not only usual dental problems as all other teeth, but also some additional problems because of their specificity. The most common problem is the impaction of these teeth in the gums and bone. These wisdom teeth are called impacted wisdom teeth.

What is an impacted tooth?
Most complications involving the wisdom teeth are due to the fact that they are the last permanent teeth to erupt, and often there is not enough free space on the back of the jaw after the second molars so that the wisdom teeth erupt normally.
Generally impacted teeth are unable to erupt through the gums, because there is not enough space. Nine out of ten people have at least one impacted wisdom tooth and less frequently impacted canine, premolar, first or second molar molar.

How serious it is to have an impacted wisdom tooth?

If left in the mouth, impacted wisdom teeth can damage neighboring teeth and nerves or they can get infected and possibly cause systemic infections and diseases to other organs in the body as bacteria travel through the bloodstream from the mouth to other organs of the body. In some cases, a bladder filled with liquid may be formed around the base of the untreated wisdom tooth. As the bladder increases, it can lead to more serious problems, such as cavities outside the jawbone and damage around the ribs, teeth and other structures.
In some cases of impacted wisdom tooth, due to inclination of the tooth and contact with the banker who is in front, permanent destruction of the bone that supports the second molar is caused, thus creating a periodontal problem.

Semi-Impacted Tooth

Wisdom Teeth can often partially erupt which means are semi-impacted in the gum.
When the wisdom tooth is semi-impacted, bacteria accumulate between the gum and the tooth, which cause inflammation with pain, swelling, stiffness of the jaw, and general malaise.
The semi-impacted teeth are also much more susceptible to decay and gum disease because, due to their position, it is difficult to bring the toothbrush to clean thoroughly all surfaces.

 

graphic symptoms

 

Symptoms

Normally when the wisdom teeth erupt in the mouth the symptoms are slight inflammation and mild pain that last for only a few days. These symptoms are not alarming and are usually alleviated with a simple painkiller.

Symptoms signaling problems and may indicate the need to extract a wisdom tooth are:

  • Pain. Pain is the most common and frequently occurring symptom when there are problems associated with the wisdom teeth. It is usually very strong, but the exact etiology may vary per event. It is not always an indication of a problem, and even wisdom teeth that rise completely normally and properly can cause severe pain as they must penetrate the layer of gum.
  • Redness, tenderness, and inflammation of the gums. A temporary inflammation of the gums is expected in the rise of a wisdom tooth. If it lasts without the wisdom tooth to appear then this may indicated an impacted wisdom tooth.
  • Irritation and face edema. Facial edema on the back side of the jaw is also a fairly common symptom. It may indicate an impacted wisdom tooth that fails to rise right and is pushing the surrounding tissues, or this may be due to pericoronitis event. Swelling can also be observed around the ear or in the neck.
  • Bad breath. It is usually the result of a periodontal infection around the wisdom tooth due to pericoronitis.
  • Pus. The appearance of pus in the mouth at the wisdom tooth region is an indication that a dental or periodontal abscess is very likely created. Usually it is accompanied by bad breath and taste in the mouth.
  • Ulcers. If the wisdom tooth erupted wrongly it can be rubbed on the inside of the cheek or tongue creating ulcers can be painful when chewing.
  • Headache. The pressure exerted by an impacted wisdom tooth can cause headaches as a side effect.
  • Pain in the neck, difficulty in swallowing. Inflammation close to the temporomandibular joint and the neck due to the wisdom teeth can cause pain in the neck, and difficulty in opening the jaw and the ingestion of food.
  • Swollen lymph nodes. The swelling of the lymph nodes under the chin because of infection which was caused from a wisdom tooth, results in swelling and pain in the neck.
  • Nausea and fever. When the infection caused by pericoronitis around the wisdom tooth, becomes severe and extend deeper into tissues of the face, jaw, and neck. This can develop nausea, fever and fatigue. Immediate medical treatment is needed.
  • Cysts or tumors. Very rarely, in cases of impacted wisdom teeth that remain trapped in the jawbone, cysts or tumors can be created.

These are some of the common symptoms associated with wisdom tooth problems, for which the most common and simplest method of treatment is the extraction of wisdom teeth.

Treatment / Surgery

When the position of the wisdom teeth can prevent proper oral hygiene, a preventive extraction is recommended.

It is important that the surgical removal of wisdom teeth to be done at an early age, when the development of the roots is not completed yet (implying easier surgery), but more importantly will not have a chance to cause permanent damage to adjacent teeth and tissues.

To be noted, if the entire wisdom tooth is normally erupted through the gum, the extraction is done as easily as that of any other tooth. But if the wisdom tooth has erupted and is encapsulated in the jaw, then it requires the bone portion above it to be removed.
In such cases, usually partial extraction of the tooth is performed in order to minimize the amount of bone that must be removed for the extraction of the tooth.
How easy it will be to extract the wisdom tooth depends on the position of the tooth. Before surgery, our oral and maxillofacial surgeon will discuss the procedure with you and tell you what to expect. This is a good time to ask questions. Also, talk to your surgeon about any concerns you have. Make sure you tell your doctor about any illness you have and medications you take.
There are various conditions that affect the removal of a wisdom tooth. These conditions include its position and the stage of development of the root. If wisdom teeth are infected, surgery may be more complicated.
Most often wisdom teeth or third molars can be removed with no pain. Removing an impacted or semi impacted wisdom tooth is done surgically under local anesthesia.
After stunning of the area an incision is effected above the gum covering the wisdom tooth. Then with the burr (dental wheel) section of the bone covering the tooth is removed. Then the tooth of leveraged in order to be exhausted from the jaw bone. Sometimes due to lack of space for the extraction it is necessary to cut the tooth with the burr. After extraction the wound is sutured. Postoperatively pain and swelling in the area may occur for two to three days, the symptoms disappear completely within a week.
Below we are listing videos with the extraction process for in impacted wisdom tooth, an impacted wisdom tooth that inclines and semi impacted wisdom tooth.


Is it difficult / painful to extract a wisdom tooth?
As indicated above, the difficulty in the removal of the wisdom tooth is related to the position of the tooth and the bone quality that surrounds it. In each case our Oral and Maxillofacial surgeon will follow a procedure that is painless and lasts from 2-3 minutes up to 10 maximum.


When should I remove my wisdom teeth?
As you can imagine, it is not wise to wait until your wisdom teeth start to hurt you to remove them. The earlier you remove them the better. The study of the American Society of Oral and Maxillofacial Surgery – AAOMS recommends that the wisdom teeth are removed by the time the patient is a young adult. The reason is that it is easier to remove wisdom teeth in a young adult, because the root system is not complete. As wisdom teeth grow, their roots extend and can be confused with the nerves of the lower jaw. If this occurs, it is more likely complications will follow.


What to expect after an extraction?
After surgery you may have pain and swelling in the area for a few days, but these symptoms can largely be prevented with a timely provision of appropriate medication.

• Bleeding may occur for several hours after a tooth extraction. Avoid hot liquids (such as coffee or soup).
• Often swelling is formed in the facial area of the extraction. To minimize swelling, place a piece of ice, in the area wrapped in a cloth. Apply for 10 minutes and 20 minutes later, repeat.
• For the pain, the Oral and Maxillofacial Surgery of our center will you provide you with analgesics to reduce pain.
• Before the export, it is likely that the doctor can will give you some antibiotics to prevent infection.
• After the extraction, your diet should be restricted to a liquid diet until all numbness from the anesthesia has gone. Eat soft foods and avoid alcohol.
• Continue to brush your teeth, but avoid the adjacent teeth during the first 24 hours. On the second day, repeat gentle brushing of your teeth.


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As indicated above what the difficulty is removed from the position of the tooth and the bone quality that surrounds it. The Oral and Maxillofacial our surgeon in each case following a procedure that is painless and lasts from 2-3 minutes up to 10 maximum.

As you can imagine, it is not wise to wait until your wisdom teeth start to hurt you to remove them. The earlier you remove the better. The study of the American Society of Oral and Maxillofacial Surgery - AAOMS recommends that the wisdom teeth are removed by the time the patient is a young adult. The reason is that it is easier to remove wisdom teeth of a young adult, because the root system is not complete. As wisdom teeth grow, their roots extend and can be confused with the nerves of the lower jaw. If this occurs, it is more likely complications will follow.

Many people think that as long as they do not feel pain, they do not have to worry about their wisdom teeth. However, lack of pain does not mean that there is no disease or problem. In fact, wisdom teeth that come out normally can still be prone to diseases, according to a study by the American Organization of Oral and Maxillofacial Surgery. Bacteria presented in the mouth can lead to gum disease and other problems before symptoms inform you that something is wrong. While brushing, flossing and dental care can help prevent these problems to other parts of your mouth, the position of the wisdom teeth makes it very difficult to keep the area clean and free of bacteria. Studies have shown that the bacteria and gum disease often affect the wisdom tooth region and other adjacent teeth in the back of the mouth.

We will ask you for an x-ray to see your wisdom teeth. The x-ray is needed in order to see their exact location and decide if surgical removal is needed. Sometimes three-dimensional imaging is required.

• After surgery you may have pain and swelling in the area for a few days, but these symptoms can largely be prevented with a timely provision of appropriate medication. • Bleeding may occur for several hours after a tooth extraction. Avoid hot liquids (such as coffee or soup). • Often swelling is formed in the facial area of ​​the extraction. To minimize swelling, place a piece of ice, in the area wrapped in a cloth. Apply for 10 minutes and 20 minutes later, repeat. • Pain, the Oral and Maxillofacial Surgery of our center will you provide you with analgesics to reduce pain. • Before the export is likely that the doctor can give you some antibiotics to prevent infection. • After the extraction your diet should be restricted to a liquid diet until all numbness from the anesthesia has gone. Eat soft foods and avoid alcohol. • Continue to brush your teeth, but avoid the adjacent teeth during the first 24 hours. On the second day, repeat gentle brushing your teeth.

After removing the wisdom teeth, the recovery period depends on the degree of difficulty of the operation (if a simple tooth extraction or an impacted wisdom tooth). Usually recovery period lasts from 1 day to 10 days.

Soft tissue injury Sometimes especially when there is such a lack of space in the jaw, the molars manage to find a way to erupt whilst fully but do not go in line with the other teeth. This means that it can be tilted outwards or inside superimposed the line of the other teeth, causing irritation and ulcers on the cheek or tongue.

Pericoronitis Pericoronitis is a problem that occurs mostly in cases of semi -impacted wisdom teeth. In this case a portion of the crown of the tooth is covered by a thin layer of scar tissue below which can penetrate trap food and bacteria, causing inflammation. Prolonged inflammation can progress to infection and abscess around the crown of the wisdom tooth with painful symptoms. Cleaning difficulty - Poor oral hygiene The molars are long in the back of the mouth, in an area difficult to clean even for those who know well how to brush their teeth. Cleaning and removal of plaque around them becomes even more difficult when it is erupted partially. Also, patients with sensitive vomiting reflex particularly find it difficult to reach the toothbrush so deep in their mouth to clean the wisdom teeth. Poor oral hygiene creates an increased risk of developing periodontal disease and Dental Caries. Gingivitis - Periodontitis The increased accumulation of plaque observed in wisdom teeth or because of access difficulty or because of the anatomical position of the tooth (eg. Slope) often creates problems of gingivitis that can progress to periodontitis. Infection may cause destruction of the bone, not only around the wisdom tooth, but also affect the neighboring tooth. Dental Caries The plaque outside of gingivitis can cause tooth decay in wisdom teeth or the adjacent tooth. The adjacent molar faces higher risk of caries from the wisdom tooth, especially if the wisdom tooth erupted tilted forwards it and rests at an angle to the second molar, creating a space between the contact point and the gum. In this area food is accumulated as well as microbes that cannot be removed by brushing alone, and this would rapidly cause decay in the most sensitive area near the gum line. The wisdom tooth is a tooth that can form dental caries more easily than any other tooth in the oral cavity. Orthodontic problems A wisdom tooth in an attempt to rise can cause movement of the remaining teeth impairing proper occlusion, creating overcrowding, and necessitating an orthodontic treatment (or even worse, destroying the result of a preceding orthodontic treatment). Many times it must be exported to safeguard the correct position of the teeth. Cysts Although the incidence of cysts around an enclosed wisdom tooth is low, when they occur, they can cause extensive damage to the jaw bone or the adjacent teeth. TMJ problems Sometimes a wisdom tooth interferes with the smooth movement of the teeth. During mastication exerted pressure on the joint and the muscles of the jaw is caused and this results into headaches, muscle spasms and other problems (Temporomandibular Joint Syndrome - TMJ).

 

Fractured jaw The development of the wisdom tooth at the back of the jaw reduces the mass of the bone at the point where the jaw bone has the smaller thickness and wherein the higher pressure is applied. The reduced mechanical strength increases the probability of a fracture of the jaw, but this is extremely small. The risk is significantly longer and calculable if the wisdom tooth creates periodontal problems, abscesses and cysts, which can destroy and further weaken the jaw bone.

" Can we treat the inflammation with antibiotics alone?" By taking antibiotics the problem is not solved, but disappears for a short time. To permanently solve the problem what is causing it should be attained, i.e. the wisdom tooth. If you feel that you have a problem with your wisdom teeth, you should promptly consult the Oral and Maxillo Facial Surgeon of our center to prevent the extension of inflammation. It is strongly suggested not to expect damage to occur before seeking a visit. Having trouble with your wisdom teeth? To contact us click here. (Contact us). To make an appointment click here.