Removal of Wisdom Teeth
By impacted wisdom teeth we mean ones that do not fit the dental arch and due to their inapropriate position may cause problems.
The cause of impaction is that mandible development is different from teeth development.
Impaction of wisdom teeth can be categorized in two degrees.
The tooth has partially erupted, a part of the tooth is visible in the oral cavity, but it cannot fit in the dental arch.
The tooth is invisible in the mouth, beacuse it is covered by gum or bone.
What problems can be caused by impacted teeth?
Tooth decay: if the tooth is inapproriately situated in the dental arch then it is difficult to clean then it is prone to tooth decay that may even spread to the tooth in front of it.
Parodontal inflammation: Parodontal inflammation and gingivitis (or inflammation of the gum) may be caused by a partially erupted wisdom tooth. As it deteriorates the general state of oral hygiene it may cause chonic gingivitis.
Inflammation around the dental crown of a partially erupted tooth (pericoronitis)
The problem occurs when the wisdom tooth erupts only in part. Only a part of the tooth breaks through the gum, the rest remains covered. As a result, between the gum and the tooth a so-called pocket is formed, which is difficult to clean and the large number of bacteria therein may easily cause inflammation.
In this case the mucous membrane swells and to open the mouth may be painful and limited. Typical symptoms are swollen glandular tissue; high temperature or fever may also occur.
If you experience these symptoms with your wisdom tooth, contact your dentist without delay. You may prevent further complications.
Cystal deviations around the wisdom tooth
If the wisdom tooth remains in the jaw bone, a cystal deviation may form (follicular cyst). If such a deviation is shown by the panorama x-ray, removal of the tooth is positively recommended.
Prevention of radicular resorption in neighbouring teeth
It usually occurs with lower wisdom teeth that – as they grow in the wrong direction – they put a pressure on the root of the molar in front. In such cases the removal of the wisdom tooth may save the neighbouring tooth.
Prosthetic/prosthodontic considerations
If a (removable) denture is being made and it would spread to the mucous membrane on the area of the wisdom tooth, then one must make sure by way of a panorama x-ray that there is no impacted wisdom tooth in the jawbone.
Facilitating orthodontic treatment
If orthodontics is to prevent crowding or compression of the front teeth, removal of the wisdom tooth may facilitate such a treatment.
How to solve problems occurring with the wisdom tooth
The main task of the dentist is to decide whether the wisdom tooth that causes problems can be saved or not. In order to reach a reassuring conclusion in this respect, a panorama x-ray is made, giving useful information on the position and shape of the tooth, its relation to neighbouring teeth and the occasional deviations around the tooth. If the dentist’s professional judgement is that the partially erupted tooth is growing in the right direction and it can be expected to fit into the dental arch, then the main goal is to prevent inflammation around the tooth crown. In such cases the dentist cleans and disinfects the pocket under local anaesthetics. As a result, the inflammation disappers in 2-3 days. When not inflamed, the mucous membrane still covering the tooth can be removed with a minor incision, thereby the tooth crown is free to develop.
The wirdom tooth may also be saved if it remains entirly in the jaw bone, causes no complaints and the x-ray shows no deviations around it.
If, according to the best professional judgement of the dentist, the wisdom tooth cannot be saved, there are two ways to remove it.
In the case of partially erupted teeth, if most of the tooth crown is visible in the mouth and it is appropriately situated, it can be removed by way of a routinely applied extraction.
If these conditions are not given, an operation may prove to be necessary. The operation is of course performed under local anaesthetics, with the least possible pain. First a small incision is made on the gum next to the tooth in question, to make the bone accessible. Then a surgical drill is applied to remove the bone surface, to make the tooth visible. The tooth is removed by using special forceps and dental elevators. The place of the removed tooth is cleaned, the mucous membrane stitched together. The stitches are taken out in 7-10 days. Post-operation care by the patient is the same as in cases of tooth extraction.
