Wisdom teeth or third molars are the last teeth to erupt in our oral cavity. It erupts between 17 to 20 years of age.
Why wisdom teeth get locked in the jaw?
Due to various factors and evolution in the size of the human jaw, wisdom teeth get entrapped inside the jaw bone or erupt in a disturbing manner with difficulties. The factors associated with the impaction of the wisdom teeth are:
- Evolution causing decrease in the bone size of the human jaw.
- Modern diet and unbalanced nutrition.
- Reduced production of growth stimulators for the stimulation of jaw bone.
- Habits followed by the individual.
- Disproportionate jaw development.
CLASSIFICATION OF WISDOM TEETH IMPACTION:
The impaction can be classified into the following:
- Vertical impaction – 38% of occurrence.
- Mesioangular impaction – 43% of occurrence.
- Horizontal impaction – 3% of occurrence.
- Distoangular impaction – 6% of occurrence.
- Buccoangular impaction.
- Linguangular impaction.
- Inverted impaction.
They are also classified based on the following relations as:
- In relation to the ramus of the mandible.
- In relation to the depth of the 3rd molar inside the bone from the occlusal line.
- According to the nature of the tissue overlying the impacted teeth.
SIGNS RELATED TO THE WISDOM TEETH IMPACTIONS
Severe complaints of pain with or without swelling.
This can be erupting pain experienced while the eruption of teeth. In some cases, the pain is due to any underlying infection caused in the impacted teeth.
They have additional complaints like cheek interferences, inability to chew or swallow food, discomfort, joint pain, inability to open his / her mouth, etc.
This is one of the common reasons for the removal of the impacted teeth.Tweet
The tissue surrounding or covering the impacted teeth inflames with pain. It is due to accidental bruising of the tissue or debris accumulation caused by bacterial action and toxin production.
It heals when cleaned and maintained properly till the eruption of the teeth. Frequent recurrences leads to the removal of the teeth.
In partially erupted teeth, food accumulation happens due to reduced access to the toothbrush.
These accumulated foods tend to harbor microorganisms and cause the destruction of the dental hard tissue causing caries.
They spread affecting the pulp of the impacted teeth and causing pain. Caries can also spread from the corresponding second molar through the saliva affecting the partially erupted teeth.
CYST OR TUMORS:
The occurrence of cyst or tumor is rare as they are usually found accidentally.
They tend to be asymptomatic initially and found only when they attain their aggressive state.
The incidence and prevalence of Periodontitis are usually more in older adults when compared to young people.
The proper association of Periodontitis with impacted teeth is still under study. Facts state that poor oral hygiene may cause accumulation of the food particles and increased bacterial growth in the oral cavity which might lead to inflammation of the gums and periodontal tissues (tissues covering the tooth root).
CROWDING OF TEETH:
Evolutionary changes led to the decrease in the human jaw size causing crowding of the anterior teeth (incisors) when the third molars erupt.
This late crowding causes misalignment and esthetic differences.
EVALUATION OF THE IMPACTED TEETH FOR SURGERY:
The tooth is assessed by clinical and Radiographical evaluations.
The association of the teeth with the nerves, position of the teeth and bones surrounding it are evaluated using a radiograph.
Care should be taken to assess the soft tissue covering it their interference with the erupting or impacted teeth. Assessment of the temporomandibular joint and its structures must be done.
TREATMENT FOR WISDOM TEETH:
The treatment plan is solely based on the chief complaint, history of infection, evaluation findings, radiographs, etc.
INDICATION FOR EXTRACTION (REMOVAL) OF THE 3RD MOLAR:
- Increased frequency of infection with pericoronitis.
- Pulp or Periapical infection.
- Deep caries with the destruction of the tooth structure.
- Abscess or cellulitis.
- Prophylactic removal.
- Partially erupted teeth affecting the prosthesis.
- Severe pain.
- Teeth in the line of fracture or orthognathic reconstructive jaw surgery.
- For transplantation.
- Orthodontic interferences.
- Tooth associated or involved with tumor resection.
- Temporomandibular joint deviation.
If the findings belong to any of the above or a combination of them then surgical removal of the impacted teeth is advised.
In most asymptomatic cases they are observed on periodic follow-ups to prevent or diagnose any growths.
If the interference is only a thick soft tissue then the tooth is exposed by surgical removal of the soft tissue.
COMPLICATIONS AFTER REMOVAL OF THE TEETH:
The dentist must inform the patient about the discomfort and possible complications after the surgical removal of the impacted teeth.
- The gradual reduction in pain with swelling persisting for 2 to 3 days.
- Inability to open your mouth.
- Inability to chew and swallow.
Complications can be:
- Paraesthesia (loss of the sensation) on the side of the tooth removed. it’s mostly a temporary phenomenon.
- Bleeding due to failure information of the clot.
- Dry socket due to improper clot formation.
- Oro-antral fistula (due to sinus involvement while extraction).
- Fracture of the mandible (lower jaw).