IMPACTED WISDOM TEETH
What are impacted wisdom teeth?
Wisdom teeth are molar teeth, which are the last to erupt into the mouth, usually after the age of 17 years, or even much later. They are four in number - one each situated in the four corners of the mouth, behind the second molar teeth and have no clearly defined shape or form unlike the other permanent teeth. They are often called wisdom teeth as they erupt at an age when the person is in the transition phase from childhood to adulthood. The remaining 28 teeth normally erupt into the oral cavity by the age of 14 years.
Wisdom teeth are considered impacted when they are unable to erupt into their normal functional positions, mainly due to lack of space for their eruption. Of the other permanent teeth in normal individuals, very few are found impacted canines.
What are the problems associated with impacted wisdom teeth?
Infection is the most common problem encountered associated with impacted teeth. It may range from a localized gum infection to acute, extensive, life-threatening infections involving the head and neck. Localized gum infections tend to recur intermittently when complete eruption of the tooth is not possible. Recurrent infections will frequently lead to gum disease and decay on adjacent teeth, which can ultimately result in the loss of these teeth in addition to the wisdom teeth. Sometimes wisdom teeth erupt in abnormal positions and angulations making them non-functional, as they are unable to contact their corresponding opposing wisdom teeth. In such situations, frequent cheek biting or tongue biting can result from the abnormal positioning causing injuries to the cheeks and tongue while chewing. Besides this, the unsupported upper wisdom tooth also starts over-erupting, lengthening out from the supporting gums, thereby leading to food trapping, decay and gum infections in the region.
There are situations when the wisdom teeth do not erupt at all into the mouth. They lie buried within the gum tissue or bone. Often, patients do not experience problems in such situations. There are also instances where wisdom teeth are totally absent in certain individuals.
Symptoms:- pain or tenderness of the gums (gingiva)
- pain when biting down on or near the area
- visible gap where a tooth did not emerge
- bad breath
- redness and swelling of the gums around the impacted tooth
- swollen lymph nodes of the neck (occasionally)
- difficulty opening the mouth (occasionally)
- prolonged headache or jaw ache
How are impacted wisdom teeth treated?
X-rays of the wisdom teeth are made to help assess the positions, shapes and sizes of the crowns and roots, the surrounding bone and the nerve, which usually runs below the roots of the teeth. X-rays also help in identification of associated disease conditions such as cysts and tumors in relation to the teeth, apart from aiding in planning of the surgical procedure.
In certain cases of impacted teeth, where there seems to be adequate space available for eruption, the dental surgeon may advise a pericoronal flap excision (removal of the gum tissue overlying the impacted tooth) and observation. In such cases, the tooth may erupt into place after the procedure. However, in many cases, infection of the overlying gum tissue has been found to recur. Here, there is no other choice other than the removal of the offending wisdom tooth.
In light of the clinical experience that most impacted teeth will ultimately give rise to some type of problem or disease, it is generally felt that preventive removal of impacted third molars is indicated. Because complications are significantly reduced when the impacted tooth has no associated disease conditions, and because difficulty of removal increases with age, it is recommended that impacted teeth be removed early. It is best done as soon as it becomes apparent that there is insufficient space or that they are not positioned for normal eruption.
Before the removal of the impacted wisdom tooth, the patient is normally put on a course of antibiotics and anti-inflammatory drugs to eliminate existing infection and inflammation in the area. The removal of an impacted tooth is normally a minor surgical operation, lasting 10 - 45 minutes. It often requires incision of the gum, cutting the tooth and probably some removal of bone too. The oral surgeon may provide anesthesia options of local anesthesia, intravenous sedation, or general anesthesia to make the procedure more relaxing for the patient. The surgical wound is often sutured with silk (non-absorbable) or with absorbable suture materials. Some surgeons advise extraction of the corresponding upper wisdom teeth also during the same sitting.