How to find out that a wisdom tooth is "coming in"?
The wisdom tooth or "figure eight" is the third molar, which starts coming into the mouth from both sides of both jaws at the age of 16-30. Since this age is considered mature, and the third molar comes last in the jaw, it is called the "wisdom tooth".
Impacted wisdom tooth is a 3rd molars in our dentition which can not make their way to appear in the mouth at the back of jaw teeth. Some people do not have any problems with wisdom tooth coming in, while others feel pain, repeated gum infections, and experience various kinds of discomfort.
If a wisdom tooth gets stuck under gum or doesn’t have adequate room to come through the gum, it’s considered “impacted.” Impacted wisdom tooth is more prone to disease, tooth decay, and other dental problems due to difficulty in their proper cleaning.
Key notes of the article:
Where and when do wisdom tooth come in
Why do wisdom tooth got impacted
Common symptoms of their coming in
How is an impacted wisdom tooth diagnosed?
Impacted Wisdom tooth removal
Recovery after surgey
Complications of wisdom tooth surgery
Home care after surgery
Where and when do wisdom tooth come in
Most people have four wisdom teeth, which are located on either side of the upper and lower jaws, behind the molars. According to the data presented in medical literature, most often wisdom teeth start coming in between 18 and 25 years of age. The nature of their eruption may differ from person to person. Most of the time wisdom teeth can only partially come in mouth or even remain under the gum's tissue. Unerupted tooth that remain covered with soft tissue or bone are called impacted tooth.
Why do wisdom tooth get impacted
For most of human history, human edibles remained rough and destructive to tooth. In such circumstances, wisdom tooth could be useful: they replaced worn-out molars. Today, when our diet consists of much softer meals and a high level of dental care has been achieved, teeth wear out more slowly and do not make room for the coming in of wisdom tooth. Also, archaeological finds show that the jaws of our prehistoric ancestors were wider.
What are symptoms of wisdom tooth coming in?
Most people barely notice the coming in of their wisdom teeth. However, when a wisdom tooth got impacted it can show a variety of symptoms like,
Pain; pain is the most common symptom which can be due to infection of the gum or due to cavity formation in the wisdom tooth or nearby molar. Pain can be mild to dull and heavy and can be also felt in the lower jaw, ear, and portion of the head. If pain is throbbing (pulsating ) the most probable reason will be the decay of the tooth.
Gum infection (Pericoronitis): most of the time wisdom tooth ia covered partially with gum when coming in. This gum covering causes accumulation of food debris which causes infection and swelling of the gum. The infected gum is traumatised by opposing upper tooth during eating. It causes severe pain and discomfort. This painful condition of infected gum is called pericoronitis.
Caries and pulpitis of nearby tooth: wisdom tooth make the cleaning of nearby teeth difficult and cause the deposition of food in the area. This results in the decay of the adjacent tooth. Symptoms will be sensitivity to cold and sweet and later on severe pain if the cavity becomes deep enough and reaches the pulp (the living portion of the tooth).
Halitosis (bad breath); wisdom tooth is the last molar and their location makes cleaning harder. Food accumulation in the area causes bad breath problems for people. Cavity formation in wisdom tooth or in the adjacent tooth can also be the reason of halitosis.
Cyst formation: in rare cases impacted wisdom tooth can result in cyst formation. Cyst can damage the surrounding bone and adjacent teeth roots. Cyst also put pressure in nearby nerves causing pain.
Malocclusion and tmj problems: wisdom tooth coming in can cause pressure on adjacent teeth and result in crowding and unbalance relation of upper and lower jaw (malocclusion). TMJ (joint of upper and lower jaw) gets hurt with unbalanced occlusion and shows pain and difficulty in mouth opening. The crowding of adjacent teeth with wisdom tooth coming in is still debatable in researchers.
As experts explain, adolescents who wear braces or other orthodontic appliances often have their wisdom teeth removed at the end of the treatment so that they do not displace the aligned teeth during eruption.
Indications for removal
Due to inadequate hygiene, wisdom tooth is especially susceptible to caries, and difficult access to them seriously complicates their treatment.
Today, many dentists disagree on whether to remove a wisdom tooth or not. Given its location, it does not affect either chewing function or phonetic. However, it frequently leads to various diseases that require complex treatment or emergency extraction.Unfortunately, problems with wisdom tooth occur quite repeatedly.
Since the wisdom tooth come in last, sometimes they just don't have sufficient space. Instead of coming straight, they come out at an angle or lie on their side, putting pressure on the adjacent tooth. Because of this, crowding, malocclusion, and many other troubles occur.
If wisdom tooth is not particularly threatening, it is not compulsory to get rid of it. But if they give you discomfort, you should think about the inexpediency of keeping them. Do not delay your visit to the dentist: During the examination, the doctor will be able to assess the situation and advise the best solution. You will also need to take an x-ray to determine the position of the tooth and to identify the range of problems it may cause in the future.
If indicated, the removal of a wisdom tooth is performed by a dentist-surgeon or maxillofacial surgeon. Depending on the complexity of the case, the operation is performed under local or general anesthesia. It is recommended to remove wisdom teeth at an earlier age when the roots are not yet fully formed. In such a situation, even removing all four teeth at the same time will not cause severe difficulties in eating and communicating.
What types of impaction are observed?
impacted wisdom teeth are mainly classified according to three criteria.
Location of the crown of wisdom tooth
At what depth the 3rd molar is located
The degree of coverage of the wisdom tooth with gingival(gum's) tissue.
Verticle impaction: more chances of normal growth and minimum trouble during coming in
Horizontal Impaction: the wisdom tooth is laying horizontally in the arch of the jaw, can damage nearby teeth, difficult in removal
Angular Impaction:the angle of inclination of the wisdom tooth axis can be any(medial, distal, lingual).
Full coverage: the gingiva(gum) completely closes the wisdom tooth, so it is problematic to notice the inflammatory process right away
Partial coverage: the gum partially cover the molar, resulting in a so-called hood that accumulates bacterial deposits, which causes infection of the soft tissue(pericoronitis)
At gingival level:if it is necessary to remove the impacted wisdom tooth , the procedure will not cause any particular difficulties
Deep in bone: extraction in such situations requires a special approach, surgical intervention is not excluded
Before making a final decision, the specialists Dentist surgeon conduct a detailed examination and take a series of X-ray images. If he doubts the conclusion made, a CT scan or orthopantomogram is prescribed.
Highlights of the extraction procedure
Extraction of the impacted wisdom tooth needs surgical intervention.
The extraction procedure requires special attention and impressive preparation. After the study, the dentist determines the factors that can cause difficulties during the operation. First of all, the tolerance of the drugs that will be used by the specialist during the extraction is checked.
If the patient has a chronic type of disease, the dentist sends him for consultation with other specialists. This approach allows you to significantly minimize the risks of problems during the operation and at the stage of rehabilitation.
Removal of impacted and dystopic wisdom tooth
The impacted wisdom tooth can be in a straight or rotated position (dystopia) - in this case, it will press on the roots of its neighbor. In order to avoid complexity, such non-grown teeth must be removed.
Removal process of impacted dystopic tooth require proper anesthesia of the sorrounding tissues.
The gum is cut with blade incision to provide access to the impacted tooth.
A hole is created in the bone with a bur using slow speed handpiece.
The tooth is removed immediately using forceps, or first it is divided into parts using a bur, and then extracted from the bone tissue.
After all the manipulations are completed, the gum returns to its place, sutures are applied on top.
After removal of impacted tooth, the bone level is restored. In some cases, the cavity freed from the tooth is filled with artificial bone material, or with the patient's own blood plasma - this measure is required so that an empty space does not form in the bone, which can be occupied by adjacent teeth. If they begin to move, then the entire dentition will gradually "creep" - gaps will appear between the teeth. In order to understand whether the hole will need to be filled with any material, an Orhtodontist's consultation is mendatory.
The operation to remove the impacted tooth takes about 30 minutes to an hour. This is a fairly common surgery that, when performing professionaly, will not lead to any morbidity. In some cases, it may take longer if there are many uneven roots. The doctor can determine the approximate time of the surgery by examining the x-ray image.
Complications after the removal of "wisdom teeth"
Impacted wisdom teeth are sometimes located quite deep in the bone, so their extraction can be a rather tough procedure - this can lead to certain complications. For example, a nerve injury in the lower jaw, as a result of which the lips, tongue and part of the cheek become numb (it goes away on its own after a few weeks or months), a rupture of the sinus (a runny nose or sinusitis is formed). With complex removal of wisdom teeth, there is a high probability of a fracture of the jaw, abutting teeth or dentures. In order to avoid such issues, it is best to remove the wisdom teeth from a maxillofacial surgeon who has extensive practical experience in this area.
Rehabilitation after an extraction operation
Since the operation is one of the most difficult, therefore, a long duration of rehabilitation is also provided. During the rehabilitation spell, one should neglect visiting saunas, refuse alcoholic beverages, limit smoking as much as possible, and refuse physical activity.
The minimum rehabilitation span is about 7 days, if the wound was deep, then the period can stretch for one month. Pain and discomfort, which mainly accompany the postoperative phase, cease to disturb the patient at about the seventh day.
By observing all the instructions of the dentist-surgeon, you can significantly shorten the rehabilitation session and quickly return to your usual way of life.