Wisdom Teeth

What is wisdom teeth?

A wisdom teeth, in humans, is actually any of the common four 3rd molars .Wisdom teeth generally show up between the ages of SIXTEEN and TWENTY FIVE. Generally most adults have 4 wisdom teeth, but it’s possible to have less or even more, in that case the extras are called supernumerary teeth Wisdom teeth generally affect other teeth while they develop, getting impacted or `coming in sideways.` They are usually extracted when this happens.

Impacted wisdom teeth fall into one of several groups:

· Mesioangular impaction is one of common form (44%), and usually means the teeth is angled forward, in the direction of the front of the mouth.
· Vertical impaction (38%) happens when the formed teeth does not erupt completely through the gum line.
· Distoangular impaction (6%) means that the teeth is angled in reverse, towards the back of the mouth area.
· Horizontal impaction (3%) is the very least common form, that happens when the teeth is angled completely 90 degrees sideways, increasing into the roots of the second-molar.

Usually mesioangular impactions are the hardest to extract in the maxilla (uppr jaw) and also simplest to extract in the mandible (lower jaw), when distoangular impactions are the simplest to extract in the maxilla and the most hard to extract in the mandible. Frequently, a completely erupted uppr wisdom teeth needs bone removal if the teeth does not yield simply to forceps or elevators. Failure to remove distal or even buccal bone when removing one of them teeth could cause the whole maxillary tuberosity to be broke off, thereby tearing out the floor of themaxillary sinus .[citation required ]
Impacted wisdom teeth can also be classified on whether they are still totally encased in the jawbone. When it is completely encased within the jawbone, this is a bony impaction. If the wisdom tooth has erupted out of the jawbone but not with the gumline, it’s known as soft tissue impaction.
In a little percentage of patients, cysts and also tumors occur around impacted wisdom teeth, needing surgical removal. Estimates of the incidence of cysts around affected teeth vary from 0.001% to 11%, with a greater incidence in old patients, recommending that the possibility of a cyst or even tumor increases the much longer an impaction exists. A retrospective overview of around 10,000 impacted teeth, advised that the chance of malignant tumors was 0.02% (2 instances in 9,994 teeth).

Partial eruption:

A few problems which can or can not occur with 3rd molar teeth:

A: Mesio-impacted, partially erupted mandibular 3rd molar,

B:Dental caries and also periodontal defectsassociated with both the 3rd and 2nd molars, caused by foods packing and also very poor access to oral hygiene techniques,

C: Inflamed operculum covering partly erupted lower 3rd molar, with accumulation of foods debris and germs underneath,

D: The upper 3rd molar has over-erupted because of insufficient opposing teeth contact, and could start to traumatically occlude into the operculum over the lower 3rd molar. Unopposed teeth are generally sharp because they haven’t been blunted by another teeth (attrition).
Occasionally the wisdom teeth fails to erupt fully through the gum bed and also the gum at the back of the wisdom teeth extends over the biting surface area, forming a soft tissue flap or even cover around the teeth known as an operculum. Teeth covered by an operculum may be hard to clean using a tooth brush. Additional cleaning methods can include by using a needle - less plastic-syringe to vigorously clean the teeth with moderately pressured water or softly wash this with hydrogen peroxide.
However, debris and also bacteria can easily build up under an operculum, which can causepericoronitis, a common infection issue in adults with partial impactions which is frequently exacerbated by occlusion with opposing 3rd or 2nd molars. Very common symptoms include a swelling and also redness of the gum round the eruption site, difficulty in opening the mouth, a poor smell or taste in the mouth, and pain in the common area which may also run down the whole lower jaw or it could be the neck. Untreated pericoronitis may progress to a much more serious infection.
If the operculum doesn't disappear, suggested treatment is extraction of the wisdom teeth. An alternate treatment involving removal from the operculum, known as operculectomy, has been advocated. There is a high-risk of permanent or short-term numbness of the tongue because of damage of the nerve with this treatment and it's also no longer suggested as a standard treatment in oral surgery.
Chronic swelling in the gingival tissue of the partly erupted 3rd-molar, i.e. chronicpericoronitis, could be the etiology for the development of paradental cyst, an inflammatoryodentogenic cyst.

Dental Extraction:

A wisdom teeth protrudes outwards through the at the back of the lower teeth.

A dental officer and his assistant remove the mandibular 3rd molar of a patient.

A removed mandibular 3rd molar with long roots.

An upper and lower right wisdom teeth removed throughout the same period under local anesthetics.

Wisdom teeth are removed for 2 common reasons: either the wisdom teeth have currently become affected, or the wisdom teeth may potentially become problematic if not extracted. Possible problems caused by the existence of properly grown-in wisdom teeth include infections caused by food pieces easily trapped in the jaw region behind the wisdom teeth where normal flossing and brushing is very difficult and ineffective. This kind of infections may be frequent, and also cause considerable pain and medical risk. Other reasons wisdom teeth are removed consist of misalignment which rubs up against the tongue or even cheek causing pain, possible crowding or malocclusion of the other teeth (a result of there being insufficient room on the jaw or even in the mouth), as well as orthodontics.

Post-extraction problems:

There are a number of problems that may occur after the removals have been completed. A few of these problems are not avoidable and natural, whilst others are under the control of the patient. The recommendations contained in the sections below are common guidelines through which a patient will be expected to abide, but the patient must follow almost all instructions that are provided by the surgeon in addition to the following rules. Above all, the patient must not disregard the provided guidelines; doing so is very dangerous and may result in any number of troubles ranging in severity from being merely inconvenient (dry socket) to possibly life-threatening (serious infection of the removal sites).

Bleeding and oozing:

Bleeding and oozing are unavoidable and should be expected to last as long as 3 days (although by day 3 it must be less noticeable). Rinsing the mouth during this time period is counter-productive, as the blood loss stops when the blood types clots at the extraction sites, and also rinsing out the mouth will likely dislodge the clots. The result will be a delay in healing period and a continuous period of bleeding. Gauze pads must be placed at the removal sites, and after that should be bitten down on with firm and also pressure. This can help to stop the blood loss, but should not be overdone as it is possible to aggravate the extraction sites and extend the bleeding or remove the clot. The bleeding must decrease slowly and noticeably upon switching the gauze. If the bleeding takes higher than a day without reducing despite having followed the surgeon's instructions, the surgeon must be contacted as quickly as possible. This is not supposed to occur under normal conditions and signals that a really serious problem is present. A wet tea-bag may replace the gauze pads. Tannin contained in tea will help reduce the bleeding.

Because of the blood clots that form in the uncovered sockets and also the abundant bacterial flora in the mouth, an offensive scent could be noticeable a limited time right after surgery. The persistent smell often is accompanied by a similarly rancid-tasting fluid seeping through the wounds. The odor and flavor are explained by some individuals as unbearable sometimes, yet regular rinsing of the mouth with saltwater or mouthwash can help temporarily reduce the odor and tastes. These symptoms will reduce over an indeterminate period of time, although 1 to 2 weeks is normal. While not a cause for great concern, a post-operative visit with one's surgeon 7 to 10 days after surgical treatment is highly suggested to ensure that the recovery process has no problems and that the wounds are fairly clean. In case infection does enter the socket, an experienced dental professional can softly plunge a plastic syringe (without the hypodermic needle) full of a mixture of the same parts hydrogen peroxide and also water or chlorhexidine gluconate, which also comes in the form of a mouth area wash, into the sockets to remove any foods or germs that may gather in the back of the mouth. This is less likely if the person has his or her wisdom teeth removed while very young.

Dry socket:

A dry socket, also called alveolar osteitis, is a very painful inflammation of the alveolar bone (not an infection); it happens when the blood clots at a removal site are dislodged, fallout prematurely, or even fail to form. In some instances, this is beyond the handle of the patient. However, in some other cases this happens because the patient has ignored the instructions provided by the surgeon. Smoking cigarettes, blowing one's nose, spitting, or even drinking using a straw in disregard to the surgeon's guidelines can cause this, as well as other activities that transform the pressure within the mouth, for example sneezing or playing a musical-instrument. The chance of developing a dry socket is higher in cigarette smokers, in diabetics, in case the patient has had an old dry socket, inside the lower jaw, and following difficult extractions. The removal site will become annoyed and painful, because of inflammation of the bone lining the teeth socket (osteitis). The signs and symptoms are made worse while food particles is trapped in the teeth socket. The patient must contact their surgeon when they suspect they have a case of dry socket. The surgeon may choose to clean the socket below local anesthetic to cause an additional blood clot to form or even prescribe medication in topical form (e.g. Alvogel) to use to the impacted site. A non-steroidal anti-inflammatory medicine (NSAID such as ibuprofen may be recommended by the surgeon for pain relief. Usually dry sockets are self-limiting and also heal in a two or perhaps three weeks without treatment.

Swelling:

Swelling must not be confused with dry socket, however painful swelling must be expected and it is a sign that the healing procedure is progressing normally. There's no general period for this problem; the intensity and duration of the swelling differ from case to case. The surgeon will inform the patient how long they must expect swelling to last, adding when to expect the swelling to peak and when the swelling will start to subside. If the swelling doesn't begin to subside when it is expected to, the patient must contact his / her surgeon instantly. Swelling generally lasts 1 week. While the swelling will normally not vanish completely for a number of days after it peaks, swelling that doesn't begin to subside or even gets more serious may be a sign of infection. Swelling that re-appears after a couple weeks is an indication of infection caused by a bone or even teeth fragment still in the injury and should be treated immediately.