The teeth of temporary and permanent dentition have their own periods of eruption and specific locations on the alveolar bone. Sometimes these teeth start to erupt prematurely or remain in the bone, appearing much later (in this case, people got used to call this phenomenon a "wisdom tooth"). Delayed dentition is known as "retention." Sometimes teeth, including wisdom tooth can occupy an incorrect position, shifting to the vestibular, palatal, lingual direction, and can also be rotated around its axis. This anomaly is called "dystopia." Most often such a delay happens with upper canines and with lower wisdom tooth.

The presence of impacted tooth (i.e. the eruption of wisdom tooth is postponed for uncertain term) in the jaw in some cases does not cause any pathological effects to the patient. In this case the wisdom tooth removal is not urgent. But if the impacted tooth was the cause of the cyst formation, neuralgic pain and inflammation process appearing, then an atypical operation for tooth removal is used.

 

 

 

Wisdom tooth eruption

Wisdom tooth is the name of the rearmost posterior teeth, third molars, which are erupting in the adolescent age. A third lower molar erupting process is often accompanied with emergence of a number of complications, and it is usually called a difficult eruption of wisdom tooth. What is the difference between wisdom teeth and other teeth?

• Wisdom teeth erupt at age of 18 -25 years old; often this process can happen later.
• Wisdom teeth do not have the distal neighbor, which could prevent the displacement of the tooth into the distal direction.
• Wisdom tooth does not have any milk predecessor, which would prepare the conditions for its eruption.
• Erupting at the age of 18-25 years old, when the formation of the jawbone is totally completed, the tooth had to overcome significant mechanical obstruction.
• Oral wing and external oblique lines are thickening the cortical plates in the projection of the mandible angle and thereby create additional difficulties for the wisdom tooth eruption.

Shortness of wisdom tooth eruption is explained with anatomical features of mandible structure and the late dates of eruption. Lack of space in a tooth row for the third molars – that is how in the dental terminology the wisdom tooth is called - is associated with a change in the masticatory apparatus in the process of human evolution. The softer food becomes, the less chewing stress is required onto teeth, which eventually led to a decrease in the size of jaws. Studies have shown that the dental arch width of modern human had decreased on 10-12mm comparing with what his ancestors had before.

 

 

 

Wisdom tooth complications in the process of its eruption and its treatment

With difficult wisdom tooth erupting process it is necessary to visit a dentist and decide what to do with this problem. Medical and dental anamnesis helps the dentist to gather all the medical information about a patient's health, because as more the dentist will know about not only how does the wisdom tooth erupting, but also have the general data about his patient's health, the better way the dentist will understand which forthcoming methods and techniques of treatment should be used. The dentist should know whether his patient suffers from any other disease, and which medication does he take.

After the dentist has collected the whole medical anamnesis and conducted the patient's examination, he goes to the X-ray survey with the help of which he estimates what kind of state the wisdom tooth and gums, tooth roots and placed around the tooth bone are in, and finds out the degree of the wisdom tooth immersion. After such a careful patient's examination the dentist decides whether the wisdom tooth should be removed or not.

The operation over impacted wisdom tooth is beginning from the access to the tooth determination. Then the muco-periosteal flap which has a triangular shape is cutting out, the located above the tooth bone tissue is taking away, and then, partly or entirely, the wisdom tooth is removing. Then the flap is fixing by sutures, and the whole is plugging with Iodoform turundas help.

The surgery is performed only under anesthesia. In some cases, for making the psychological state of the patients better, the doctor can advice to take medication for reducing the feeling of concern during and after the wisdom tooth removal process.

Pericoronitis

One of the most frequent problems that arise due to improper tooth position is pericoronitis.

Pericoronitis - is an inflammatory process of wisdom tooth surrounding tissues. The cause of Pericoronitis appearance is a difficulty in tooth passing through the gum. Even a small tooth protrusion above the gum can form a hole in it, which gradually expands forming pockets of infection. In this space between the gum and the tooth a plaque, which would be difficult to clean up, accumulates. Pericoronitis symptoms are sensitivity and swelling of gums, which surround the wisdom tooth. Sometimes a strong pain comes up, bad breath or bad taste in the mouth appearing.

If the dentist finds out that the cause of Pericoronitis is a submerged wisdom tooth, he suggests to remove the wisdom tooth. The patient is prescribed a seven-day course of treatment. Antibiotics help to reduce the infection, which also assists the process of tooth removal and subsequent healing to go more smoothly. After the course of treatment with antibiotics usage, the wisdom tooth is removed. Periodontal diseases (gum diseases)

Incorrectly located wisdom teeth can lead to periodontal disease. With the wrong position of a wisdom tooth the patient can't clean out the plaque with a toothbrush and floss help, and this leads to the development of bacteria and drive unit to periodontal disease. If this disease is neglected, it may bring a great harm to gums and surrounding bone tissue. Periodontal disease does not develop in isolation around a single tooth, that's why for its prevention the dentist recommends to remove improperly located wisdom teeth.

In which cases you can save a wisdom tooth?

• If the wisdom tooth is on the correct position at which the axis is parallel to the axis of the third molar standing next to the second molar, and between the front edge of the jaw branch and the second molar there is enough space.
• The medial position of the tooth: when the tooth axis is inclined to the second molar, which should be removed. (Removal of defective second molar provides conditions in which the wisdom tooth eruption goes normally).

In which cases wisdom tooth is necessary to be removed?

• During distal, buccal, mesial-horizontal submerging of wisdom tooth;
• During acute and chronic Pericoronitis;
• If abscess, osteomyelitis or phlegmon is stands by;
• Other complications (trigeminal neuritis, complications of dental caries in second molar, etc.)

Wisdom tooth postoperative complications

Dry holes – is one of the most common complications encountered during the wisdom tooth removal. After tooth removal process a blood clot is formed in the empty hole. The blood clot formation – is an important part of hole's healing. If for some reason the blood clot is not formed, then this leads to a dry hole appearing.

Normally dry holes are formed after difficult deletions associated with significant injuries. Dry holes are manifested in the form of arid or severe pain in 3-4 days after wisdom tooth removal. There is a feeling that the pain in wisdom tooth extends from the point of disposal straight into the ear direction. In a case of dry hole formation an unpleasant taste or smell in the mouth is an often fact.

For the dry hole treatment the dentist puts a cotton swab with a drug onto the site of disposal, which reduces and relieves pain. Every 24 hours the tampon should be changed until all symptoms disappear. This process can take several days.

Paresthesia - is the rarest complication during the procedure of wisdom tooth removing. Paresthesia is a long nagging numbness of lip, tongue and chin. This happens because of wisdom teeth can be located very close to the mandibular nerve. And during the process of tooth disposal these nerves are sometimes can be hurt or injured. Paresthesia commonly lasts during several days, weeks or months: but, unfortunately, if the nerve is seriously damaged, paresthesia can become permanent.
Age-related indications for wisdom tooth removal

There are no rules which define the optimal age for wisdom tooth removal – they simply do not exist. However, practice shows that the sooner one get rid of these teeth, the less complications he can expect from them. If there are quite serious reasons for wisdom tooth disposal, it should be removed as quickly as possible. It is better to make wisdom tooth removal when the roots of these teeth haven't yet been formed and the bone surrounding the wisdom tooth is not very thick – this is late teens or early adolescence period.