For patients

For patients WISDOM TEETH (3-rd MOLARS).

Human permanent dentition consists of 32 teeth. Four of them are called third molars or wisdom teeth, and they, as a rule, erupt between 17 and 21 years of age.

Why does it happen this way? Why our wisdom is losing its way? And what is the proper time to extract these teeth?

Problems and complications, which are caused by wisdom teeth, have an ontogenic background underneath. The mandible (lower jaw) bone of a modern people is becoming shorter and shorter. Our ancestors needed rather strong teeth for rough and tough food grinding. Nowadays, our food has become milder, and people do not need apply strong efforts to masticate it. As a result, the mandibular bone atrophied to a certain extent, while the teeth remained of the same size, and their number in the mouth has not changed. If wisdom teeth do erupt, they often do not find enough space in the mouth. Therefore, they grow sideways, or are located transversally against the mandibular bone. In some cases, wisdom teeth erupt only partially, which causes certain complaints on the part of the patients. If, under the circumstances, all of the rest teeth are developed normally, there is no special need in wisdom teeth, as they are not critical for food mastication. If they provoke complications and complaints, they are extracted, which happens rather often to those in the mandible.
Well, and now I invite you to consider in details all the possible complications inflicted on by abnormal wisdom teeth eruption. Of all the conditions, which occur after the third molar eruption, caries is undoubtedly the most common and typical one. As a result of buccal tilting, the tooth buccal surface is hard to reach, and difficult to clean. It cannot be naturally cleaned through the process of mastication, and cannot be toothbrushed properly. Thus, fast plaque building-up causes carious lesion in the teeth. This lesion is especially common of maxillar wisdom teeth. As for the mandible, it presents a typical picture, but, in most cases, it is even more complicated, as this "wise" tooth, due to its buccal tilting, exposes to caries, not itself but its neighbours, i.e. second molars, and the central group teeth, making them crowding, and, thus, preventing their lateral surfaces from being properly cleaned.

The picture clearly demonstrates all the destructive changes, which occur as a result of irregular teeth eruption in the mandible. Apart from threatening caries condition, the problem is fraught with purely cosmetic and aesthetic appearance. Central group teeth crowding in the mandible results in a fan-like divergence of maxillar teeth, which requires complicated orthodontic intervention to correct the situation. However, this is not the worst, which can happen, as the teeth crowding, in the long run, provokes parodontic diseases, which cause a lot of troubles and treatment problems.

All the above-mentioned facts pertain to the situation, when wisdom teeth somehow managed to erupt, but what are our chances, if they erupted only partially, or refused make their way into the mouth at all? Unfortunately, this situation is also fraught with numerous complications. You could hardly hear of such condition as pericoronorit, but, however, it is rather common one. It occurs when the wisdom tooth erupts only partially, and part of it still remains underneath the gum. In this case, food residuals and bacteria build-up in the formed gingival pocket give start to gum inflammation. The formed hood, when pressed, may produce a pus drop. The patient also may complain about painful swallowing. The dental arch may be hyperemiased and reddened, which is the case of so called dental quinsy. If the process is left untreated, it can gain a diffused character. The inflammation can invlove jaw periosteum (periostitis), and even bone (osteomielitis). The general condition of the patient is growing worse and worse, and is aggravated by severe pain and high fever, he or she can hardly open the mouth.

Depending on clinical manifestations, the treatment of this condition may vary from case to case. In milder cases, when there is hope for ultimate natural tooth eruption, conservative treatment is applied through antiseptic rinsing and physical therapy. When there is no hope for successful outcome, surgical intervention is recommended. However, it does not necessarily mean that the tooth should be always extracted. Quite often, in case of acute perioconorit, it is possible merely to make the insicion of the hood to let the ps drain. Still, if there is not enough space for the normal tooth eruption, it should be extracted.

However, it is not the last of the troubles, our "wise" tooth has in stock for us. Perhaps, my dear readers, you have already noticed how gradually I am thickening the colours around these teeth, the way we were taught to do, i.e. from simpler things to more complicated ones. I am doing it, not in the least to bull you, the only aim on my mind is to make you to pay due attention to the healthy state of your teeth. Do not wait the nature to splash wonders on you, instead be wise enough to consult the doctor at once. I happened to witness the case, when a 50-year-old patient was operated on for about 2.5 hours on the mandible third molar extraction, which entailed a subsequent loss of the adjacent second molar. That is why I want once more to draw your attention to the fact that the earlier you go through examination, and take the adequate steps, the less pain and complications will be involved in surgical intervention.

So, what may happen, if wisdom tooth was stubborn enough, and decided to remain impacted? Unerupted wisdom tooth may cause facial pains or neurological diffusive lesions. Pain can be experienced in both of the jaws, ears, throat, neck, head and chest. The causative tooth provoking prolonged or recurrent pains, should be extracted.

An impacted wisdom tooth can also push on the adjacent tooth root, producing a damaging impact on it. Often, it is noticed too late. Surgical intervention in this case leads to both tooth extraction, and is fraught with possible complication, such as break-off of the second molar destructed root. To prevent this trouble, it is necessary to go through early qualified x-ray examination of the impacted wisdom tooth, and make timely decision on its extraction.

According to observation data, approximately one third of unerupted wisdom teeth provoke cyst formation. Therefore, their extraction is a must. After normal teething, the dental sac disappears. In case of abnormal wisdom tooth eruption, the sac remains, and the fluid accumulated inside it, can cause cyst formation. The cyst is growing slowly, but stubbornly, destructing the jaw bone.

The left picture shows normal dental sac around the lower wisdom tooth crown. The right picture displays the same patient 10 years later: the cyst has been formed around the impacted wisdom tooth crown, which involved a large zone of mandible bone in destructive process.

Yet, this is not the end of the possible troubles. Even, if wisdom teeth did not erupt at certain period of your life, and did not manage to inflict any troubles on you, for the time being, they are still capable of doing it later on. While going through orthopedic treatment, and making gum-supported dentures, which is not the case to be excluded, the "sleeping" tooth can suddenly show the signs of resurrection, and entail a lot of physical, moral and financial problems. Thus, before starting your orthopedic treatment, you should remove your impacted wisdom teeth.

March 98. Oleg Zybin

Translation Olga Lubchenko

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