Wisdom Tooth

The process by which the third molar or the wisdom tooth erupts is by piercing or cutting through the gums.

Pericoronitis

A common problem encountered during the wisdom teeth eruption process is called Pericoronitis. It refers to the inflammation of the gingival or the gums in relation to the crown portion of an incompletely erupted tooth. It commonly occurs in the lower jaw’s third molar area. The space present between the crown of the tooth and the gingival over it, is an area where food debris gets accumulated and initiates bacterial growth.

In the acute stage the gingiva covering the crown is greatly inflamed which interferes with the closure of the jaws. The result is a red, swollen gingiva which is acutely tender and painful with pain radiating to the ears, throat and the floor of the mouth.

There is foul taste in the mouth and a swelling in seen on the cheek with lymphoid inflammations and occasionally  jaw stiffness or a spasm like condition is seen.

The other problems encountered are formation of decay in the partially erupted wisdom tooth. As saliva, bacteria and food particles get trapped between the gum flap and the tooth underneath, formation of decay is initiated as it is not easy to clean these areas.

Patient who are going for dentures should get their third molars removed as they would be a cause of irritation and infection if they erupt underneath these dentures.

A cyst too can develop around a wisdom tooth and cause bone destruction and infection which can develop into a tumour. But this is seen in rare cases only.

Impacted Tooth

A wisdom tooth if erupted in a position not conducive to normal acculusal patterns of the second molar can cause further problems. The various positions in which it can erupt are:

1. Vertical
2. Mesioangular
3. Horizontal
4. Distoangular
5. Buccoangular
6. Tinguangular
7. Inverted
8. Unusual

The number of roots of a third molar also is a cause of concern for surgical procedure. The roots may be fused—two roots or multiple roots.

Removal of wisdom tooth is usually recommended for individuals during or after orthodontic treatment because these teeth can sometimes produce an exterior force that will cause crowding of the lower jaws front teeth. This study is still a controversial thought. 

Treatment

The most common treatment of wisdom tooth problem is extraction. The extraction of wisdom tooth if impacted is a surgical process in which either the bone around the tooth is removed to facilitate its removal or if that is not possible the tooth is split into parts and then removed.

Complications and post operation care

Various kinds of mishaps may occur during the removal of wisdom tooth third molar such as:

1. Haemorrhage
2. Injury to nerves
3. Inferior alveolar nerve (nerve for the lower jaw)
4. Lingual nerve (nerve for the tongue)
5. Fracture of the root of the tooth
6. Injury to the adjacent tooth
7. Instrument breakage
8. Displacement of wisdom tooth into its surrounding areas

Haemorrhage

Massive haemorrhage may occur if there is an accidental injury to the artery that is, inferior alveolar artery which supplies blood to the lower jaws.

This usually happens if this artery is situated between the roots of the tooth. An absorbable material that is, cotton, etc. should be placed at the site of extraction. Pressure is put on the extraction site and a stitch is placed to close the wound.

Injury to nerves

1. Inferior Alveolar nerve (nerve for the lower jaw)Sometimes an injury to the nerve is unavoidable due to the position of the nerve. If it does occur then complete loss of sensation or partial loss is felt in the lower lip and chin. It may be caused by compression of the nerve by pieces of bone and can be rectified by removal of these. If by any chance the nerve is torn, it can be repositioned. In certain cases the nerve can regain its function in five weeks to six months time. As recovery takes place the initial symptom felt is a prickling sensation and after some time the affected part may be hypersensitive. If there is no change even after six months then chances of recovery are slim. Certain micro-surgical techniques have been utilized to treat such cases.

2. Injury to Lingual nerve (nerve for the tongue)Due to fracture of the jaw or accidental cut in the nerve, there may be loss of sensation—complete or partial. The recovery and treatment is same as that of previously explained case of injury to Inferior alveolar nerve.

Fracture of the root of the tooth

During wisdom tooth extraction, if the roots of tooth are curved and weak they get fractured. To prevent any further complications  fractured segment of the root tip up to 3-5mm in length is left behind, if the tooth is non-infected. This is done to prevent its displacement into sinus or to prevent compression of nerve during its attempted removal.

Generally, it is best to remove all roots if the tooth is infected. The patient should be aware if root pieces are left behind.

Injury to the adjacent tooth

When third molar is in very close contact with the second molar, it may get injured during the removal of wisdom tooth. Protection to it is very important.

Injury can happen if the procedure of removal of third molar is improper and may cause fracture of it or may damage its blood supply. The best way is division of the third molar to facilitate its removal and possible complications can be avoided.

Instrument breakage

Sometimes when your dentist is operating on you the instrument might break due to a flaw in the metal or more commonly due to more than required force applied during tooth extraction. These cases are difficult to manage but can be taken care of by simple techniques.

Displacement of a maxillary or mandibular third molar

The most common reason for this misdirected force during extraction. Sometimes here the tooth can only be seen by radiographic finding only.

Fracture of mandible/lower jaw

Mandibular fracture is a disappointing accident but fortunately is a rare occurrence. Common reason for it is fragility of the jaw, the position of the tooth, the advanced age of the patient or joint diseases affecting the jaw. The treatment is immobilization of the jaw.

Post extraction instructions for patients

1. The cotton should be kept in the extraction site to be maintained in position for an hour to help stop bleeding.
2. Spitting out of blood and saliva following the extraction procedure must be avoided as it prolongs the healing process.
3. Application of ice pack orally on the extraction site is recommended to reduce the postoperative swelling.
4. Avoid eating hot, hard, spicy food and aerated drinks for a day following the extraction.
5. Consumption of soft and cold food during the healing phase is recommended.
6. Do warm salt water gargling 3 to 4 times daily from the second day of surgery for the next 3 days, or as advised your dentist.