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Wisdom Teeth
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What are Wisdom Teeth? |
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Wisdom teeth, also known as third molars are the last teeth to erupt. They usually
erupt between the ages of 17 and 25. There is a controversy regarding whether these
teeth need to be removed or not. It is generally suggested that these teeth remain
completely un-erupted. In a normal position they are unlikely to cause harm. However,
if these teeth are in an abnormal position their potential for harm should be assessed.
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What is an Impacted Wisdom Tooth?
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A tooth becomes impacted due to lack of space in the dental arch and gum, bone,
another tooth or all three prevent its eruption. Lack of space occurs because our
jaws have become smaller through evolution.
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When Should the Wisdom Teeth be Removed?
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Wisdom teeth generally cause problems when they erupt partially through the gum.
The most common reasons for removing them are: |
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Decay |
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Saliva, bacteria and food particles can accumulate around an impacted wisdom tooth,
causing it, or the next tooth to decay. Cleaning is difficult it may lead to bad
breath. It is very difficult to remove such decay. Pain and infection will usually
follow. |
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Gum Infection (Pericoronitis) |
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When a wisdom tooth is partially erupted, food and bacteria collect under the gum
causing a local infection. This may result in bad breath, pain, swelling and trismus
(inability to open the mouth fully). The infection can spread to involve the cheek
and neck. Once the initial episode occurs these subsequent attacks become more frequent
and more severe. |
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Pressure Pain |
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Pain may also come from the pressure of the erupting wisdom tooth against other
teeth. Repeated pressure pain may cause the erosion of these teeth. |
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Orthodontic Reasons |
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Wisdom teeth may cause movement of the front teeth when they try to erupt and this
may cause relapse of treatment. |
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Prosthetic Reasons |
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If a wisdom tooth erupts beneath a denture it will cause severe irritation and if
removed, the patient will need to have a new denture constructed, as the shape of
the gum will have changed. |
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Cyst Formation |
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A cyst can develop around an impacted wisdom tooth. It can cause bone destruction,
jaw expansion and displacement. or damage to nearby teeth. Rarely, tumors may develop
within these cysts or the jaw may fracture spontaneously if the cyst grows very
large. |
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Why Should it be Removed
if there is no Discomfort?
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Impacted wisdom teeth are almost certain to cause problems if left in place. This
is particularly true of the lower wisdom teeth. Such problems may occur suddenly,
and often at the most inconvenient times. |
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When is the Best Time to Remove? |
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It is now recommended that impacted wisdom teeth to be removed between the ages
of 14 and 22 years whether they are causing problems or not. Surgery is technically
easier and patients recover much more quickly when they are younger, later it becomes
quiet difficult for the patients over 40. Also the risk of complications increases
with age, and the healing process is slower.
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Whether it Can be Removed
During acute Infection?
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Usually no, Surgery in the presence of infection can cause infection to spread and
become more serious. First, the infection must be controlled through antibiotics. |
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What Happens if left Untreated? |
Harmless though they may sound, impacted teeth if left to fend for them, can cause
serious damage. Their awkward positioning makes ideal places for food to get trapped
and increases bacterial activity, leading to major complications. Besides there
are the usual risks, discomforts like the inability to open your jaws, and breeding
ground for bacteria
Gum disease and serious decay to the tooth
Advanced infection
Formation of cysts and tumors
Jaw Pain & Headache
Unnatural Movement of teeth |
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Advantages of Removing a Wisdom Tooth |
An early diagnosis and treatment can really take the load of one's shoulders. Simply
because an unchecked impacted wisdom tooth can wreak havoc on a healthy mouth.
No congestion of teeth
Easy mastication of food
No inordinate stress on jaw bone
Facilitation of better oral care
Difficult to brush or floss.
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Disadvantage of Removing the Wisdom
Teeth |
The only difficult thing about the
extraction process is, it involves the physical wrenching of a perfectly healthy
molar, leading to small problems. But it can be controlled by medicine. The following
effects are however more pronounced in older people.
Swelling, bruising, bleeding
Bone exposure due to uneven blood clotting
Rare cases of severe pain due to some times blood clot get dislodged and bones get
exposed. |
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Treatment Procedure |
As the only way out is extraction we will make the procedure as painless as possible.
The steps are simple, if the wound is too large, then sutures are essential.
Proper history is taken
Clinical examination is carried out
X-ray is taken to find out roots and relation with neighboring teeth
Medication is prescribed to control pain and infection
Eat well before the removal of tooth.
Anesthesia is given
Incision is given
Gums are lifted away
If there is a bone it will be removed
Breaking of tooth is carried out
The broken tooth is removed
Closure of Flap is carried out
Suture is given
Dressing is applied |
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Incision is Given |
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Gums are Lifted away |
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Breaking of Tooth is Carried Out |
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The Broken Tooth is Removed |
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Suture is Given |
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Post Operative Care |
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The first 8-12 hours after the extraction are most important. There is little more
discomfort, but usually manageable with ice packs and medication. |
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Control of Bleeding |
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Sterile gauze pads will be placed over the socket, for 30 to 45 minutes to control
bleeding and to encourage clot formation. If the bleeding does not stop change the
pack and put it for 30 minutes again with little pressure. If slight oozing persists
then contact the dentist. |
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Blood Clot |
A clot develops at extraction site should not be disturbed.
Do not suck through straw, smoke, and rinse mouth vigorously for 24 hours, which
could dislodge clot and delay healing.
Do not clean the teeth next to site for rest of the day .You should however brush
and floss your other teeth thoroughly. Gently rinse your mouth afterward.
Limit strenuous activity for 24 hours after extraction. So that clot will not dislodge. |
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Control of Swelling |
After surgery, some swelling is to be expected. This can be controlled through the
use of cold packs, which slow the circulation. Usually it is placed for first 24
hours in a cycle of 20 minutes on and 20 minutes off.
After the first 24 hours, it is advisable to rinse with warm saltwater every two
hours to promote healing. |
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Anesthesia |
The effect of anesthesia will last for few hours till it subsides. Till then don't
bite your cheek, lip or your tongue.
Medication for Control of pain and infection
Medication is used to control minor discomfort following oral surgery. |
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Diet |
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A soft diet may be prescribed for a few days following surgery. |
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Oral Hygiene |
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It is important to continue to floss your teeth and brush thoroughly at least twice
a day and rinse with mouthwash regularly. |
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Removal of sutures |
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Usually sutures are removed after 7days. |
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How Many Visits are Required?
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It is done in one sitting and usually takes one hour to remove. It is advisable
not to have strenuous activity for 2-3 days. |
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Alternative |
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There is no alternative to extraction in case of impacted wisdom teeth. |
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Home Care |
Within the first few days of extraction, everything will be back to normal. Since
you haven’t been able to take proper care of your teeth due to the post-operative
wound, you must not leave any stone unturned now.
Gentle and repeated rinsing
Brushing with a soft brush
Flossing |
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Summary and Conclusion |
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It is better to get rid of them if they are likely to cause harm. So till science
finds a way to make your jaw as flexible as a snake’s, wisdom dictates that
we choose the only known successful method.
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