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Teeth of wisdom: to remove or not?


The co-author of this article is Ken Miyazato, DDS. Dr. Miyazato is a dentist at the Santa Clara Valley Medical Center in California. He graduated from the residency at the Lutheran Medical Center in 2014.

The number of sources used in this article is 40. You will find a list of them at the bottom of the page.

Wisdom teeth (third molars) are so named because they are usually the last teeth that erupt in late adolescence. Some people do not have wisdom teeth at all. Wisdom tooth infection can be very unpleasant, in which case immediate measures should usually be taken. There are several ways to relieve pain before you can visit the dentist.

Attention:The information in this article is for informational purposes only. Before using any methods, consult your doctor.

What complications can wisdom teeth cause?

The difficulties arising from the third molars are associated primarily with the late terms of their eruption and some anatomical features of the structure of the jaw:

  • Lack of space for normal teething. By the time “Eights” begin to cut, a person’s dentition is usually fully formed, and the third molars may simply not have enough space. In addition, during evolution, the jaw in a person decreased by about 1 cm, which also does not contribute to the normal growth of the “eights”. In this case, tooth extraction is indicated in order to prevent the displacement of the entire dentition.
  • Incorrect row position (dystopia). It leads to soft tissue injuries, destruction and displacement of adjacent teeth.
  • Incomplete eruption (retention). Refined "eights" cause a lot of problems and discomfort - often such a wisdom tooth causes inflammation of the gums and diseases of the "neighbors" in the dentition.
  • Pericoronaritis. An inflammatory disease characterized by swelling of the gums near the wisdom tooth followed by suppuration. When teething is difficult around the G8, a so-called hood from the mucous membrane is formed, which is the optimal place for the accumulation of food debris and the growth of bacteria. In this case, the wisdom tooth is cut and sore due to inflammation of the hood. If nothing is done, gum inflammation develops not only next to the tooth, but throughout the jaw - a long and costly treatment of the gums will already be required here.
  • Deep tooth decay of wisdom. Third molars, as a rule, begin to collapse rapidly - often at the teething stage. Why does the wisdom tooth crumble? This is due to the peculiarities of its structure and position: it’s simply impossible to clean the “eights” with a paste and a brush, so food and bacteria residues are sure to accumulate there, creating favorable conditions for the development of infectious processes.

In all the situations described, it is better to remove wisdom teeth immediately, without waiting until serious complications develop, and you will have to spend a lot of time and money on treating nearby teeth, as well as inflamed gums.

Can third molars be treated?

Wisdom teeth, like any others, are subject to treatment. But only if they erupted correctly, they do not threaten the health and position of the rest of the dentition, and there is also confidence that the treatment will be successful. Subject to the above conditions, the "eight" makes sense to keep on such indications:

  • If the sixth and seventh teeth are sick or badly damaged and must be removed, in this case the wisdom tooth is left as the “best of the worst” in order to provide the patient with at least some conditions for chewing, and the doctor the basis for future prosthetics.
  • If the six and seven are already removed and it is necessary to save the abutment tooth for installing prosthetic structures.
  • In the presence of an antagonist tooth that is completely healthy and must be preserved.

With curved roots that complicate endodontic intervention, severe tissue destruction, dystopia or retention, not a single competent dentist will take the treatment of the G8 - he will definitely recommend removal.

Causes of Pain

Adults experience more severe pain during tooth growth than children. Their gums are less elastic and coarse. The eight grows very slowly. therefore the main cause of pain is tooth growth through fully formed bone tissue.

The following factors can lead to increased pain:

  • Incorrect anatomical placement of teeth. With the germination of a wisdom tooth in the cheek, the mucous membrane is injured. There is a constant injured ulcer. The tooth in this case needs to be removed.
  • Lack of space for normal teething. It presses on the nearest teeth, causing pain that can be heard in the jaw or temple. When the teeth are propped up against each other, malocclusion may occur. You need to take a picture to determine if the tooth is positioned correctly.
  • On the gum, when a figure eight erupts, a tubercle (“hood”) appears, covered with a mucous membrane. He is often injured by solid food debris. An environment is created for the development of pathogenic organisms that provoke purulent inflammation.
  • Infection of the channel through which the wisdom tooth grows. Eights are located in hard-to-reach spots. This makes it difficult to maintain good oral hygiene. Often the tooth is already cut through with carious lesions.

Why do we need wisdom teeth?

Why does our body need third molars at all? In fact, these are rudiments that today far from all people erupt - about a third of the entire population of the planet do not even have the beginnings of third molars, although several thousand years ago absolutely all adults grew wisdom teeth. They practically do not perform the chewing function, since other healthy teeth usually cope with it.

Today, the G8 is needed only as a "fallback option" in case the first and second molars fall out or are badly damaged, and also as a factor preventing the loosening of neighboring teeth. They can also serve as a support for prosthetics - but, again, in all these cases we are talking about healthy and correctly erupted G8s. In the same case, when a person has rotten wisdom teeth in his mouth, they will not be able to perform any of these functions and it is better to remove them so as not to jeopardize the rest of the dentition.

Indications for removal

Healthy, correctly located third molars, with good access to the oral cavity for possible treatment, do not need to be removed. There are clear indications for such an operation, and if they exist, it should be removed without waiting for complications:

  • Deep caries of the wisdom tooth, as well as the lack of normal access for proper treatment.
  • Chronic inflammatory processes caused by third molars, including in those cases when the wisdom tooth caused gum inflammation.
  • Chronic injuries of the mucous membranes of the mouth due to an improperly located G8.
  • Retarded or dystopic teeth.
  • The need for orthodontic treatment of occlusion defects, if the doctor believes that the "eights" will prevent the dentition from occupying the correct position.

In all these situations, it is recommended to remove the "eights" without delay.

Removal Features

As a rule, operations to remove third molars are always considered difficult, since it is with these teeth that more problems usually arise. The operation can be simple, provided that the "eight" is located on the upper jaw and does not have pronounced deviations in development. In all other cases (as well as in situations where the tooth is located on the upper jaw, but at the same time has strong, curved and branched roots), the operation is considered complex and should be performed by a qualified dental surgeon.

Before the intervention, the doctor determines possible contraindications for a particular patient, examines an X-ray of the problem area and determines the optimal tactics for the operation. The duration of the procedure is from 1-10 minutes with simple removal and up to 20-120 minutes with complex, requiring a series of manipulations and suturing of the hole.

Extraction of wisdom teeth under general anesthesia

Too many patients are afraid to remove the problematic "eights", because they fear that this process will be painful. However, you should not postpone the operation because of your own fear: modern anesthesia methods allow removal as painlessly and comfortably as possible for the patient.

Usually, doctors recommend an intervention under local anesthesia, which will be enough to provide the patient with comfortable conditions during the operation. In the event that local anesthesia methods for some reason do not suit a person, there is always the opportunity to remove a wisdom tooth under anesthesia. It should be remembered that this option of pain relief is not available to everyone - there are certain contraindications:

  • Uncompensated diabetes and cardiovascular disease.
  • Post-infarction or post-stroke periods for up to 6 months.
  • Acute inflammatory diseases of internal organs, including the respiratory system.
  • Epilepsy.
  • Severe thyroid disease.
  • Bronchial asthma.
  • Alcohol or drug intoxication.

The presence of at least one of the listed standing makes the removal of wisdom teeth under general anesthesia impossible. Before the operation, a patient examination is required to identify contraindications available for the use of anesthesia. In addition, it must be remembered that a certain preoperative preparation will be required, and the clinic itself, in which the wisdom tooth will be removed under anesthesia, should have all the necessary equipment, as well as a team of specialists who will treat and monitor the patient's condition (anesthetists, resuscitators, trained nursing staff).

Treatment or removal during pregnancy

In cases where the wisdom tooth is cut and sore, causing constant discomfort to the pregnant woman, it can and should be treated regardless of gestational age. If there is no acute pain and treatment can be postponed, then it is advisable to carry it out in the second trimester of pregnancy or after delivery.

It is worth remembering that the removal of a wisdom tooth, especially under anesthesia, is clearly contraindicated for pregnant women. Removing third molars is strongly discouraged due to the complexity of such an operation and the risk of postoperative complications. As for anesthesia, it can not be used either for removal or for treatment - during pregnancy only local anesthesia can be used, and drugs should be selected very carefully and taking into account the patient's condition.

Despite its name, wisdom teeth do not bring their owners increased intellectual abilities, but they can cause a number of very unpleasant problems with the health of the oral cavity. Usually, third molars “lead” gum swelling, purulent inflammation, the development of caries of neighboring teeth, and severe pain. Therefore, in modern dentistry they are preferred to be removed, without waiting until serious difficulties begin and a longer and more expensive treatment is required. In many European countries today, such a practice as the removal of "eights" immediately after their appearance, regardless of their condition and correct eruption, is widespread.

The wisdom tooth is cut: what to do if the gum is sore and swollen?

If there is pain in the gum need to visit the dentist. He will determine the nature of the pain and prescribe the appropriate treatment. It can be a surgical intervention or therapeutic agents to alleviate the condition.

Drug therapy includes the use of drugs against edema, antiseptics, anti-inflammatory and pain medications.

If you can’t see a doctor soon, you can use home remediesthat will temporarily help relieve pain. Put ice on the outside of the cheek for 20 minutes.

Rinse your mouth regularly with a solution of potassium permanganate or furatsilina (3 tablets per glass of water). Do not take antibiotics without a doctor's prescription.

How long does the gum heal after tooth extraction? Find out here how to relieve pain and prevent complications.

How to relieve pain with folk remedies?

  • Prepare a decoction of 6 tablespoons oak bark and 400 ml of boiling water. Simmer for 5 minutes. Add 4 tablespoons of sage, remove from heat. Rinse with mouth 4-6 times a day.
  • Sage (2 tablespoons) pour 0.5 liters of boiling water and infuse for 1 hour. Rinse your mouth as often as possible until symptoms subside.
  • Take 2-3 tablespoons chopped turnips, to fill with water. Cook for 15-20 minutes. When the broth cools down, rinse your mouth 4-6 times a day.
  • Strengthens gums and relieves inflammation Hypericum infusion. For 500 ml of water, 2 tablespoons of grass are needed. Irrigate the mouth 5 times a day.
  • Dissolve 1 teaspoon soda in 200 ml of warm water. Gargle as needed.

Even with the disappearance of pain symptoms after applying the recommended remedies, a visit to the dentist should be mandatory. He will determine if there is a need for surgery.

Dissection of the gums may be necessary to facilitate growth, or removal of a wisdom tooth. Before this, the doctor will take a picture to assess the condition of the tooth. Often, an antibiotic is prescribed to treat inflammation.

How and how to anesthetize the wisdom tooth growth process during pregnancy?

Pregnancy is associated with significant hormonal changes in the body. There is an increase in the growth of hair, nails, and often - wisdom teeth. Eights erupt for a long time, so during pregnancy you need to monitor the condition of the teeth and gums.

All actions during tooth growth should be aimed at preventing the inflammatory process. After eating, the oral cavity should always be rinsed with antiseptics that are safe for the health of the woman and the unborn child.

  • Dissolve 1 teaspoon of soda in a glass of water.
  • Grind 3 tablets of furatsilin and dissolve in 200 ml of water. This solution retains its properties for 2 hours. Then you need to make a new one.
  • Rinse with decoction of chamomile and sage.

Do not rinse your mouth with an antibiotic solution (Dioxidine). Penetrating through the vascular walls, it enters the bloodstream and can have a negative effect on the fetus.

For analgesia, pregnant women should not take conventional analgesics (Ketanov, Analgin). Acceptance of No-shpa, rinsing with a solution of Chlorhexidine.

You can soothe the pain through the use of local applications. Moisten cotton with a solution of lidocaine and attach to the gums for 10 minutes. After removing the application, press a palm to the sore cheek. This will slow down the blood flow, prolong the action of the drug.

The use of surgical intervention during pregnancy is carried out in exceptional cases, if there is a danger to the life and health of the child and mother. It is advisable to carry out such treatment in the 2nd trimester. Today there are modern painkillers that do not penetrate the placenta, and do not harm the fetus.

With the advent of wisdom teeth, almost every person is found. Often their growth is accompanied by complications caused by various reasons. For any signs of inflammation, do not postpone a visit to the dentist. Any omissions in dental treatment can lead to irreversible negative consequences.

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