How is the hood formed and why does it become inflamed?
Wisdom teeth are the last teeth to emerge, usually between seventeen and twenty-five years of age, and by this time there is often no room left for them in the jaw. The jaws of modern humans are shorter than those of our ancestors, and the number of teeth remains the same, so the figure eight often comes out only partially, turns around, or rests the crown against the adjacent tooth. The mucous membrane above its chewing surface does not completely dissolve, but remains in the form of a flap.
Then a mechanism is launched that supports itself. Remains of food and microbes get under the flap, among which bacteria that live without access to oxygen predominate - it is in such a closed pocket that they are most comfortable. Inflammation develops, the hood swells and rises. The raised hood begins to fall between the teeth when the jaws close, and the person bites it again and again. This increases the swelling, the flap protrudes even more, and is injured even more often. The circle closes, and without intervention it almost never breaks on its own - the inflammation only goes into a sluggish form until the next exacerbation.
- Lack of space behind the seventh tooth is the main reason
- Slanted or horizontal position of the eight in the dice
- Thick, dense mucosa above the crown, characteristic of the lower jaw
- Constantly biting the hood with the upper wisdom tooth
- Decreased general immunity: colds, fatigue, stress
- Poor hygiene in the farthest part of the dentition, where the brush reaches the worst
Symptoms and why it radiates into the ear
It all starts with a feeling of discomfort and pressure in the farthest corner of the jaw. Within a day or two, pain sets in, the gum above the tooth becomes swollen and painful when touched with the tongue, and a cloudy liquid or pus with an unpleasant taste may be released from under the hood. After a few days, the masticatory muscles become involved in the process, and the main sign of deterioration appears - it becomes difficult to open the mouth. The lymph node under the jaw on the same side often becomes enlarged and painful.
- Aching or throbbing pain in the depths of the jaw, aggravated by chewing and swallowing
- Swollen, red, painful gums overhanging the crown of the tooth
- Purulent discharge and persistent unpleasant taste in the mouth
- Limitation of mouth opening - from mild stiffness to the inability to open teeth
- Enlarged, painful lymph node under the lower jaw
- Pain radiating to the ear, temple and throat on the same side
- Fever, weakness, severe headache
Analysis of the misconception: the wisdom tooth is not always to blame
The wisdom tooth has become in the mass consciousness the universal culprit of everything that hurts in the depths of the jaw. Meanwhile, pain in this area is caused by at least several fundamentally different conditions, and they are treated completely differently. A mistake here is costly: a person agrees to removal, undergoes surgery, but the pain remains because the source was different.
- Caries or pulpitis of the seventh tooth, especially on its back wall, facing the figure eight - this surface is not visible either in the mirror or during a cursory examination
- Temporomandibular joint dysfunction: pain in front of the ear, clicking, jaw fatigue in the morning
- Myofascial pain in the masticatory muscles due to clenching of the jaws - the entire half of the face hurts, but it is impossible to indicate a specific tooth
- Sore throat, chronic tonsillitis and peritonsillar abscess - pain when swallowing, but the gum above the tooth is calm
- Inflammation of the salivary gland under the jaw - pain and swelling intensify before eating and at the sight of food
- Neuralgia and referred pain in diseases of the ear and paranasal sinuses
It is not difficult to distinguish between these conditions if the doctor does not limit himself to looking at the sore spot. The examination includes an assessment of the hood itself, a mandatory check of the adjacent seventh tooth, palpation of the masticatory muscles and joint, assessment of the volume of mouth opening and examination of the pharynx. The photograph puts an end to it: it shows the position of the figure eight, the condition of the neighboring tooth, and the presence of a lesion at the roots. The opposite mistake is no less common: the number eight is removed “just in case,” and a month later it turns out that all this time the seventh tooth was being destroyed, which is now left without a neighbor and with caries on the back wall.
Examination and what the image decides
- Осмотр с оценкой состояния капюшона, наличия отделяемого, объёма открывания рта и состояния лимфатических узлов.
- Обязательная проверка седьмого зуба и его задней поверхности — самой частой скрытой причины боли в этой зоне.
- Прицельный снимок или ортопантомограмма: положение зуба мудрости, наличие места позади седьмого зуба, форма и направление корней.
- Оценка расстояния между корнями восьмёрки и нижнечелюстным каналом — от этого зависит и техника удаления, и риск временного онемения губы.
- КЛКТ — при горизонтальном положении зуба, искривлённых или расходящихся корнях, близости канала и при подозрении на фолликулярную кисту вокруг коронки.
- При тяжёлом течении — оценка общего состояния и признаков распространения воспаления за пределы челюсти.
In the picture, the doctor answers one practical question: does this tooth have the prospect of fitting normally into a row? If the figure eight is directed vertically, there is enough space behind the seventh tooth and it has almost erupted, it makes sense to save the tooth and solve the hood problem. If a tooth lies obliquely or horizontally, rests against its neighbor, there is no space behind the seventh tooth, and the roots are formed, there is no point in preserving it: it will never participate in chewing, but will remain a constant source of inflammation and will slowly destroy the back wall of the neighboring tooth.
Treatment: relieve exacerbation and solve the cause
Treatment of pericoronitis is divided into two different stages, and they should not be confused. The first is to relieve acute inflammation: the doctor treats and rinses the pocket under the hood with an antiseptic, removes food debris and plaque accumulated under it, if necessary, cuts a flap to drain the pus and prescribes local remedies. Relief usually occurs quickly, within a day or two. The second stage is to eliminate the pocket itself, because without this the inflammation will return.
- Обработка и промывание кармана под капюшоном антисептическими растворами, удаление отделяемого.
- Обеспечение оттока гноя, при необходимости — рассечение капюшона и дренирование.
- Общая терапия по назначению врача при температуре, отёке и распространении воспаления.
- Иссечение капюшона — небольшая операция, при которой лоскут слизистой над коронкой убирают полностью. Показана, когда зуб стоит правильно, места за седьмым зубом достаточно и он способен полноценно прорезаться.
- Удаление зуба мудрости — при неправильном положении, нехватке места, повторных обострениях, кариесе восьмёрки или соседнего зуба, наличии кисты вокруг коронки.
- Контрольный осмотр после заживления и оценка состояния соседнего седьмого зуба.
Should wisdom teeth be removed and how is recovery done?
Preventative removal of all eights in a row is not considered mandatory today. A fully erupted, evenly standing wisdom tooth, which intersects with the antagonist, is accessible for cleaning and does not cause inflammation, lives quietly throughout its life and is sometimes even useful as a support for a prosthesis. The decision is made individually and according to specific criteria, and not according to the principle “eights are not needed.”
- Repeated episodes of pericoronitis are the most common and compelling argument in favor of removal
- Oblique or horizontal position of the tooth, emphasis on the adjacent tooth
- Caries on the number eight, inaccessible for quality treatment, or caries on the back wall of the seventh tooth due to it
- Follicular cyst around an unerupted crown
- A tooth completely embedded in the bone without signs of eruption and without complaints - usually observed rather than removed
- An evenly standing tooth with an antagonist and good hygiene is preserved
There are many conflicting opinions about removal in the acute period, and specifics are important here. The modern approach allows tooth extraction due to inflammation, if there is an outflow of pus and the general condition allows this: this way the problem is solved immediately, and not after two weeks of waiting. But with a pronounced restriction in mouth opening, spreading edema and high temperature, drainage is first provided and acute symptoms are relieved, and the intervention is performed later - it is more difficult to operate in tense, inflamed tissues and the risk of complications is higher. The doctor decides this during the examination.