Impacted wisdom tooth: when it needs to be removed and when it can be left - in Tashkent

Why do wisdom teeth often fail to fit?

The jaw of modern humans is shorter than that of our ancestors: food has become softer, the chewing load has decreased, and the size of the jaw bones has decreased over the millennia, but the number of teeth has remained the same. The eighth teeth are the last to erupt, when all the others have already taken their places, and often they simply have nowhere to go. The tooth rests with its crown on the adjacent seventh one, turns around, deviates forward or lies horizontally - and remains in the bone or only partially erupts.

The position of the tooth determines everything: both the likelihood of problems and the complexity of the future operation. A vertically standing tooth that has enough space usually erupts calmly and works like a regular molar. The one tilted forward rests against its neighbor and creates a narrow gap between them that cannot be cleaned with a brush - plaque accumulates there for years, and caries occurs not so much in the wisdom tooth itself, but on the back surface of the healthy seventh tooth. A horizontal tooth puts pressure on the neighbor’s root and can cause its resorption. Semi-retinated, covered with a fold of mucous membrane, regularly inflamed.

• Vertical position - the tooth is positioned correctly, but there may not be enough space for complete eruption
• Medial tilt forward, towards the seventh tooth, is the most common option for the lower eights
• Horizontal position - the tooth lies sideways in the bone, with the crown facing the neighbor’s root
• Distal tilt backwards towards the ramus
• Buccal or lingual deviation, in which the tooth injures the mucous membrane of the cheek or tongue
• Complete retention without any complaints - an incidental finding on the image

Should everyone delete or not: the main misconception

The idea of ​​universal removal of eights was born from a common-sense observation: problems really occur more often with these teeth. But “more often” does not mean “always”. If the tooth has fully erupted, stands straight in a row, is involved in chewing, you can reach it with a brush and it does not have caries, there is no reason to remove it. The absence of complaints with a completely impacted tooth, which lies quietly in the bone and does not put pressure on its neighbor, is also not an indication for surgery: such teeth are observed from photographs.

• The tooth has fully erupted, stands straight and is accessible for cleaning - leave
• The tooth is completely in the bone, does not cause complaints and does not affect the neighboring one - observed from photographs
• The tooth is needed as a support for a future prosthesis, but there are no other supports - take care of it
• The tooth has partially erupted and is covered with a hood of mucous membrane - the risk of inflammation is high, the issue is resolved individually
• The tooth is tilted and creates an unwashable gap with its neighbor; it is often removed while the neighbor is intact
• The image shows an expansion of the periodontal space around the crown - a reason for control or removal

Separately, it is worth dispelling the popular belief that wisdom teeth necessarily “move” the front teeth and destroy the result of orthodontic treatment. Crowding of the lower incisors also develops with age in people who do not have eights at all, and is explained by a combination of reasons - a change in the chewing load, jaw growth, and soft tissue pressure. Wisdom teeth may be one of the factors, but removing healthy eights just for the sake of straight incisors is a decision without a reliable justification. A properly selected retainer protects the results much more reliably.

When is removal really necessary?

Indications for removal are always specific, and each of them is visible either with the eye or in the picture. Key principle: the longer you wait for an existing problem, the more often, along with the eight, you have to treat or remove the healthy seventh tooth, which it spoils.

1. Повторяющееся воспаление капюшона слизистой над частично прорезавшимся зубом. Один эпизод можно пролечить, но после второго-третьего вопрос об удалении становится основным.
2. Кариес самого зуба мудрости, до которого невозможно нормально добраться инструментом, и тем более кариес на задней поверхности соседнего седьмого зуба.
3. Рассасывание корня соседнего зуба под давлением лежащей восьмёрки — это необратимо и обнаруживается только на снимке.
4. Киста или другое образование вокруг коронки непрорезавшегося зуба.
5. Подготовка к ортодонтическому лечению, когда для перемещения зубов нужно освободить место.
6. Зуб травмирует слизистую щеки, прикусывается при каждом жевании, вызывает незаживающие язвы.
7. Зуб мешает установке протеза или находится в зоне планируемой операции.

What to watch before deleting

Complex removal begins not in the chair, but in the picture. The doctor’s task is to understand exactly where the mandibular canal with the nerve passes, how close the roots come to the bottom of the maxillary sinus, how many roots the tooth has and in which direction they are curved. The technique of the operation and the warnings that you will receive in advance depend on this.

1. Осмотр: положение зуба, состояние капюшона, доступность для инструмента, объём открывания рта, состояние соседнего зуба.
2. Панорамный снимок обеих челюстей — базовое исследование, показывает наклон, форму корней и отношение к каналу в одной плоскости.
3. КЛКТ — объёмная томография челюсти. Её делают, когда на панорамном снимке корни накладываются на канал, при горизонтальном положении зуба, при подозрении на кисту и перед удалением верхних восьмёрок, тесно связанных с пазухой.
4. Оценка общего состояния: приём препаратов, разжижающих кровь, сахарный диабет, недавно перенесённые операции на сердце, приём препаратов от остеопороза — всё это обсуждают до операции, а не после.
5. Планирование анестезии и, при необходимости, седации — особенно при выраженном страхе или при удалении нескольких зубов сразу.

Separately, the doctor evaluates signs of proximity of the roots to the nerve. If the volumetric image shows that the roots literally cover the canal, a coronectomy is discussed - an operation in which only the crown of the tooth is removed, and the roots are deliberately left in the bone. It sounds unusual, but the point is that the left roots do not become inflamed, are gradually covered with bone and over time even move away from the canal, and the risk of persistent numbness of the lip is sharply reduced. This is not a universal method, but a calculated compromise in a specific anatomical situation.

How is the operation performed?

Removing an impacted tooth is an elective surgical procedure and not a “tooth extraction.” It takes place under local anesthesia, and during it there should be no pain: there may be a feeling of pressure, vibration and the sound of the instrument, but not pain. If sensitivity returns during the intervention, you should immediately tell the doctor about this - anesthesia will be added.

1. Обезболивание и проверка его достаточности перед началом.
2. Разрез слизистой и отслаивание лоскута, чтобы получить доступ к зубу.
3. Удаление небольшого объёма кости над коронкой, если зуб находится в кости.
4. Разделение зуба на фрагменты бором. Это ключевой момент: разделённый зуб извлекают по частям через маленькое отверстие, вместо того чтобы удалять много кости ради целой коронки. Именно поэтому современное сложное удаление переносится легче, чем удаление старыми методами.
5. Очистка лунки, промывание, при необходимости — заполнение костнозамещающим материалом или мембраной.
6. Наложение швов и марлевого тампона. Швы чаще снимают через 7–10 дней, а рассасывающиеся не снимают вовсе.
7. Обычное сложное удаление занимает от двадцати минут до часа, простое — заметно меньше.

After removal: what is normal and what is not

The body's reaction to surgery is predictable, and knowing its schedule eliminates unnecessary anxiety. The swelling does not increase immediately: it is minimal in the first hours, maximum on the second or third day and then subsides. Restriction in mouth opening and bruising on the cheek or neck are also expected phenomena, and not a complication. The pain is worst on the first day, when the anesthesia ends, and should decrease further. It is the direction of the dynamics that is the most reliable guide: everything that decreases day by day goes according to plan, everything that increases after the third day requires inspection.

• The gauze swab is kept tightly compressed for 20–30 minutes, then removed and no longer changed unless necessary.
• For the first day, do not rinse your mouth or spit with force - this washes the clot out of the hole
• Coldness to the cheek in the first hours in short sessions; heat and warming compresses are strictly prohibited
• The food is soft and warm, not hot; you need to chew on the opposite side
• Smoking and drinking through a straw sharply increases the risk of dry socket - stop for at least a few days
• Baths, saunas, gyms and air travel are undesirable in the first days due to the risk of bleeding and increased swelling

Dry socket is the most common complication and is easy to recognize. The blood clot, which should close the hole, is destroyed or washed away, the exposed bone comes into contact with the environment of the oral cavity, and on the third to fifth day a strong nagging pain occurs, often radiating to the ear and temple, with a putrid taste. Painkillers don't help much. This condition cannot be treated at home: the doctor washes the hole and puts a bandage in it, after which the pain noticeably decreases on the first day. Smokers experience dry socket much more often - precisely because of the vacuum in the mouth when puffing and because of the effect of smoke on healing.