Wisdom/Impacted Teeth

Wisdom teeth are the rear (third) Molars that erupt sometime around late teens or early twenties. Wisdom teeth can cause various dental problems including overcrowding of the existing teeth and impaction. Impacted teeth are unerupted or partially erupted teeth as their eruption process is being obstructed due to:

(a) Lack of space:
In some cases, there may not be enough room in the jaw for the erupting wisdom teeth. This can stall their exit at the halfway point, making room for food lodgement. Food and bacteria will build up between the wisdom tooth and its neighbouring molar, so decay and gum infections are more likely. Partially impacted or crowded (tilted) wisdom teeth in the upper jaw have tendency to lean sideways and grate against the cheek causing cheek bite and chewing problems. The pressure from wisdom teeth may also force the other teeth closer together causing crowding, thus interfere with the bite.

(b) Ankylsos:
The roots of the impacted tooth can fuse to the surrounding bone, creating a tooth stuck in an unerupted or partially erupted state.

(c) Competitive position (a tooth has erupted over another tooth’s position):
The teeth most likely to become impacted are the third molars also known as the “wisdom teeth”. There is rarely enough space to fit these last teeth into the small space left behind the second molars, thus causing obstruction in their eruption and the wisdom tooth becomes impacted. An average mouth dentition holds 28 teeth. There can be discomfort/pain when 32 teeth try to fit in a space comfortable for only 28 teeth. These four other non-funtional teeth are the wisdom/third molars. The tendency to get impacted is due to the small space available to them.

Using panaromic X-ray, dentist can evaluate the position/angulation of the wisdom teeth and determine the severity of the impaction. This is important for planning the treatment course. If a wisdom tooth is erupted but the clinical visibility is obstructed due to soft tissue flap over it, the dentist may need to snip the soft tissue to avoid food lodgement and hence infection.

The impaction can be subcategorized into four depending on the way they are positioned and their relation with the adjoining tooth or any other bony structures:

1. Vertical impaction :
This may cause cheek-bite or infective abcess inside the jaw bone.

2. Mesio-angular :
This may press on the second molar causing cavity and subsequent infection in connection with the second molar.

3. Horizontal impaction :
This kind of placement can cause trismus (inability to open mouth fully) in addition to symptoms similar to those of mesio-angular impaction.

4. Tissue impaction or partial impaction:
Some portion of wisdom tooth erupts out of the soft tissue, with some tissue portion still overlying the tooth. This provides room for food debris in the pockets leading to gum inflammation and pain. Surgical removal should only be done if the wisdom tooth starts causing persistent discomfort. This highly skillful extraction procedure is performed by a Maxillofacial surgeon in our team. The surgery is performed under appropriate anesthesia to maximize patient comfort. The procedure is performed under conditions of optimum safety, utilizing modern equipment, and by staff thoroughly experienced in the procedure.

Some useful tips for self care after dental extraction:

  • Apply cold compress to avoid swelling.
  • Take appropriate pain relievers as and when required, keeping adequate gap before the next dose.
  • Rinse with lukewarm and prescribed anti-microbials after 24 hours of extraction.
  • Do not brush over the area for two days.
  • Eat cold diet on the day of extraction and soft/easy to chew food for the next few days.

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CROWN/FIXED TEETH LAMINATES

Crown is an artificial covering of a tooth-like structure called porcelain, which restores damaged tooth, replaces the missing tooth wall, thereby protecting and strengthening the tooth and preventing further deterioration.

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Pediatric Dentistry deals specifically with the oral care of children. It is very important for a dental surgeon to have training in child psychology, growth and development before treating any child.

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