Third molars (wisdom teeth) being the last to erupt, usually between the ages of 18 to 24 year. Wisdom teeth may erupt normally into correct dental alignment and function or conversely develop in non- or minimally functional positions. Impaction occurs when there is prevention of complete eruption due to lack of space, obstruction or development in an abnormal position.
This may result in a tooth erupting partially or not at all. Wisdom teeth can also be impacted, either erupting partially or not at all. Impaction may be associated with pathological changes including pericoronitis, an increased risk of caries and periodontal disease in adjacent teeth, and orthodontic problems in later life.
Indications and non indication for the wisdom teeth removal:
-Wisdom teeth may erupt normally into correct dental alignment and function may not require removal as in this situation person is able to maintain oral hygiene.
-Impaction occurs when there is prevention of complete eruption due to lack of space, obstruction or development in an abnormal position. This may result in a tooth erupting partially or not at all. Wisdom teeth can also be impacted, either erupting partially or not at all. Impaction may be associated with pathological changes including pericoronitis, an increased risk of caries and periodontal disease in adjacent teeth, and orthodontic problems in later life.
Surgical removal of impacted third molars should be limited to patients with evidence of pathology. Such pathology includes nonrestorable caries, non-treatable pulpal and/or periapical pathology, cellulitis, abscess and osteomyelitis, internal/external resorption of the tooth or adjacent teeth, fracture of tooth, disease of follicle including cyst/tumor, tooth/teeth impeding surgery or reconstructive jaw surgery, and when a tooth is involved in or within the field of tumor resection.
Local collection of plaque around the wisdom tooth may lead to local infection known as pericoronitis. I don’t suggest the wisdom tooth removal if this happens first time but more subsequent episodes than my recommendation for oral surgeon evaluation and removal would be wise.
What is the appropriate age for the wisdom tooth removal?
-Third molar extractions can be performed successfully for patients in all age groups, but here are a number of age-related factors that tend to place comparatively older patients at greater risk for complications.
-Of course, any discussion about the preferred age for extracting wisdom teeth implies that a decision can be made about the need for their removal in the first place. However, in some cases it takes additional time to determine if a particular tooth really is likely to remain impacted.
Some teeth that have an errant initial inclination, or seem slow to erupt, may ultimately come into normal position if given enough time. So in these cases, the dentist may need an additional few years of observation to make their determination.
-Numerous third-molar studies have confirmed that, as a rule of thumb, relatively older patients experience a higher incidence of complications with the extraction process, postoperative recovery and post-surgical healing than comparatively younger ones.
The most common complications being those same ones most often associated with wisdom tooth extractions in general: 1) dry sockets (alveolar osteitis), 2) root fracture and 3) nerve damage (paresthesia).
-Why is age an issue?
The wisdom teeth of comparatively older patients are more likely to be more fully formed which lead to difficult or traumatic extraction. Also with aging bone become more dense, that means it tends to difficult or more traumatic extraction.
Also with age reduced capacity for healing compare to young age.
-The factors above explain why a higher level of complications are experienced by comparatively older patients.
But it’s important to note that for healthy individuals, age alone should not necessarily be considered to be a significant risk factor. When need is there than wisdom tooth extraction can be done at any age.
-Put all these in perspective sometimes it’s more advisable that wisdom teeth removal between age 18-24 yrs.,Once it’s confirmed that not enough room for the eruption and other risk factors, to avoid more complications in later life.
-Complications after the wisdom teeth removal:
-Dry Sockets also known as Alveolar osteitis.A dry socket is a painful, foul smelling postoperative condition that develops during the course of the first several days after a tooth extraction.
Dry sockets occur when either an adequate blood clot has failed to form in the extracted tooth socket (the hole left in the jawbone after an extraction) or else the blood clot that did form has been dislodged and lost.
-What is the treatment for dry sockets?
The best treatment for a dry socket comes from your dentist:
They will place a medicated dressing down into the socket that can soothe and moderate its pain. Depending on the level of symptoms displayed, the use of prescription pain relievers is indicated too.
B) Paresthesia (nerve damage).A wisdom tooth may have a position in the jawbone where its roots lie in close proximity to a nearby nerve.
If so, during the process of extracting it the nerve may be bruised or damaged. As a result, numbness of the tongue, lip, or chin may occur. Having this condition is termed “paresthesia.”
A patient’s risk correlates with age.
Hoping to avoid the complication of paresthesia is one reason why dentists suggest that wisdom teeth should be removed when a patient is relatively young.
Treatment for paresthesia:
In most cases, a patient’s paresthesia will resolve on it’s own over time. This can, however, take several months to over a year. In some cases, a person’s sensory loss is permanent.
For those who experience persistent or permanent paresthesia, surgical repair may be possible.
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