affected wisdom teeth (or the impacted third molars ) is the wisdom teeth that do not fully burst into the mouth due to blockage from other teeth (impaction). If the wisdom tooth has no open connection to the mouth, the pain may develop with the onset of inflammation or infection or damage to adjacent teeth. The general accepted hypothesis determining the eruption is the angle at which the 3rd molar sits, the 3rd molar root formation stage at the screening point, the depth of the impaction, how much space there is for eruption and the 3rd molar size.
The youngest teeth are likely to be affected due to incompatibility between the size of the teeth and the size of the jaw. The affected wisdom teeth are classified by impaction direction, its depth is compared to adjacent tooth surface bites and the number of dental crowns extending through the gum tissue or bone. The affected wisdom teeth can also be classified by the presence or absence of symptoms and disease. Screening for the presence of wisdom teeth often begins in late adolescence when partially developed teeth may become affected. Screening usually includes clinical examination as well as x-rays such as panoramic radiography.
Infections resulting from affected wisdom teeth can be initially treated with antibiotics, local debridement or soft tissue surgery of the gum tissue covering the teeth. Over time, most of these treatments tend to fail and patients experience recurrent symptoms. The most common treatment is the wisdom tooth extraction. The risk of wisdom teeth removal is roughly proportional to the difficulties of extraction. Sometimes, when there is a high risk of the inferior alveolar nerve, only the crown of the tooth is removed (intentionally leaving the root) in a procedure called coronectomy. The long-term risk of coronectomy is that chronic infection can persist from tooth remnants. The prognosis for the second molar is good after the wisdom tooth extraction with the possibility of bone loss after surgery increases when the extraction is completed in people aged 25 years or older. A medical controversy exists about the need and timing of the elimination of a disease-free, dental policy that does not cause problems. Initial removal advocates cite increased risks for extraction over time and undeleted monitoring of wisdom teeth. Supporters to maintain their flower teeth mention unnecessary risks and operating costs.
This condition affects up to 72% of the Swedish population. The youngest teeth have been described in the ancient texts of Plato and Hippocrates, Darwin's works and in the early manuals of operative dentistry. It was a meeting of sterile, radiological and anesthetic techniques in the late 19th and early 20th centuries that allowed the more routine management of affected wisdom teeth.
Video Impacted wisdom teeth
Classification
All teeth are classified as developing, erupting (embedded), embedded (failing to erupt even if there is no blockage from other teeth) or affected. The affected tooth is one that failed to erupt due to blockage from other teeth.
The youngest teeth grew between the ages of 14 and 25, with 50% of root formation completed by age 16 and 95% of all erupted teeth by age 25 years. However, the movement of teeth can continue beyond the age of 25 years.
The affected wisdom teeth are classified based on the direction and depth of the impaction, the amount of space available for tooth eruption. and the amount of soft tissue or bone (or both) that covers them. The classification structure helps doctors estimate the risk of impaction, infection and complications associated with wisdom teeth removal. The youngest teeth are also classified by the presence (or absence) of symptoms and illness.
One review found that 11% of teeth will have evidence of the disease and are symptomatic, 0.6% will be symptomatic but have no disease, 51% will be asymptomatic but have the disease and 37% will be asymptomatic and have no disease.
The affected wisdom teeth are often described by their impaction direction (forward tilt, or mesioangular being the most common), impaction depth and age of the patient as well as other factors such as an existing infection or pathology.. Of these predictors, age correlates best with difficulty extraction and complications during wisdom removal rather than impaction orientation.
Another classification system often taught in US dental schools is known as Pell and Gregory Classification . This system includes both horizontal and vertical components to classify the location of the third molar (especially applicable to the mandibular third molar): the third molar relationship with the occlusal plane to vertical or x-component and anteriorly to the horizontal or ramus boundary < i> y-component . Vertically, Class A impaction is one in which the occlusal surface of the affected tooth is parallel or nearly parallel to the occlusal plane and the cervical line of the adjacent second molar.
Maps Impacted wisdom teeth
Signs and symptoms
Impaired toothless dental pests, which have no dental-related pathology and have not caused tooth resorption of tooth strangulation are rare. In fact, only 12% of affected wisdom teeth is associated with pathology.
When the youngest tooth communicates with the mouth, the most common symptoms are localized pain, swelling and tissue bleeding that covers the teeth. This tissue is called the operculum and a disorder called pericoronitis which means inflammation around the dental crown. Low-level chronic periodontitis usually occurs in the wisdom tooth or second molar, leading to less obvious symptoms such as bad breath and bleeding from the gums. Teeth can also remain asymptomatic (pain-free), even with illness. When the teeth near the mouth during normal development, people sometimes report mild stress or other symptoms similar to teeth.
The term asymptomatic means that the person has no symptoms. The term asymptomatic should not be equated with the absence of disease. Most diseases have no symptoms at the beginning of the disease process. Painless or asymptomatic teeth can still be infected for years before symptoms of pain develop.
Cause
The youngest teeth become affected when there is not enough space in the jaw to allow all the teeth to erupt into the mouth. Because wisdom teeth are the last to erupt, because of insufficient space in the jaw to accommodate more teeth, the wisdom teeth become trapped in the jaw, that is, affected. There is a genetic predisposition to dental impaction. Genetics play an important, though unpredictable, role in determining the size of the jaw and teeth and the potential for teeth eruption. Some also believe that there is an evolutionary decrease in jaw size because of the softer, less delicate modern diet than our ancestors.
Pathophysiology
Impacts that are completely covered by bone and soft tissue have clinically low levels of pathology - generally small cysts or unusual tumors formed from residual epithelium around the dental crown.
The estimated incidence of cysts or other neoplasms (almost all benign) around the affected tooth is 3% on average, usually seen in people under 40 years of age. This suggests that the possibility of tumor formation decreases with age.
For partially impacted teeth on those over the age of 20, the most common pathology seen, and the most common reason for removing wisdom teeth, is pericoronitis or infection of the gum tissue above the impacted tooth. Bacteria associated with infection include Peptostreptococcus, Fusobacterium, and Bacteroides bacteria. The next most common pathology seen is cavities or cavities. Fifteen percent of people with wisdom teeth exposed to the mouth have cavities in the wisdom tooth or second molar teeth adjacent to the wisdom tooth. Levels of cavities behind the second molar have been reported anywhere from 1% to 19% with wide variations associated with increased age.
In five percent of cases, advanced periodontitis or gum inflammation between the second and third molars triggers the wisdom tooth extraction. Among patients with asymptomatic wisdom teeth, about 25% had gum infections (periodontal disease). Teeth with periodontal pockets greater than 5 mm have a tooth loss rate ranging from 10 missing teeth per 1000 teeth per year at 5 mm to 70 missing teeth per year per 1000 teeth at 11mm. The risk of periodontal disease and caries in third molars increases with age with a small minority (less than 2%) of adults aged 65 years or older maintaining teeth without caries or periodontal disease and 13% maintaining a young tooth that is not done without caries or disease periodontal.. Periodontal probing progression increased over time to more than 4 mm in a significant proportion of young adults with affected wisdom teeth associated with elevated serum inflammatory markers such as interleukin-6, soluble intracellular adhesion molecule-1 and C-reactive protein.
The front teeth crowd is not believed to be caused by the wisdom tooth eruption although this is the reason many dentists use to justify the removal of molars. ,
Diagnosis
The diagnosis of impaction can be made clinically if enough of the wisdom tooth is seen to determine angulation, depth, and if the patient is old enough so that further eruption or uprighting is not possible. The youngest teeth continue to move into adulthood (20-30 years) due to eruption and then resume some later movement due to periodontal disease.
If the tooth can not be assessed by clinical examination alone, the diagnosis is made using panoramic radiography or CT cone-beam. Where the wisdom teeth that have not erupted still have the potential for eruption, some predictors are used to determine the possibility of those teeth affected. The ratio of space between the length of the dental crown and the amount of space available, the angle of the tooth compared to the other is the two most frequently used predictors, with the most accurate space ratio. Despite the capacity to move into early adulthood, it is likely that the tooth will be impacted predictably when the ratio of available space to the crown gear length is below 1.
Screening
There is no standard for filtering wisdom teeth. It has been suggested, there is no evidence to support routinely maintaining or removing wisdom teeth, evaluating it with panoramic radiography, beginning between the ages of 16 and 25 will be completed every 3 years. Once there is a possibility of developing disease gear, then discussions about the risk of surgery versus long-term retention risk with oral and maxillofacial surgeons or other doctors trained to evaluate the wisdom tooth is recommended. This recommendation is based on evidence of expert opinion level. Screening at a younger age may be necessary if the second molar ("12 year molar") fails to erupt because the ectopic position of the wisdom tooth can prevent eruption. Radiography can be avoided if most teeth are seen in the mouth.
Treatment
The youngest teeth that are completely erupted and in normal function do not need special attention and should be treated just like other teeth. However, it is more challenging, to make treatment decisions with a symptomless, disease-free tooth teeth, the wisdom tooth that has no oral communication and no clinical evidence or radiographic disease (see Treatment controversy below).
Local care
If there is a gingival operculum affecting an already infected tooth, gingiva can be treated with local cleansing, antiseptic rinsing in the area and antibiotics if severe. Definitive treatment may be tissue excision, however, the recurrence of this infection is high. Pericoronitis, while a small area of ​​tissue, should be viewed with caution, as it is located near the anatomical neck and can develop into a life-threatening neck infection.
Wisdom teeth
The youngest tooth transfer (extraction) is the most common treatment for affected wisdom teeth. In the US, 10 million wisdom teeth are removed each year. The general agreement for wisdom teeth removal is the presence of any disease or symptoms associated with the tooth.
The procedure, depending on the depth of the impaction and the angle of the tooth, is to make an incision in the oral mucosa, removing the lower or maxillary bone adjacent to the tooth, bypassing the tooth and extracting it. This can be solved under local anesthesia, sedation or general anesthesia.
Recovery, risks and complications
Most people will experience pain and swelling (worst on first postoperative day) then return to work after 2 to 3 days with discomfort level decreased to about 25% on postoperative day 7 unless affected by dry socket: wound healing disorder which prolong pain post-operation. This can be 4 to 6 weeks before the patient fully recovers with a variety of jaw movements. The Cochrane investigation found that antibiotic use either before or after surgery reduced the risk of infection, pain and dry socket after the wisdom teeth were removed by oral surgeons, but the use of antibiotics also caused more side effects for this patient. Twelve patients are required to receive antibiotics to prevent 1 infection and for every 21 people receiving antibiotics, the possibility of side effects. The conclusion of this review is that antibiotics given to healthy people to prevent infection can cause more harm than good benefits to individual patients and the population as a whole. Other Cochrane investigations found that post-operative pain was effectively managed with ibuprofen, or ibuprofen in combination with acetaminophen.
Many variations of surgical techniques exist, but by 2014, evidence is not sufficient to recommend one type of surgical practice over another.
Long-term complications may include periodontal complications such as bone loss in second molar teeth after wisdom tooth extraction. Bone loss as a complication after tooth extraction is rare in young children but is present in 43% of those aged 25 years or older. Initiation or worsening of temporomandibular joint problems is rare and unpredictable. Injuries to the inferior alveolar nerve causing numbness or partial numbness of the lower lip and chin have reported varying numbers from 0.04% to 5%. The largest study was from a survey of 535 oral and maxillofacial surgeons in California, where a rate of 1: 2,500 was reported. The large variations in the reporting rate are associated with variations in techniques, patient pool experiences and surgeons. Other unusual complications have been reported including persistent sinus communication, adjacent tooth decay, lingual nerve injury, disconnected teeth, osteomyelitis and jaw fracture. Alveolar osteitis, postoperative infection, excessive bleeding may also occur.
Treatment controversy
Many affected wisdom teeth are extracted before the age of 25, when full eruption can be reasonably expected and before symptoms or illness have begun. This causes controversy of treatment commonly referred to as tooth extraction of asymptomatic wisdom, free of disease.
In 2000, the first National Institute of Clinical Excellence (NICE) of the United Kingdom set guidelines to restrict the removal of a third molar without disease without disease, citing the number of pathologies free of tooth released and the potential cost savings to the public purse. Policy advocates show that affected wisdom teeth can be monitored and avoidance of operations also means avoiding the recovery, risks, complications and costs associated with it. Following the adoption of the UK NICE guidelines saw a decrease in the number of affected third molar operations between 2000 and 2006 and an increase in the average age at extraction from 25 to 31 years. The American Public Health Association has adopted a similar policy towards the appointment of a third molar before the problem occurs.
Those who oppose the blanket moratorium on the symptom-free and disease-free tooth extraction indicate that wisdom teeth commonly develop periodontal disease or cavities that can ultimately damage second molar teeth and there are costs associated with monitoring the wisdom tooth. They also point to the fact that there is an increase in postoperative periodontal disease rates in second molar, operational difficulties and postoperative recovery time with age. The UK has also seen an increase in dental caries rates in lower second molars increased from 4-5% before NICE guidance to 19% after adoption.
Although most studies come to the conclusion of long-term negative outcomes, eg. increased pocketing & amp; loss of attachment after surgery, it is clear that early elimination (before 25 years), good postoperative hygiene & amp; plaque control, and lack of pre-operative periodontal pathology are the most important factors that minimize the possibility of adverse post-operative outcomes.
The Cochrane review of surgical removal versus uninfected asymptomatic dental retention of toothless teeth shows that the presence of incontinent asymptomatic teeth may be associated with an increased risk of periodontal disease affecting adjacent second molars (measured by a distal probing probe of 4 mm on teeth) in the long run, but it is very low quality proof and high risk of bias. Another study of high-risk bias, found no evidence to suggest that the removal of wisdom teeth that affects asymptomatic disease has an effect on the crowd in the dental arch. There is also insufficient evidence to highlight the difference in risk of decay with or without affected wisdom teeth.
One trial in adolescents with orthodontic treatment compares the removal of the affected youngest affected mandibular teeth with identified retention. Only examined the effect on lower incisors and was considered 'highly biased' by the authors. The authors conclude that there is not enough evidence to support either routine removal or tooth retention of asymptomatic affected teeth. Another randomized controlled trial conducted in the UK has suggested that it is unreasonable to remove undetectable asymptomatic asymptomatic teeth only to prevent incisors because there is no strong evidence to demonstrate this relationship.
Due to a lack of sufficient evidence to determine whether or not the tooth should be removed, the patient's preference and value should be considered with the clinical expertise performed and the risk & amp; benefits to determine care. If it is decided to maintain a symptom-free wisdom tooth, regular clinical assessment is advised to prevent undesirable outcomes (pericoronitis, root resorption, cyst formation, tumor formation, inflammation/infection).
Coronectomy
Coronectomy is a procedure used when surgeons believe that there is a high risk of inferior alveolar nerve injury. After making an incision in the mucosa and removing the bone adjacent to the tooth, the crown is cut and removed without attempting to remove the roots. This is indicated when there is no dental pulp disease or infection around the dental crown and there is a high risk of inferior alveolar nerve injury.
Coronectomy, while reducing the direct risk to inferior alveolar nerve function has its own complication rate and may result in repeated surgery. Between 2.3% and 38.3% of the roots loosen during the procedure and need to be removed and up to 4.9% of cases require repeated surgery due to persistent pain, root exposure or persistent infection. Roots have also been reported to migrate in 13.2% to 85.9% of cases.
Prognosis
The prognosis for affected wisdom depends on the depth of the impaction. When they have no mouth-to-mouth communication, the main risk is the possibility of a cyst or formation of a relatively rare neoplasm.
After communicating with the mouth, the onset of illness or symptoms is unpredictable but the likelihood increases with age. Less than 2% of the wisdom teeth are free of periodontal disease or caries at age 65. Furthermore, some studies have found that between 30% - 60% of people with previously untreated wisdom teeth will experience extraction due to symptoms or illness, 4-12 years after initial examination.
The youngest tooth extraction eliminates disease in the wisdom teeth itself and also appears to improve the periodontal status of the second molar, although this benefit is reduced beyond the age of 25 years.
Epidemiology
Several studies have looked at the percentage of wisdom teeth present or the level of eruptive tooth wisdom. Lack of up to five teeth (excluding third molar teeth, the wisdom tooth) is called hypodontia. The third missing molar occurs in 9-30% of the population studied.
One large-scale study in a group of young adults in New Zealand showed 95.6% had at least 1 wisdom tooth with a rate of 15% eruption in the upper jaw and 20% in the lower jaw. Another study of 5,000 recruited soldiers found 10,767 affected wisdom teeth. The impaction frequency of lower third molar teeth has been found to be 72% and the frequency of affected wisdom teeth free from disease and symptoms is estimated at 11.6% to 29% which decreases with age.
The incidence of teeth extraction was estimated at 4 per 1000 person years in England and Wales before the 2000 NICE guidelines.
History
The young teeth have been described in the ancient texts of Plato and Hippocrates. The "wisdom tooth" comes from the Latin, dentes of sapientiÃÆ'Â| <, which in turn comes from the term Hippocratic, sophronisteres , from the Greek sofron , which means wise.
Charles Darwin believed that wisdom teeth would decline with contemporary evolution, Paolo Mantegazza, then proved false when he discovered Darwin did not open the jawbone of the specimen to find the collision teeth that lodged in the jaw.
In the late 19th and early 20th centuries, the collision of sterile techniques, anesthesia and radiology made routine surgery on the wisdom teeth possible. John Tomes's 1873 text A Dental Surgery System describes techniques for removing "third molar, or dentes sapientiÃÆ'Â|" including description of inferior alveolar nerve injury, jaw fracture and pupil dilatation after opium is placed in the socket. Other texts from around this time speculate on their deevolution, that they are susceptible to decay and discussion about whether or not they cause crowding from other teeth.
References
Source of the article : Wikipedia
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