General Health

How to treat Wisdom Teeth associated complications?

The third molars form the wisdom teeth that normally erupt during the late teenage to early adult years. There are four wisdom teeth that grow bilaterally on the posterior ends of the upper jaw (maxilla) and lower jaw (mandible). Wisdom teeth eruptions are often responsible for many dental issues and facial pain in adults.

MedPiper Technologies and JournoMed along with the Association of Maxillofacial Surgeons of India, (AOMSI) Tamil Nadu and Puducherry Branch, conducted a webinar on 9th January, 2021 where the expert speakers, Dr. Balakrishnan R and Dr. Catherine Diana discussed the various complications associated with the wisdom tooth. Dr. Balakrishnan R.N. works at the Department of Oral Maxillofacial Surgery at Tagore Dental College and Hospital, Rathinamangalam. Dr. Catherine Diana works at the Department of Oral Maxillofacial Surgery, CSI College of Dental Sciences, Madurai. The event was moderated by Dr. R. Murugan, Consultant Maxillofacial Surgeon and Associate Professor at the Rajah Muthiah Medical College (RMDCH), Chidambarm. 

Wisdom teeth are considered as vestigial organs and tend to erupt in a tilted position causing food impactions, cheekbites and issues to the adjacent dental and bone structures. More often than not, wisdom teeth complications are not addressed until the patient experiences pain, swelling or restricted mouth opening. Some of the problems associated with the problematic wisdom tooth are: 

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Dental caries (cavities): 

The tilted third molar will knock onto the second molar creating a V-shaped cavity and it is hard to reach while brushing. Food often gets trapped here and can cause caries in the distal part of the second molar which often go unnoticed and are only caught when there is pain. To prevent the further spread of these cavities the surgeons end up removing the second molar. Caries in this region can also cause space infection (infection of the soft tissue below the mouth) which ends up affecting the parapharyngeal region. 

Crowding of the lower anteriors (the four incisors and two canines on the lower jaw) 

Evolution has led to an incongruity in the tooth size and jaw size in humans. The small jaw has to accommodate the larger teeth which results in crowding of the teeth. The crowding of the incisors and canines in the lower jaw is further aggravated when the mandibular third molar erupts so as to accommodate itself in the small space of the jaw. The speakers suggest the prophylactic removal of the wisdom teeth especially in patients who have undergone corrective orthodontic treatment for crowding to prevent recurrence. 

Fracture of the mandible 

In the anterior region of the jaw, there is the alveolar process, which contains sockets to hold the growing teeth. The wisdom tooth, however, occupies core bone in the distal region of the lower jaw towards the condyle. The condyle is a weak bone by nature and is highly susceptible to fracture. The wisdom tooth growth further weakens this region and increases the risk of jaw fractures. Impacted wisdom teeth can also exacerbate the formation of cracks in the temporomandibular joint. Thus, many maxillofacial surgeons recommend wisdom tooth removal to avoid such fractures especially for athletes who practice contact sports. 

Oral Cancer

The problematic wisdom teeth can be one of the contributing causes of oral cancer. The maxillary third molar is normally positioned inwards in buccooral cavity and causes cheekbites. Prolonged cheek bites lead to traumatic ulcers. Untreated chronic traumatic ulcers can lead to oral cancer. If the oral cancers occur in the retromolar region, it is hard to salvage the area. The upper wisdom teeth can also cause keratosis (whitening of the tissues in the lower jaw due to friction) which can progress to oral cancer. 

Idiopathic jaw and facial pain

The wisdom tooth can erupt incorrectly which creates a nagging pain in the jaw and the face. This could be due to space infection or inflammation of the submandibular lymph nodes, thus radiating the pain towards the neck. Maxillary wisdom tooth eruptions can also lead to headaches. The speakers suggest taking an orthopantomogram (OPG) to obtain a full X-ray view of the orodental region which can help detect impacted teeth and determine underlying pathologies.

Formations of cysts in the jaw

The reduced enamel epithelium surrounding the third molar is susceptible to having small odontogenic cysts which can erode the adjacent bone and teeth structures. These cysts would have severely damaged the jaw and associated structures by the time they are large enough to be clinically identified. The removal of these cysts requires extensive surgical strategies such as jaw resection. These cysts can be detected through a radiograph. 

Treatment options: 

The prophylactic removal of the wisdom teeth requires numbing and anesthesia. Local anesthesia is normally used when the wisdom teeth are to be removed one at a time. For patients who are apprehensive or anxious, the surgeons will either give them conscious sedation or preoperative anti anxiety drugs. General anesthesia is given in the following scenarios:

  1. When the patient suffers from cognitive mental disorders or physical disabilities and are uncooperative 
  2. When all four wisdom teeth are to be removed at once
  3. When the tooth is embedded deep into the gingiva close to the nerve endings. 

Conscious sedation and general anesthesia are given under the supervision of an anesthesiologist. The speakers stressed on active mouth opening within 24-48 hours post operation to help with recovery as it can help reduce inflammation and prevent trismus (lockjaw). 

The position of the wisdom tooth prevents it from being detected until it manifests itself as pain. The absence of symptoms does not necessarily indicate the absence of wisdom tooth associated complications. If there is a tilted third molar or decay in the wisdom tooth, the speakers suggest removing the wisdom tooth at the earliest to avoid further complications.

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