Dr Shail Jaggi: Do wisdom teeth always need to go?

Dr Shail Jaggi: Do wisdom teeth always need to go?

I don’t know how much wisdom teeth have to do with wisdom but they can definitely be related to a lot of pain, discomfort, swelling and discomfort while eating if they decide to play up and be nasty.

Last week, I saw two patients with the same identical symptoms severe pain, inability to open their mouth and swelling associated with the third molar. The only thing that differed was their age.

One of them was just about 19 years and the other much older in the 40s. The treatment plan for both however was different. The 19-year- old was wait-and-watch with some palliative treatment and my older patient was advised a disimpaction with the same.

Basically why do third molars or the wisdom tooth get impacted in funny positions in the jaw? The answer is simple: Evolution

Our ancestors like the apes had very large jaw sizes and plenty of teeth. But as we evolved as a species our jaw sizes became much smaller but the number of teeth remained the same. The third molar being the last tooth to erupt sometimes doesn’t have enough space in the smaller jaw and will grow into any available space and position in the jaw. And very often these positions are unfavorable.

Does every third molar need to be extracted?

Orthodontic Treatment: A lot of orthodontists will advise the removal of the third molar before braces . But there is no definite evidence that tooth movement will take place once the third molars erupt. So this may actually be unnecessary.

Age of the Patient: Age of the patient is an important criteria of the third molar eruption. Younger patients where the molar is erupting and trying to push its way through may have complaint of discomfort for a day or two and this settles completely with some medication .

However, with older patients, if they have recurrent discomfort and pain with the third molar every couple of months may warrant the need for disimpacting the third molar.

Direction of the tooth: A completely erupted standing upright third molar will rarely need to be extracted since its position and placement will not damage adjacent teeth.

A sleeping third molar however may need immediate attention since its has the potential to damage adjacent healthy teeth and bone.

These sleeping teeth are the ones which are most likely to cause all the unpleasant symptoms.

Position of the Tooth: Very often, the position of the tooth may be very close to the nerve of the jaw. This position has to be carefully evaluated before any surgical planning. Any damage to the nerve can have long-term implications like loss of sensation to the jaw, pain, discomfort .

The loss of sensation being the most damaging.

The upper teeth may in close proximity to the sinus and extraction without evaluation can lead to damage of the sinus which is a delicate area.

Precautions before third molar surgery :

Third molar surgeries come under the category of minor surgical procedures.
A surgery however minor always needs adequate surgical and disinfection protocol for safety of the patient
Any surgery, however simple-looking, should not be done without adequate information. A 3-D Scan or CBCT is an absolute must to evaluate the position and direction of the tooth
The surgical procedure is best carried out by a trained oral surgeon
Post-Operative Care:

Heavy exercise or breathing exercises should be avoided for the first few days after the surgical procedure .
Inability to open the moth completely is normal
Excessive bleeding, loss of sensation should be reported immediately to the surgeon
Plenty of cold compress for the first couple of hours and soft food are important
Impeccable oral hygiene is a must after the surgery. This can be done with warm saline rinses 24 hours after the surgery
Got that third molar that’s waiting to be extracted ? Don’t sit on it! Have it evaluated and go ahead and do it before it gets more complicated.

Keep smiling till I see you next week!

DentalWiz is one of the best dentist in Pune. Aesthetics and Beauty for all is the prime motto of the clinic! They are well known in Pune for their cosmetic dentistry at reasonable prices.


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