Wisdom Teeth Extractions
Wisdom teeth, which are also known as the third molars, are the last permanent teeth to develop in the oral cavity as well as the final ones to come into place. However, as is often the case, many wisdom teeth do not have sufficient room to erupt, are not developing properly, or are causing issues for the adjacent teeth and the surrounding tissues. Oral and maxillofacial surgeons frequently see patients with impacted or problematic wisdom teeth for an evaluation or extractions as indicated.
A wisdom tooth is considered impacted when it is submerged under gum tissue or bone and unable to erupt into position. Based on the type and amount of overlying tissue, impactions are classified in a few different ways. Soft tissue impactions occur when a wisdom tooth remains covered by gum tissue. If a wisdom tooth remains completely, or partially obstructed by bone, it’s known as a bony impaction.
Impacted wisdom teeth can potentially cause many problems and may need to be removed when they are the source of:
- Pain
- Infection
- Cysts
- Tumors
- Damage to adjacent teeth
- Gum disease
- Extensive tooth decay
Although the extraction of wisdom may be recommended for older patients, the early removal of problematic or potentially problematic wisdom teeth in young adults is often the case. Among the many reasons for this approach to care is that extractions at this stage of life are simpler, and patients experience a shorter recovery time with fewer complications.
Whatever the case may be, patients of all ages can rely on the expertise of an oral and maxillofacial surgeon for the evaluation and treatment recommendations for developing, impacted, or erupted wisdom teeth.
Impacted Teeth
An impacted tooth is one that fails to erupt and remains covered to varying degrees by the soft tissue and bone.
According to statistics, the maxillary canines are, after the wisdom teeth, the second most common teeth to become impacted. Close to 8% of the time, these impactions are bilateral, which means that both the left and right upper canines are unable to erupt into the dental arch. Because the canines play a crucial role in providing facial support and are essential for optimal bite function, it’s a good idea to consult an orthodontist to discuss how these impacted teeth might be brought into appropriate alignment. In many cases, the patient is referred to an oral and maxillofacial surgeon for a procedure to expose the tooth and enable tooth movement.
Before the actual surgical exposure is performed, the orthodontist places appliances to address any underlying malocclusions and to develop sufficient space to bring the impacted canine into the dental arch. When the orthodontist decides it’s the right time, the oral and maxillofacial surgeon performs the surgical procedure. To expose an impacted canine, the oral and maxillofacial surgeon reflects the tissue overlying the canine and removes sufficient overlying bone to allow the placement of an orthodontic bracket as well as an elastic or metal chain. With these attachments, the orthodontist gradually moves the canine into its proper position.
Other impacted teeth may also warrant this type of procedure. For example, a central incisor that fails to erupt due to an overlying supernumerary (extra) tooth may require a similar approach to care. Also, not every tooth that’s surgically exposed requires the placement of an orthodontic attachment. In these cases, it’s felt the uncovered tooth is likely to erupt on its own. Every case is unique, and each step in treatment will be discussed at the consultation visit.
Surgical exposure is typically performed under local anesthesia, along with dental sedation. Patients receive detailed instructions on what to expect postoperatively, managing any postoperative bleeding or discomfort, along with detailed dietary and hygiene instructions.
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