All of us at some point have come across the talk about bothersome wisdom teeth. Either our own impacted wisdom teeth that occasionally cause lots of pain and swelling in the back of the mouth or a friend’s story of how they had to go through surgery to get theirs out.
Impacted (trapped) Wisdom Teeth
Impacted wisdom teeth is something that is common among people. You may ask what is exactly an impacted wisdom tooth? Well, the evolution of human anatomy is something that not always goes according to our likings. Through development of human anatomy, there have been some unfortunate changes. One of these changes has been shortening of the length of the jawbone.
In each human jaw either lower or upper jaw, there are usually 16 teeth, that means 8 teeth on each side of the jaw. Now, the development of jawbone or alveolar length has been in such way that there has been left little room for the last tooth in the row (wisdom tooth). Because of this, the wisdom tooth does not have enough room to come out (erupt) completely. Because of this, problems will follow. This issue is much more common in the lower jaw.
The problem is usually occurrence of a pocket between the tooth and the gum over and on the backside of the tooth.
In this pocket, bacteria and food particles can get trapped. This can cause an inflammation in a confined and narrow space and will cause increased pressure, swelling and redness around the tooth. Sometimes, the opposite wisdom tooth in the upper jaw aggravates this swollen area of the gum during chewing by pounding on an already irritated gum. This is the beginning of a vicious cycle where the inflammation leads to even more inflammation.
This pain may subside on its own after several days and may reoccur in cycles
The second most common complication of a trapped wisdom tooth can be cavity formation on the neighboring tooth. This could lead to the need for root-canal treatment (rotfylling) of the neighboring tooth or even extraction in more advanced cases.
Painful wisdom teeth should be examined by a dentist. Treatment options are based on two principles. The simplest treatment would be to flush out the bacteria and food particles out of the pocket between the tooth and the gum. The flushing would be performed using a syringe filled with either saline (or an antibacterial solution like chlorhexidine) and a blunt needle. This treatment may help the pain subside temporarily however the pain may come back, which will call for a more permanent treatment option.
So if you want the problem gone once and for all, the most predictable and final treatment option would be extraction of the impacted wisdom tooth (trekking av visdomstann).
Extraction of Impacted Wisdom Teeth
Now, when it comes to extraction of partially erupted wisdom teeth, many factors must be taken into consideration. For most oral surgeons, the first option is to cut the gum open, remove some of the bone around the tooth, and take the tooth out. Now this is not scary as it sounds, but it is an invasive approach. Alternatively, the dentist could take the tooth out without cutting into the bone or gums if the dentist has the expertise and the right equipment to do it.
By not cutting the gum and especially the bone, the patient could be spared from a lot of post-op complications such as pain and swelling or even nerve damage.
In order to perform this procedure, there is a need for a good plan as to whether there is a need to cut the tooth in several spots and a good plan on which directions to apply our forces in. In addition to this, there is need for sharp-thin instruments that can dig around the tooth in the space called the PDL or periodontal ligament.
“Teeth are not in complete contact with the bone surrounding it. Between the tooth and the bone, there is a tiny space called PDL or periodontal ligament. This space contains lots of connective tissue which attach the teeth to the bone.”
Thin sharp edged instrument (a periotome) that can
cut deep into PDL around the tooth
All this demands patience and restrain from the dentist. The initial goal of the procedure is to get the tooth as loose as possible before trying to take it out. The final goal is to remove the loosened tooth. This is where most dentists fail. The consequence of this is usually fracture of the tooth beneath gum or bone line. In this case, the extraction would get much more complicated.
In this latter way, a dentist could spare the patient from a surgery and post-operative complications associated with it. Now, this description would apply to most cases of partially erupted wisdom teeth but there are cases where the tooth or most of it is covered in the bone. In these cases, there are not many other options than surgery. In most of these cases, the indication for extraction would be something other than pain in the surrounding tissue of the tooth.
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