Our bodies simply are not equipped to support wisdom teeth, extra molars that form at the back of our mouths and usually occur after age 20. Some wisdom teeth never develop completely; others erupt only partially before becoming buried by gum tissue.
Untreated molars can lead to crowding, tooth decay and infection – and may even damage adjacent teeth.
Impacted Wisdom Teeth
The jaws have evolved to house 28 teeth, including wisdom teeth (third molars) in the rear of both upper and lower gums. Wisdom teeth typically erupt during late teenage or early twenty years if there is enough space in the mouth; when they come through at an angle or become trapped between bone or gums it is called impaction.
There can be various reasons for wisdom teeth to become impacted, with the most prevalent being lack of space for them to erupt properly, whether due to jaw shape, genetics, or any combination thereof.
An impacted wisdom tooth may cause severe discomfort, damage to adjacent teeth and lead to gum disease or infections like pericoronitis.
Incapacitated wisdom teeth often cause crowding of other teeth and further issues like tooth decay or gum disease in future, as well as pushing against roots of adjacent teeth, leading to crookedness and shifting.
If a wisdom tooth is causing trouble, the best approach may be having it extracted by either a dentist or oral maxillofacial surgeon who specializes in surgery of teeth, bones and jaws.
Prevent the need for removal by being pro-active with your dental health. Brushing, flossing and regular checkups can keep your teeth in optimal condition.
Doctors use local anesthetic injections to numb the area around your tooth and jawbone before proceeding to use a dental drill to cut into and extract your tooth in sections, with or without using water jet or laser division if possible. Prior to any procedure it’s essential that all medications that have recently been taken or will be taken are disclosed to their doctors as some can interfere with anaesthesia and recovery processes or recovery from surgery itself. Your physician may also inquire as to your general health; certain conditions could impact on surgery or anaesthesia outcomes.
Impacted Third Molars
One of the major dental milestones is the arrival of wisdom teeth or third molars, typically between 17-21. Although they typically erupt without incident, issues may arise if they do not erupt correctly, leading to crowding or other problems that need to be addressed immediately.
Impaction can result in several issues, including peri-implant infections, cysts and granulomas. An infection may arise because an impacted tooth does not have an adequate seal that prevents bacteria from invading its pulp. Other complications include surgically-induced subcutaneous emphysema and perforation of sinuses; additionally wisdom tooth extraction may cause chronically infected post-extraction granulomas which must be addressed surgically to be resolved.
Many patients have wisdom teeth impacted, yet most do not experience symptoms or disease. Extraction of asymptomatic wisdom teeth has become controversial as some researchers suggest this action could cause new issues like jaw bone loss and increased facial width.
Third molar impacts could also be related to local pathologie, including achondroplasia, Treacher Collins syndrome or occipitomandibular syndrome. Such conditions can lead to abnormal development of the third molars and increase their susceptibility to impaction.
Mesial migration, which causes crowding of lower incisor teeth, is another of the more frequently experienced issues. This may be caused by force transmitted by third molar eruption through dental arch and into mesial region resulting in mesial movement towards incisor area.
Also a concern, some impacted third molars can dislocate into the maxillary sinus due to excessive force used to extract an erupted third molar, leading to increased pressure pushing it into its usual spot in the sinus cavity and leading to pain and swelling. Diagnosis for such cases typically includes history review, clinical examination or the use of radiographs; prevention can be accomplished through scheduling regular six-month cleaning appointments with your dentist for cleaning and X-rays so he or she can monitor how your wisdom teeth progress over time.
Impacted Second Molars
Normal eruption of second permanent molars typically follows that of first premolars between 11-13 years, although clinical reports have documented instances in which lower permanent second molars become impacted prior to upper ones [1]. The cause may lie with lack of space due to crowding of maxillary teeth or premature eruption of third molars.
Studies showed that in many patients experiencing delayed eruption of their second lower molar, there was significant mesial angulation resulting from delayed eruption. This condition can lead to ankyloses or loss of tooth in its mesial position; additionally, root distortion and the development of taurodontic relationships between roots of second lower molar and distal ridge of adjacent first permanent molar can occur as a result.
In this case, orthodontic treatment began by extracting four mandibular first premolars to ease bimaxillary protrusion and gain necessary space. Nickel-titanium open coil springs were placed to allow mesial advancement of both left and right permanent second molars that had become impacted over time; orthodontia then closed this space successfully and Class I intercuspation was achieved.
This case highlights the value of collaboration between orthodontist and oral surgeon when treating impacted second molars. A proper diagnosis can be made and effective treatment plans formulated, thus avoiding complications that might otherwise hinder results. Additionally, an oral surgeon must recognize the significance of maintaining adequate mesial space around impacted second molars so as to prevent third molar ectopic eruption and any related complications such as ankyloses or impaction. At this crucial juncture in dental treatment, it is vital to maintain close ties between an orthodontist, periodontist and patient during this challenging phase. An effective team effort among these professionals can yield excellent and optimal results in patients with impacted permanent molars; furthermore, patient cooperation plays a crucial role in treating such cases successfully.
Impacted First Molars
Impaction occurs when your child’s first permanent molar (M1) does not erupt normally and it causes discomfort while chewing, affects growth of second permanent molars, or causes other teeth to shift into unusual positions. It should be managed immediately for optimal results.
Clinician and radiographic examination alone cannot differentiate between impaction, primary retention and secondary retention of M2s; each condition’s diagnosis and treatment options differ considerably.
Normaly, eruption of permanent molars occurs without incident; however, sometimes their path becomes blocked, even without structural issues in the jaws being present. When this happens, they are considered “impacted” and must completely erupt by 16 years old or they may become “impactsed”.
If the path for eruption of a molar tooth becomes blocked due to factors like an impaction from baby teeth or physical obstructions such as physical space shortage, its movement may become impaired and lead to impaction. Impaction could also occur from failing to practice proper oral hygiene or from infections such as periodontitis preventing it from coming to fruition properly.
An erupting molar must consider its surroundings when emerging; including surrounding teeth, the presence of the sulcus and even itself. All of these will impact how much room there is available for movement as well as any degree of mesiodistal angulation it can achieve.
When the first permanent molar is extracted too early, the second permanent molar may experience unfavorable influence due to this alteration in mesiodistal angulation. When this occurs, molars tend to lean more mesially which can result in spaces between its roots or even cause it to become impacted [7].
Mandibular M2 angulation can vary widely from individual to individual. Therefore, it is crucial that one can recognize these variations and differentiate between types of malocclusion in order to select an effective treatment method. Repositioning can often correct malocclusion without resorting to surgery by realigning root tips back into their natural positions and increasing force on the mesial portion of M2. By doing this, molars can be moved back into place more rapidly.