Dear friends, today I invite you to talk about wisdom teeth. Moreover, to talk about the most difficult and most incomprehensible - the indications for their removal.
Since ancient times, a lot of anecdotes, superstitions, legends and stories, including very scary ones, have been associated with eights (third molars or “wisdom teeth”). And all this mythology is widespread not only among ordinary people, but also in the medical community. Gradually, during the discussion, I will try to debunk them and show that wisdom teeth are not such a problem, both in terms of diagnosis and removal. Especially when it comes to a modern doctor and a modern clinic.
Why are wisdom teeth so called?
Everything is very simple. Eighth teeth usually erupt between the ages of 16 and 25. At a conscious age, quite late, in comparison with the rest of the teeth. Like, become so wise? Get wisdom teeth in the form of bite problems and pericoronitis - on! Yes, sometimes a person's wisdom begins with the pain and suffering associated with wisdom teeth. No pain no gain, as they say.
Why do some wisdom teeth erupt and others don't?
Because some are wise and some are not. Joke.
To begin with, it should be clarified that the vast majority of people have wisdom teeth, and their absence from birth is a very, very rare thing. Being born without wisdom teeth and their germs is like winning the jackpot - buy a lottery ticket right away, because you are a lucky person.
But not everyone cuts through the eights. And it depends on the state of bite. Or rather, from the availability of space in the jaw for their eruption.
It so happened that they begin to grow at a time when the active growth of the jaw bones slows down, and the dentition, it seems, is already “staffed”. The tooth grows up (or down, if on the upper jaw), stumbles upon an obstacle in the form of a seven that has already erupted, stops or starts a turn.
This way, not only impacted (not cut through), but also abnormally located (dystopian) eights are obtained.
In fairness, it should be noted that there can be more wisdom teeth than four. Occasionally there are not only “eights”, but also “nines” or even “tens”. Of course, such an assortment in the oral cavity does not lead to anything good.
If there are eights, then this is necessary for some reason?
Well, most people have a belly button. And he, obviously, is also intended for something. For example, for storing woolen spools and other materials for applied arts.
Seriously speaking, the eights are a kind of atavism. A reminder that millions of years ago our ancestors ate raw meat, mammoths and other living creatures, and even vegans were much more brutal, chewing baobab bark instead of celery.
In this regard, the jaws of our ancestors were much larger and wider, and even Nikolai Valuev would have looked a little feminine against their background. And all thirty-two teeth in such jaws fit perfectly, everyone was happy.
However, in the process of evolution, people became smarter, learned how to process food, fry meat and stew broccoli baobab. The need for large jaws and a massive chewing apparatus has disappeared, people have become more elegant and glamorous. Their chewing muscles and jaws too. But the number of teeth has not changed. And sometimes they just don't fit in glamorous jaws. And the one who is the last one gets to be the pope in the position of retention or dystopia.
So the eights became "unnecessary" teeth. And, probably, it would be more correct to call them not “wisdom teeth”, but “australopithecus teeth” - you see, and people will begin to treat them more adequately.
What are eights?
You will not believe, but, basically, the eights are the eighth in a row.
What happens if you don't bother with wisdom teeth at all?
If the eights have erupted, are in the bite and function normally, then, of course, nothing will happen. It is enough to carefully monitor the hygiene in their area, because there may be some difficulties with it due to the gag reflex and poor visibility, periodically appear to the dentist - and the norms. Such wisdom teeth will exist happily ever after.
With dystopian wisdom teeth, everything, it seems, is also understandable - due to their location, oral hygiene is difficult, and these teeth are quickly affected by caries. It happens worse if caries spreads to neighboring sevens, which, unlike eights, are functionally very important. Often, caries appears on the farthest and poorly visible surface of the tooth. And a person notices it only when the whole thing starts to hurt. That is, too late.
In addition, abnormally located wisdom teeth create a so-called bite in the bite. "traumatic knots", break the usual reflex connections, which leads to problems with the muscular-articular chewing apparatus. Subsequently, this is aggravated by the pathology of the bite, overstrain of the masticatory muscles, crunching in the temporomandibular joints, i.e., signs of muscular-articular dysfunction appear. And, as a rule, the treatment of such muscular-articular dysfunctions begins precisely with the study of the role of the eighth teeth in this pathology and the adoption of the necessary measures (i.e., removal).
It’s more difficult to understand what happens to impacted (uncut) wisdom teeth. It would seem that the tooth is not visible, caries almost does not threaten him, he would sit and sit for himself ... However, there are a number of unpleasant consequences here.
Despite the fact that the tooth has not yet erupted, it already affects the dentition. It can cause tooth movement and crowding in the anterior region:
Due to the lack of a bony septum between the holes of the seventh and eighth teeth, a deep pocket is formed between them, where food debris, plaque and microbes can get in, which leads to inflammation. Sometimes quite sharp and dangerous to health.
The very process of eruption of impacted teeth, especially at the age of 20 years and older, is often accompanied by inflammation - pericoronitis.
Treatment of pericoronitis is a separate issue. Someday we will discuss it, but now you need to know the main thing - it is better not to bring it to pericoronaritis, and if it is clear that there is not enough space for wisdom teeth, and their eruption will be associated with difficulties, it is better to remove them in advance.
But the most unpleasant thing that can be expected from impacted wisdom teeth is cysts.
Their source is the follicle surrounding the tooth germ. When the tooth erupts, the follicle disappears, but in the case of retention, it remains and can serve as a source of tumors and cysts.
Sometimes - quite large and very dangerous to health.
And although all this is quite curable, you will agree that it is better not to bring yourself to such a state.
Why are the opinions of doctors about the removal of wisdom teeth so controversial?
Basically, it all comes down to how much experience the doctor has in removing wisdom teeth. If the procedure itself is difficult for the doctor, takes a lot of time and brings only suffering to the patient, then he is basically an opponent of removal. And vice versa, if the removal of eights, even the most difficult ones, does not present serious difficulties for the doctor, then on the contrary, he advocates the final and radical solution - the removal operation.
When is it impossible to execute, to remove, to remove, to leave?
Meanwhile, the criteria for removal / non-extraction of wisdom teeth are very simple. They can all be summed up in one simple phrase:
Diseases and complications associated with wisdom teeth, or the threat of these same diseases and complications are indications for the removal of wisdom teeth.
All. There are no other indications/contraindications.
Let's look at examples:
- Ordinary, erupted and fully functioning in a normal bite does not need to be removed. Moreover, such teeth in case of caries can (and should) be treated. The situation is different if caries is complicated by pulpitis or periodontitis - in such cases it makes sense to think about it, because the treatment of root canals in third molars presents certain difficulties. Maybe you don't need to bother with channels?
- Abnormally located (dystopic) wisdom tooth. He did not have enough space and he either leaned to one side, or remained half in the gum. Such a tooth will never function, but it creates problems for both the bite and neighboring teeth. Should it be removed? Undoubtedly.
- Impacted (uncut) wisdom tooth. It seems like it doesn't bother. It is somewhere out there, far away. Does not participate in chewing and never will participate. What the impacted eight can lead to, we already know. Does it make sense to wait for these complications? I think no, it doesn't.
- The tooth began to erupt, the gum over it became inflamed. Pericoronitis, as this disease is called, is a sign that the tooth does not have enough space in the jaw and, as a result, it will either be dystopic or lead to misalignment of the teeth and malocclusion. Is it worth treating pericoronitis with a simple excision of the hood? Hardly. It is better to solve this problem radically, namely, by removing the problematic tooth.
Conclusion
From the foregoing, we can conclude that the removal of wisdom teeth most often occurs when they do not particularly bother the patient. That is, this procedure is the prevention of possible complications from the eights. This is correct. There is no method more effective and cheaper than prevention. And the best medicine is preventive medicine.
Next time I will tell you about how, in fact, the removal of wisdom teeth takes place, how to prepare for this procedure and what to do after it.
Thank you for your attention! Don't switch!
Sincerely, Andrey Dashkov.
Source: habr.com