The wisdom teeth, wisdom teeth or third molars are the last molars to erupt, between the ages of 17 and 26. This is one of the main reasons why the eruption space may be limited.
Third molars can be pathological or not and symptomatic or not. That is, it is common to find patients who present pathological molars without these presenting symptoms. Therefore, a good diagnosis must be made in order to be able to classify them properly and, if they are extracted, carry out a correct planning of the surgical technique to reduce the incidence of complications.
What complications do third molars usually have?
- Pericoronitis is an infection that affects the soft tissues surrounding the crown of a partially erupted tooth, that is, when the gum around the third molar or area becomes infected.
- Paradental, radicular and follicular cysts.
- Ameloblastoma and malignant tumors
- Ulceration Both of the jugal mucosa and the lingual mucosa due to repeated trauma.
- Injuries to the second molar, such as root resorption.
- Dental displacements. Rotation of the incisors, malposition of the anterior teeth. Although this point is in doubt according to current scientific evidence.
- Temporomandibular joint (TMJ) disorders.
- Sensitivity disturbances, such as cutaneous hyperesthesia.
- Motor disturbances, such as tics, lip twitching, or trismus.
- Disorders in the secretion of saliva, such as hyposialia.
- Cutaneous-mucosal trophic disorders, such as cutaneous erythema.
- Sensory disorders, related to hearing and vision.
- Periodontal pathology
- Third molar resorption
- Jaw fractures
When should wisdom teeth be removed?
It is important to take a good medical history, noting all the data of interest about the patient, along with a clinical examination and complementary tests, such as a radiological study.
In the radiological study, the orthopantomography gives an overview and the periapical radiographs, local details. With its correct interpretation, most of the local factors that intervene in the difficulty of the extraction of the tailpiece can be diagnosed.
There are several treatment options in the presence of a third molar:
- Expectant behavior, that is to say, wait, controlling and preventing possible complications. As long as there is no pathology associated with this third molar. A clinical-radiological assessment is carried out where local problems are assessed, such as the risk of injury to neighboring structures and acute infections, among others.
- Surgical extraction, that is to say to extract the wisdom tooth. A risk-benefit assessment is carried out, such as the presence of infection (pericoronitis). This is usually the behavior of choice.
- Transplant. Sometimes the third molar can function as another previously lost molar.
- Cauterization. It consists of the placement of caustic substances in order to relieve pain and cure the infection (pericoronitis).
- Excision of the mucous cap. In repeated infections, such as pericoronitis, it may be helpful to remove the mucous cap that forms above the erupting third molar.
Wisdom tooth extraction is indicated in the following cases according to the SIGN criteria (NICE Guidelines):
- Infection. Such as pericoronitis, phlegmons or other clinical pictures of odontogenic infection.
- Pathologyaaassociated. As a cystic, tumor and malignant lesion (ameloblastoma).
- Periodontal injury. If there is periodontal pathology in the distal root of the second molar due to the position of the second molar, cause a resorption of this root or there is an associated pathological probing depth.
- Orthodontic reasons. To improve the eruption of second molars, in orthognathic surgery, among others.
- Restorative Prosthodontics. Such as distal caries of the second molars, difficulty to sanitize the area or to be in the region where the patient wears a prosthesis, hindering functionality.
Currently, the prophylactic extraction of third molars, that is, extracting them when they are asymptomatic and without pathology, presents a controversy of criteria among dentists. According to current publications, more scientific evidence is necessary to establish criteria to support prophylactic extraction of third molars.
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