Patients often experience fear before surgical treatment. This is completely natural and understandable. As a doctor, and simply as a person who also has to seek medical help, I completely share these feelings. That is why I want to talk in more detail about such a widespread procedure as the removal of third molars (wisdom teeth) in order to dispel a number of myths about this manipulation, and, I hope, help patients drive away unnecessary anxiety and properly tune in to treatment.
international experience
In different countries, the answer to the question: “Do you always need to remove wisdom teeth?” different. In the USA, 8s are removed already in adolescence, before they lead to problems, that is, they act according to a preventive scenario. In the CIS countries, if teeth erupt correctly and do not cause problems, they are left behind. Apparently this is due to the characteristics of healthcare models.
At the same time, many scientific works on this problem among conscript soldiers in the Russian Federation attract attention, and it is no coincidence. It is at this moment that wisdom teeth begin to actively grow and reveal previously hidden problems. And treatment often requires surgery.
Where do the folds come from?
Oral and maxillofacial surgeons and orthodontists are well aware of how wrinkles are associated with missing teeth. For example:
“Eights” , also known as wisdom teeth, were considered unnecessary for many years. They were never treated and offered to be removed even if they did not hurt. It turned out - and dentists recognized this - that “eights” are useful from the point of view of preserving youth. If they have grown, they act as an internal frame for the cheeks, and the removal of these teeth promises early vertical wrinkles on the cheeks and sagging of the lower part of the cheeks, the so-called jowls.
Questions and answers Why do teeth fall out?
Molars are the main support for the cheeks from the inside. If they are missing, the cheeks become sunken, and asymmetrically sunken. And depressions quickly lead to the formation of deep vertical wrinkles and strengthening of nasolabial folds. Following the loss of chewing teeth, the corners of the eyes droop, “crow’s feet” appear, and they are complemented by the same jowls and marionette lines—multiple branching folds running down from the corners of the lips, because of which the lower jaw appears to be attached to a hinge.
The canines , both upper and lower, are responsible for the curve of the lower line of the oval of the face - approximately along the edges of the lower jaw. If they are missing, the oval of the face loses its clarity, folds and sagging like a double chin form. The corners of the mouth droop, which gives the face a tired expression, and after them the nasolabial folds become stronger. The same jowls and marionette wrinkles may appear.
The absence of one or more front teeth leads to the recession of the upper or lower lip, which then transforms into wrinkles. Later, wrinkles in the area of the nasolabial triangle intensify, and sagging appears under the lower lip. The smile line goes down - now the corners of the mouth do not rise when smiling. Well, marionette wrinkles traditionally accompany the loss of a tooth, no matter where it is located.
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What is the diagnosis
Doctors often use 2 terms when describing problems with wisdom teeth.
Retention – when a tooth fails to erupt. It grew, but remained inside the jaw completely or partially. This can create a focus of inflammation, which either subsides or worsens again. But the most unpleasant consequence can be a cyst around the tooth if it has not erupted at all.
Dystopia is an abnormally positioned tooth, for example, horizontally. At first, such a tooth germ may not bother you at all. But when it starts to grow, it can lead to a lot of problems. You also need to remember that the tooth simultaneously grows in 2 directions towards the crown and towards the roots. If such a rudiment is tilted, then the tooth may appear from the side of the cheek or, conversely, grow inside the mouth and scratch the tongue.
One of the options for dystopia is a horizontal arrangement.
During the process of growth, a slightly inclined tooth in a narrow jaw can “catch” on the neighboring one, which will lead to an accident. The growing tooth will turn around and lie horizontally. Further, the growing tooth can gradually displace the remaining teeth and lead to crowding of the front teeth. This will create a new problem, not only an aesthetic one, but daily hygiene becomes more difficult and the risk of caries increases.
Often dystopia is combined with retention, which provides more reasons to remove problematic eights.
Consequences and possible complications
It is necessary to separate the consequences of the operation and complications after it. All patients experience consequences to one degree or another - this is a normal reaction of the body to intervention, but it is better to avoid complications.
Consequences include:
- painful sensations;
- bleeding gums within 3-5 hours after surgery;
- swelling of the gums, cheeks;
- bruises on the face in the area of intervention;
- rise in temperature.
Complications may be as follows:
- prolonged bleeding
- due to the fact that the tissues around the lower “eights” are saturated with blood vessels. In this case, the doctor may apply additional hemostatic measures; - alveolitis
- inflammation of the wound surface associated with infection in the hole. It is characterized by the following symptoms: fever, bad breath, swelling, pain. Requires additional wound treatment and antibiotics; - paresthesia
- loss of facial sensation. Usually the lips, cheeks, and tongue suffer - they do not feel touch, do not distinguish between hot and cold. Loss of sensitivity is associated with damage to the facial nerve and may go away on its own within 1-2 weeks, but in some cases requires additional therapy; - dislocation of the mandibular joint
is a rare but possible complication associated with excessive efforts made by the surgeon to extract the tooth. The dislocation can be corrected immediately.
Attention!!!
Removing a problematic lower molar is a full-fledged operation, so special attention should be paid to the recovery period. It is necessary to strictly follow the doctor’s recommendations and carefully care for the oral cavity, then the likelihood of developing the complications described in the previous section will be minimal. Standard assignments include:
- taking painkillers and antihistamines
- antibacterial rinses
- cold compresses on the cheek in the area of intervention (reduce hematomas and reduce the risk of re-bleeding)
- prohibition on eating during the first hours after surgery
- ban on smoking, drinking alcohol, physical activity
- ban on visiting the sauna and swimming pool, taking hot baths
If the doctor did not make mistakes during the operation, and the patient does not violate the recovery regime, then very soon there will be no trace of unpleasant sensations.
Risks
There are genetic features that do not change, but there are those that depend on various factors, including age.
Facial structure
One of the easiest ways to determine whether there is a greater or lesser risk of problems with wisdom teeth is through a mirror. Let's pay attention to the face. If it is elongated from bottom to top, has narrow cheekbones, and people say a small, neat face, then there may not be enough space for wisdom teeth. But the wider the cheekbones, the wider the “bone”, the more space there is for cutting figure eights.
Also, sufficient space in the jaw reduces their crowding and creates conditions for good hygiene. And this is the best prevention of caries, not only of the seemingly unnecessary tooth that we inherited from our ancestors, but also of all other teeth.
A consultation with an orthodontist and radiation diagnostics (X-ray/MRI) will help you understand the situation.
Age dependent
Problems that can arise with wisdom teeth at different ages can vary significantly2.
In youth, the main problem is inflammatory processes during the eruption of wisdom teeth. As well as the need to remove them for orthodontic treatment.
In adulthood, those who have retained their teeth begin to experience caries. The occurrence of pulpitis and cysts usually leads to a surgeon for removal.
In old age, the main problem is periodontal disease, which usually also leads to the removal of wisdom teeth. Or it becomes a preparation stage for prosthetics.
Is it possible to remove a molar tooth yourself?
Trying to remove a molar tooth yourself is extremely dangerous. The only exception is very severe tooth looseness. It should be borne in mind that complete removal even in this situation will not work. You will simply break off the body of the tooth from the root, and nothing more. In any case, after such an independent removal, you need to visit a dentist, who will determine what should be done next. Sometimes an artificial tooth is installed at the root, and it can last for more than one year. If the root has defects, then it has to be removed.
There are situations when you have to remove a child’s very loose baby tooth at home. In this case, you should thoroughly brush the baby’s teeth and disinfect the oral cavity. Then you should wrap your fingers in sterile gauze, loosen the tooth thoroughly, and only then try to pull it out. If this was not possible on the second attempt, then the child must be taken to the dental clinic in any case.
If you have successfully removed the tooth from the socket, then you must firmly place a gauze swab in the socket and leave it there for 30 - 40 minutes. In the next two hours, the child should not be allowed to eat or drink.
Even if the removal was successful, the baby still needs to be shown to the dentist. This is the only way to protect your child from possible complications.
Why is it so scary
Whether wisdom teeth need to be treated or removed immediately is not easy to decide. They are inconvenient to treat either for patients or for dentists themselves. The former “run out of steam” in the chair, trying to open their mouths wider, while the latter must show all their dexterity in order to reach the problem tooth. A dentist can even cure a difficult tooth, but the gum pockets around the gums can constantly become clogged with food, then the “carious monsters” again attack the tooth and all efforts are in vain.
If pulpitis occurs, rarely will anyone undertake root canal treatment. Roots in the amount of up to 5 pieces, adhesions, shapes in the form of hooks and squiggles, will become an impenetrable labyrinth for any speleologist dentist.
So, having suffered and spent N amount of money, many come to the logical result - “Delete!”
But removal can be just as scary as treatment. According to studies, complications occur after removal in more than 50% of cases3. They are often successfully treated, but add sick days and discomfort.
After wisdom tooth removal, there is a high probability of encountering complications.
Features of the eighth teeth
Wisdom teeth close the row of teeth on both sides. A highly qualified dentist is able to reach them safely and treat them. This will take more effort and time, but saving the organ is quite possible.
The difficulty of treating the canals of premolars and molars is explained by the frequent curvature of tooth roots and canals, and in addition to the fact that the patient is simply not able to open his mouth wide enough to provide the doctor with direct access to the affected area. Select people react acutely to such deep touches and show a predisposition to develop a gag reflex. Therefore, the doctor does not always treat wisdom teeth efficiently, hence the high percentage of complications in the treatment of dental pulpitis.
A person, when coming to an appointment, must understand - after consulting a dentist - that the decision to save a tooth will have to be made independently. The doctor will invariably receive his earnings - either by performing therapy or by removing the organ. The main thing is that his intervention brings benefit to the patient.
Should I delete or not?
Yes. If diseases or complications have already arisen. Or the situation with 3 molars creates a high risk of diseases and their complications. Such cases include:
- lack of space in the dentition. Crowding – deformity – malocclusion;
- incorrect anatomical position (dystopia). The tooth grows towards the cheek, tongue, throat. May damage mucous membranes and cause ulceration;
- installation of braces to correct the bite. Freeing up space for other teeth;
- destruction of a neighboring tooth. As the tooth grows, it can damage the adjacent molar;
- problems with eruption (retention).
No. The teeth are healthy, there are no problems and no problems are expected.
Special attention. Long business trips, pregnancy, any situations that limit the possibility of providing medical care. Before these events, it is better to get advice and assess the risks, because treatment often requires surgery.
Patient reviews
Review 1
Before describing the procedure, I want to talk about my pain threshold. I can NOT stand pain. At all! I LOVE IT!!! For example, before treating caries, I ask you to give me 2 painkiller injections. And then one day my wisdom tooth began to hurt. I endured it steadfastly! But patience has come to an end! I had to go to the clinic.
Sitting down in a chair, I, as usual, asked for 2 injections and mentally prepared myself for torture :) Instead of somehow supporting and encouraging me, the doctor said: - Nahhh... but the tooth is in an inaccessible place! You can’t even get close to him!!!
Then she asked me to open it wider, then even wider, then again and again... It seemed to me that the corners of my mouth were already torn, and the doctor kept asking me to make my “mouth wider”! At the same time, she said, “What can I do here...” and tried to pick up the tooth with pliers.. These attempts lasted about 5 minutes. There was no particular pain, it was just unpleasant that the doctor could not pick up the tooth and was scared from waiting for the outcome. In the end, I asked: - Maybe I’ll go already?!!! If she can’t pick up a tooth, then WHAT will happen next?! To my deep surprise, the doctor did not even try to persuade me to stay and complete the procedure. She simply said: “Go!”
Well, wow :) This has never happened to me before. Usually doctors persuade: - Well, be patient... If you came, then you need to be patient. And here on you - go... I ask: - And what to do now? The answer was: “Nothing!” Rinse! And don't eat anything for 2 hours. And don't drink anything hot all day. - Why??? - Because the wound should heal. - So you REMOVED my tooth??? - Yes!
Just like that! While I was preparing for “medieval torture” and many hours of torment, the specialist did her job! BRAVO!!! I was delighted! After a couple of hours, the freezing sensation began to subside and the pain returned. She was tolerable, rinsing helped. After a few days the pain went away, but the wound healed for probably a whole month! The pain was weak and dull... The gums ached a little and as if something was pulling. But everything ended well! Everything is overgrown evenly.
Review 2
One of the four teeth had grown into the gum and began to rot there. Therefore, when I came to my favorite dentist, there was only one diagnosis - the wisdom tooth needed to be removed. I honestly couldn’t even get scared when I was already given anesthesia and the fragile dentist started pulling my tooth.
From the sensations, I can’t say that it hurt, no, the anesthesia worked well, but there was a feeling, I felt the tooth being taken with forceps, how it was being pulled, and I was even surprised how my fragile doctor pulled out this chunky tooth. He fought hard to get out, but for professionals there are no problems.
After this, of course, my gums bled a little, I was prescribed mouth rinses so that everything would heal faster. My gums healed within a day. I did not feel any discomfort due to the missing wisdom tooth.
Therefore, I can say for sure that the devil is not as scary as he is painted. Yes, it was unpleasant, but not painful and it could be tolerated. And if I have to remove the rest of my wisdom teeth, I won’t be the least bit upset or scared. Since there is nothing scary in this procedure.
Prevention
The right strategy, starting with teething, will help you worry less and reduce risks:
- Orthodontic consultation at a young age.
- The culture of brushing teeth using effective methods in hard-to-reach places, not only with a brush, but also:
- dental floss;
- irrigator;
- mono-beam brush.
- Preventive hygiene and examination
- Timely removal when problems are inevitable and it is better to prevent them than to treat the consequences.
The wisest decision regarding your health and wisdom teeth would be to visit a dentist in a timely manner. This will help protect you from problems and, most importantly, from consequences.
Literature:
- Iordanishvili A.K., Korovin N.V., Serikov A.A. ANATOMIC AND TOPOMETRIC CHARACTERISTICS OF THE JAWS DURING EARTHING AND RETENTION OF WISDOM TEETH // Problems of Dentistry 2021 No. 3.
- Iordanishvili A.K., Korovin N.V. et al. AGE FEATURES OF WISDOM TEETH DISEASES//Kursk Scientific and Practical Bulletin “Man and His Health” 2015 No. 4.
- Iordanishvili A.K., Korovin N.V. et al. COMPLICATIONS AFTER REMOVAL OF WISDOM TEETH AND THEIR TREATMENT//Kursk Scientific and Practical Bulletin “Man and His Health” 2021 No. 4.
Myth No. 1. Wisdom tooth removal is a difficult and painful procedure.
Let's start in order. Third molars do have a number of features. The anatomical structure of the tooth itself may be different. For example, one person's tooth will have four roots diverging to the sides, while another person will have only one straight root. In addition, the position of the tooth in the jaw is of great importance. The tooth can be located in the dental arch or located far beyond it (such a tooth is called dystopic). It can also be located inside the jaw (be impacted or impacted). Therefore, before proceeding with the removal, the dental surgeon will carefully study your X-ray image and think over the surgical technique. I hasten to reassure patients, there is a lot of domestic and foreign literature on this issue. Methods for removing teeth have long been developed and described depending on their structure and position. World experience (and my personal one) show that the effectiveness of this manipulation is 100%. The 7 Doctors clinic employs professional, experienced doctors. No matter how difficult the removal may seem to you, the success of this procedure is guaranteed.
So, we have sorted out the question that a tooth will be removed regardless of the “complexity” of its structure and/or position. But how will the patient feel during the operation, will he experience pain?
The answer is no, it won't hurt. Modern drugs used for local anesthesia in dentistry make it possible to completely reversibly (during the operation) turn off pain sensitivity. The sensitivity of the surrounding tissues (in the area where the operation is not performed) is preserved, so the patient will feel the touch of the doctor’s hands, some pressure on the surrounding tissues, but no more.
In some cases, when the fear of the procedure is so great that a person cannot cope with it, we recommend contacting a psychotherapist. A specialist will help you get rid of this problem, and you will be able to continue treatment in a comfortable environment. However, there is an alternative: tooth extraction under anesthesia. This option is also used if the patient has contraindications to local anesthesia (for example, an allergic reaction to local anesthetics).
In any case, there is a way out. Our clinic employs a team of professionals from various specialties. Doctors at the multidisciplinary clinic “7 Doctors” will always find an individual approach to solving your problem.
Difficult removal
Such an operation is considered difficult when the upper molar has to be extracted in parts with an incision in the gum and sawing of the crown. The procedure occurs in stages:
- X-ray or CT scan;
- gum pain relief. In case of a complex clinical picture, it is possible to perform the operation under general anesthesia;
- dissection of the gum is performed to open access to the crown;
- the surgeon pulls out the molar. It is often necessary to first remove the crown with a drill to ensure free access to the roots;
- the hole is carefully checked for the presence or absence of bone fragments.
In cases of bone resection, the hole is filled with special bone chips, which subsequently form new bone tissue.
Since the operation is complex, the rehabilitation period is longer and can last for several weeks.
