MUDr. Brokešová: Removal of “wisdom tooth” (“eight”)

smile will say it for you

MUDr. Viktória BrokešováTo a very frequent and sometimes feared surgery belongs the extraction of “eight”. Third molars grow into the dental arch in an adult (18 to 24 years of age).  But the tooth may grow in the oral cavity even at a later age. Expert opinion on the removal of third molar varies considerably depending on the overall health of the patient, the patient’s age and specific diagnosis as well as the expertise and experience of the dentist / dental surgeon. It is always necessary to consider the personality of the individual patient and their current needs. Therefore, it is difficult to strictly define the boundaries for the decision to remove “eight”. The decision must be implemented individually. For these above mentioned reasons, the patient may receive different recommendations from different dentists.

Simply we can say that the removal of third molars is physically better tolerate by younger patients (17-22 years). Procedures at a younger age usually takes less time because tooth roots are not yet fully developed in length and jaw bones are more flexible. Therefore, removal elaborately placed “eight” can be performed easily. With increasing age there are changes in tissue that partially increases the potential of complications (e.g. wrap of the roots, worse healing). Specific situations is always individual. The first option of preventive surgical removal of wisdom teeth is 15years of age.

The most common reasons for extraction of third molar (wisdom tooth)

  • PRECAUTIONARY REASONS

Soft diet of modern times requires fewer mechanical processing of food by chewing. As a result of gradual changes in diet it occurs to decrease the length of the human jaws and thus reducing the space for pruning “the eight”. Partial pruning of  “the eight” in the oral cavity, where the tooth leans against the adjacent „seven“ over a long period, significantly increases the risk of caries of both teeth. Due to poor clean ability gradually become inflamed gums, eventually to the development of caries itself “eights” or even neighboring “sevens”.  Mouth washes, pastes, douches or showers do not replace the mechanical cleaning of the tooth surface therefore they can slow the process, but not completely prevent the tooth decay

Since in this case the decay is almost always located in the root portion of both tooth, despite the early discovery of the caries, the treatment is usually technically not possible. For this reason, both teeth must be often extracted!

The process of the development of both teeth decay is usually unnoticed for years and does not make a person any subjective difficulties! Put simply: the patient does not see or feel anything significant. Since the “eight” is in a pathological status, together with the adjacent tooth the situation is difficult to solve. Therefore, in this particular case it doesn’t help even if the patient goes for regular preventive dental examination with X-ray of teeth. Because the state is painless for years and the patients have a natural fear of the recommended surgery, they often put off a decision on the removal of eight at a time when they needlessly loose an adjacent tooth. If the patient tolerates the long term clearly unsatisfactory anatomical situation, he must reckon with this eventuality.

  • ORTHODONTIC REASONS– we recommend  the removal of eights unequivocally before placing the fixed orthodontic apparatus  – before putting the braces on.
  • CURING OF THE PERIODONTITIS.  The plaque bacteria maintaining a long time in the vicinity of the third molar gums promotes the development of periodontitis, which leads to loss of teeth.
  • REMOVING “EIGHT” FOR REASON OF EXTENSIVE CARIES OF “EIGHT”, INFLAMMATION OF DENTAL NERVE, DEVELOPMENT PERIAPICAL DISCOVERY OR CYST BEHIND TOOTH
  • EXTRACTION OF “EIGHT” PRIOR TO MAKING NEW PROSTHETIC WORK, IN PARTICULAR ON THE ADJACENT TEETH (CONSTRUCTION OF A NEW CROWNS AND BRIDGES). Subsequent removal of “eights” after deployment of the lab crown can lead to irreversible damage to the new dentures or release of it (peel off). Repeated fixation of prostheses on teeth reduces their lifespan.
  • HYGIENIC ASPECTS – HALITOSIS.  Hygiene in the area of third molar is usually difficult, this space could be responsible for the odor from the mouth.
  • UN-FUNCTIONALITY.  “Eight” in the upper jaw without a possibility of the connection with “eight” in the opposite dental arch of the lower jaw does not fulfill the chewing function.  Over the years the teeth without opposite load slowly slides out from jaw bed and gradually cause impossibility to clean the back side of the “sevens”. Again it leads to the risk of caries “sevens” and the risk of its extraction.

Patients often have a fear of ‘loosening’ teeth and the visible gaps between the teeth after removal of “the eights”. But in full dental arch this condition doesn’t occur.

If “the eight” correctly prunes into the oral cavity, does not cause any problems, and the patient sufficiently takes care of dental hygiene, its extraction is not necessary. Rarely there may be situations where we recommend to keep the “the eight” affected by caries or inflammation, the tooth is treated and we provide also endodontic root canal treatment.

Due to the wide individuality of each case it is suitable for the planned dental surgery to arrange prior consultation of the situation. Each dentist bears its own responsibility for the treatment and therefore cannot perform surgery in the opinion of another expert.

Generally, you can also say that to deal with the removal of third molar at a time of acute problems and severe pain leads to a risk that extraction can be uncomfortable for the patient and especially more painful. In these cases, the effect of local anesthetics is biologically limited by the inflammation. Therefore, we recommend that patients deal with the removal of wisdom teeth, especially in their own interest as early as possible.

MUDr. Viktória Brokešová/Gajdošová

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