The third molars, commonly known as the wisdom teeth, are often impacted in the mandible due to the lack of jaw arch length. Oral hygiene around the wisdom teeth has proven to be extremely difficult, and is often associated with acute flareups of gum infections.
Pericoronitis is a condition when there is acute infection of the gum around a partially erupted mandibular wisdom tooth. This condition can be debilitating and is often the primary reason for individuals to present at an emergency appointment.
At the consultation, a panoramic view x-ray or Cone-beam computed tomography (CBCT) is taken to assess the severity of the impaction. The proximity of the wisdom teeth to the neighboring vital structures can be assessed to predict the risks of complications post operatively. The extraction of wisdom teeth almost always requires surgical removal.
Just like any teeth in the dentition, the minerals on the wisdom tooth structure are susceptible to the decay process if oral hygiene is compromised. Acute dental pain can arise when the decay has invaded into the nerve. When this happens, local anesthetic may not be very effective and the removable of wisdom teeth may need to be delayed.
In some cases, wisdom teeth can impact against the back of second molars resulting in dental decay or resorption. The affected second molar may be removed to allow eruption of the wisdom tooth into position. If the wisdom tooth are in an extreme angulation or decayed, both will require extraction, weakening the entire oral function and occlusion.
The maxillary wisdom teeth face the same fate when the oral hygiene is not up to par. If the maxillary wisdom tooth is extracted before the roots are fully formed, there is less likely for the sinus floor to be perforated during the removal process. A perforated sinus lining can lead to chronic sinusitis, with chances of occasional acute sinus infection. Elective extraction of the maxillary wisdom teeth is often done at the same visit as the extraction of the mandibular wisdom teeth. Without the opposing occlusion, the upper wisdom teeth are dangling like a ticking time bomb, descending freely down until it hits the mandible. This traumatic relationship will warrant another session for its removal from the oral cavity.
Wisdom teeth removal is best done at a younger age when it comes to risks and post-operative recovery speed. The roots of wisdom teeth are still forming in teenagers and the removal procedure will less likely cause trauma to the adjacent vital structures.