Tuesday, December 14, 2010

* Wisdom Tooth *

Hi alls!!!
Since these last few days I was suffered with the wisdom tooth problem, today I would like to share some info that I get from the internet....I believe many of us got wisdom tooth, who's doesn't please carefull with your wisdom...Hahaha, please ignore!!! I'm just joking...=P

A wisdom tooth, in humans, is any of the usually four third molars, including mandibular third molar and maxillary third molar. Wisdom teeth usually appear between the ages of 17 and 25.[1] Most adults have four wisdom teeth, but it is possible to have more, in which case they are called supernumerary teeth. Wisdom teeth commonly affect other teeth as they develop, becoming impacted or "coming in sideways". They are often extracted when this occurs.
Impaction
The upper left and upper right wisdom tooth are distoangularly impacted. The lower left wisdom tooth is horizontally impacted. The lower right wisdom tooth is vertically impacted .Impacted wisdom teeth fall into one of several categories:
Mesioangular impaction is the most common form (44%), and means the tooth is angled forward, towards the front of the mouth.
Vertical impaction (38%) occurs when the formed tooth does not erupt fully through the gum line.
Distoangular impaction (6%) means the tooth is angled backward, towards the rear of the mouth.
Horizontal impaction (3%) is the least common form, which occurs when the tooth is angled fully ninety degrees sideways, growing into the roots of the second molar.[citation needed]

Typically mesioangular impactions are the most difficult to extract in the maxilla and easiest to extract in the mandible, while distoangular impactions are the easiest to extract in the maxilla and most difficult to extract in the mandible. Frequently, a fully erupted upper wisdom tooth requires bone removal if the tooth does not yield easily to forceps or elevators. Failure to remove distal or buccal bone while removing one of these teeth can cause the entire maxillary tuberosity to be fractured off, thereby tearing out the floor of the maxillary sinus.[citation needed]

Impacted wisdom teeth may also be categorized on whether they are still completely encased in the jawbone. If it is completely encased in the jawbone, it is a bony impaction. If the wisdom tooth has erupted out of the jawbone but not through the gumline, it is called a soft tissue impaction.

In a small portion of patients, cysts and tumors occur around impacted wisdom teeth, requiring surgical extraction. Estimates of the incidence of cysts around impacted teeth vary from 0.001% to 11%, with a higher incidence in older patients, suggesting that the chance of a cyst or tumor increases the longer an impaction exists. Only 1-2% of impactions result in malignant tumors.[2]
The oldest known impacted wisdom tooth belonged to a European woman of the Magdalenian period (18,000 - 10,000 BC).[3]

Partial eruption
Sometimes the wisdom tooth fails to erupt completely through the gum bed and the gum at the back of the wisdom tooth extends over the biting surface, forming a soft tissue flap or lid around the tooth called an operculum. Teeth covered by an operculum can be difficult to clean with a toothbrush. Additional cleaning techniques can include using a needle-less plastic syringe to vigorously wash the tooth with moderately pressured water or to softly wash it with hydrogen peroxide.

However, debris and bacteria can easily accumulate under an operculum, which may cause pericoronitis, a common infection problem in young adults with partial impactions that is often exacerbated by occlusion with opposing third or second molars. Common symptoms include a swelling and redness of the gum around the eruption site, difficulty in opening the mouth, a bad odor or taste in the mouth, and pain in the general area which may also run down the entire lower jaw or possibly the neck. Untreated pericoronitis can progress to a much more severe infection.

If the operculum does not disappear, recommended treatment is extraction of the wisdom tooth. An alternative treatment involving removal of the operculum, called operculectomy, has been advocated. There is a high risk of permanent or temporary numbness of the tongue due to damage of the nerve with this treatment and it is no longer recommended as a standard treatment in oral surgery.

 Extraction
A wisdom tooth protrudes outwards from the gumline at the back of the lower teeth.
A dental officer and his assistant remove the mandibular third molar of a patient.
An extracted mandibular third molar that was horizontally impacted.
An upper and lower right wisdom tooth extracted during the same session under local anesthetics.Main article: Dental extraction

Wisdom teeth are extracted for two general reasons: either the wisdom teeth have already become impacted, or the wisdom teeth could potentially become problematic if not extracted. Potential problems caused by the presence of properly grown-in wisdom teeth include infections caused by food particles easily trapped in the jaw area behind the wisdom teeth where regular brushing and flossing is difficult and ineffective. Such infections may be frequent, and cause considerable pain and medical danger. Other reasons wisdom teeth are removed include misalignment which rubs up against the tongue or cheek causing pain, potential crowding or malocclusion of the remaining teeth (a result of there being not enough room on the jaw or in the mouth), as well as orthodontics.[4]

 Post-extraction problems
There are several problems that might occur after the extraction(s) have been completed. Some of these problems are unavoidable and natural, while others are under the control of the patient. The suggestions contained in the sections below are general guidelines that a patient will be expected to abide by, but the patient should follow all directions that are given by the surgeon in addition to the following guidelines. Above all, the patient must not disregard the given instructions; doing so is extremely dangerous and could result in any number of problems ranging in severity from being merely inconvenient (dry socket) to potentially life-threatening (serious infection of the extraction sites).
Cyst around right lower wisdom tooth.

Bleeding and oozing
Bleeding and oozing is inevitable and should be expected to last up to three days (although by day three it should be less noticeable). Rinsing the mouth during this period is counter-productive, as the bleeding stops when the blood forms clots at the extraction sites, and rinsing out the mouth will most likely dislodge the clots. The end result will be a delay in healing time and a prolonged period of bleeding. Gauze pads should be placed at the extraction sites, and then should be bitten down on with firm and even pressure. This will help to stop the bleeding, but should not be overdone as it is possible to irritate the extraction sites and prolong the bleeding or remove the clot. The bleeding should decrease gradually and noticeably upon changing the gauze. If the bleeding lasts for more than a day without decreasing despite having followed the surgeon's directions, the surgeon should be contacted as soon as possible. This is not supposed to happen under normal circumstances and signals that a serious problem is present. A wet tea bag can replace the gauze pads. Tannin contained in tea can help reduce the bleeding.[5]

Due to the blood clots that form in the exposed sockets as well as the abundant bacterial flora in the mouth, an offensive smell may be noticeable a short time after surgery. The persistent odor often is accompanied by an equally rancid-tasting fluid seeping from the wounds. These symptoms will diminish over an indeterminate amount of time, although one to two weeks is normal. While not a cause for great concern, a post-operative appointment with one's surgeon seven to ten days after surgery is highly recommended to make sure that the healing process has no complications and that the wounds are relatively clean. If infection does enter the socket, a qualified dental professional can gently plunge a plastic syringe (without the hypodermic needle) full of a mixture of equal parts hydrogen peroxide and water or chlorohexidine gluconate, which also comes in the form of a mouth wash, into the sockets to remove any food or bacteria that may collect in the back of the mouth. This is less likely if the person has his/her wisdom teeth removed at an early age.

Dry socket
Main article: Alveolar osteitis
A dry socket is a painful inflammation[dubious – discuss] of the alveolar bone (not an infection); it occurs when the blood clots at an extraction site are dislodged, fall out prematurely, or fail to form. It is still not known how they form or why they form. In some cases, this is beyond the control of the patient. However, in other cases this happens because the patient has disregarded the instructions given by the surgeon. Smoking, blowing one's nose, spitting, or drinking with a straw in disregard to the surgeon's instructions can cause this, along with other activities that change the pressure inside of the mouth, such as sneezing or playing a musical instrument. The risk of developing a dry socket is greater in smokers, in diabetics, if the patient has had a previous dry socket, in the lower jaw, and following complicated extractions. The extraction site will become irritated and painful, due to inflammation of the bone lining the tooth socket (osteitis). The symptoms are made worse when food debris is trapped in the tooth socket. The patient should contact their surgeon if they suspect that they have a case of dry socket. The surgeon may elect to clean the socket under local anesthetic to cause another blood clot to form or prescribe medication in topical form (e.g. Alvogel) to apply to the affected site. A non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen may be prescribed by the surgeon for pain relief. Generally dry sockets are self limiting and heal in a couple of weeks without treatment.

Swelling
Swelling should not be confused with dry socket, although painful swelling should be expected and is a sign that the healing process is progressing normally. There is no general duration for this problem; the severity and duration of the swelling vary from case to case. The surgeon will tell the patient how long they should expect swelling to last, including when to expect the swelling to peak and when the swelling will start to subside. If the swelling does not begin to subside when it is supposed to, the patient should contact his or her surgeon immediately. While the swelling will generally not disappear completely for several days after it peaks, swelling that does not begin to subside or gets worse may be an indication of infection. Swelling that re-appears after a few weeks is an indication of infection caused by a bone or tooth fragment still in the wound and should be treated immediately.

Nerve injury
Mandibular division of trigeminal nerve, seen from the middle line.Nerve injury is primarily an issue with extraction of third molars, but can occur with the extraction of any tooth should the nerve be near the surgical site. Two nerves are typically of concern and are found in duplicate (on the left and right side):

The inferior alveolar nerve, which enters the mandible at the mandibular foramen and exits the mandible at the sides of the chin from the mental foramen. This nerve supplies sensation to the lower teeth on the right or left half of the dental arch, as well as sense of touch to the right or left half of the chin and lower lip.

The lingual nerve, which branches off the mandibular branches of the trigeminal nerve and courses just inside the jaw bone, entering the tongue and supplying sense of touch and taste to the right and left half of the anterior 2/3 of the tongue as well as the lingual gingiva (i.e. the gums on the inside surface of the dental arch).

Such injuries can occur while lifting teeth (typically the inferior alveolar) but are most commonly caused by inadvertent damage with a surgical drill. Such injuries are rare and are usually temporary.[6] Depending on the type of injury (i.e. Seddon classification: neuropraxia, axonotmesis, and neurotmesis) they can be prolonged or permanent.

Treatment controversy
Preventive removal of the third molars is a common practice in developed countries and is usually recommended by dentists. According to Pediatric Dentistry: Infancy Through Adolescence, 4th Edition:

Evaluation of third molars is usually completed during mid- to late adolescence. Parents commonly ask about treating these teeth. The reasons for extraction of third molars include impaction or failure to erupt; potential or existing pathosis such as cysts or ameloblastoma; decay; posteruption malposition; nonfunction as a result of an absent opposing tooth; difficulty with hygiene; and recurrent pericoronitis. If any of these are considerations, third molars should be removed during adolescence.... The evaluation of developing third molars in adolescent athletes is of particular importance. Not only can an athletic season suddenly be interrupted by the annoying and often painful eruption of third molars with associated acute pericoronitis, but mandibular fractures in the gonial angle region of developing third molars can also occur in adolescent athletes.[4]

Several dental textbooks encourage the removal of third molars. From Contemporary Oral and Maxillofacial Surgery, 5th Edition:

As a general rule, all impacted teeth should be removed unless removal is contraindicated. Extraction should be performed as soon as the dentist determines that the tooth is impacted. Removal of impacted teeth becomes more difficult with advancing age. The dentist should typically not recommend that impacted teeth be left in place until they cause difficulty. If the tooth is left in place until problems arise, the patient may experience an increased incidence of local tissue morbidity, loss of or damage to adjacent teeth and bone, and potential injury to adjacent vital structures. Additionally, if removal of impacted teeth is deferred until they cause problems later in life, surgery is more likely to be complicated and hazardous because the patient may have compromising systemic diseases and the surrounding bone becomes more dense. A fundamental precept of the philosophy of dentistry is that problems should be prevented. Preventive dentistry dictates that impacted teeth are to be removed before complications arise unless removal will cause more serious problems.[7]

The rationale of prophetically removing third molars prior to their complete root formation is that the likelihood of nerve damage or other complications is extremely low. This is not the case however with symptomatic removal of a third molar after root formation is complete and more intimate with the inferior alveolar nerve and as the mandible becomes more dense with age.[8]

However, studies have shown that dentists graduated from different countries—or even from different dental schools in the same country[9]—may have different clinical decisions regarding third molar removal for the same clinical condition. For example, dentists graduated from Israeli dental schools may recommend more often for the removal of asymptomatic impacted third molar than dentists graduated from Latin-American or Eastern European dental schools.[10]

# Got problem and have pain with our teeth & mouth is one of the worst pain in the world...I don't know how about others opinion..

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