Impacted wisdom teeth and their removal (when they cannot erupt). Eruption of a wisdom tooth Eruption of a wisdom tooth: possible pathologies of eruption

What are impacted teeth and what, in fact, is the essence of the problem with them;
For what reasons are wisdom teeth often unable to erupt normally and how long can this situation last?
Should the impacted tooth be removed, or perhaps it is better to preserve it and the problem will somehow “resolve” by itself;
Characteristic symptoms that are usually observed with tooth impaction;
How impacted wisdom teeth are removed - the sequence of actions of a dental surgeon;
What can await you after the operation (including in cases where the removal was difficult);
And finally, what should you do if serious complications suddenly arise...

A general idea of what an impacted tooth is can be obtained by taking into account that the word “retention” (retentio) translated from Latin language means "containment", "delay" or "hold". So, when they talk about an impacted wisdom tooth, we are talking, first of all, about a delay in the eruption of the tooth or about a disruption in the process of its eruption.

Simply put, an impacted wisdom tooth is an eighth tooth that has formed but has not broken through the bone tissue of the jaw or gum.

The photo below clearly shows that an impacted wisdom tooth is literally hidden in the gum:

On a note

It's not just wisdom teeth that can be impacted. For example, both upper canines and lower premolars (small molars) can “get stuck” in the bone or gum. But still, it is the eighth teeth that most often turn out to be impacted.

Here it is necessary to clarify some nuances. In particular, can such retention be called an eruption anomaly? If we talk about wisdom teeth, their failure to erupt before age 25 in the absence of corresponding problems generally cannot be considered an anomaly. Later - formally it is already possible, since after 25 years of age, normally (for most people) eights still erupt.

Can partial eruption of the eighth tooth be called retention? When a wisdom tooth appears from under the gums with one or two cusps, it is considered that it is no longer an impacted tooth, but a semi-impacted one. This semi-retention has its own characteristics and sometimes brings much more trouble than the retention itself - we’ll talk about this a little later.

If a tooth is impacted, this does not mean that it will necessarily need to be removed. For example, there are many examples when the eighth tooth, which had been “dormant” for years, suddenly became active and literally in a matter of months safely took its rightful place in the dentition.

However, quite often, impacted teeth still create serious problems, which can have a detrimental effect not only on dental system, but also throughout the body...

Why wisdom teeth cannot erupt and how long does it take for this to happen?

Sometimes a wisdom tooth does not erupt for more than a year, causing significant discomfort, while there are cases of completely painless and rapid eruption. Experts are still arguing about why wisdom teeth in some cases cannot erupt normally.

On a note

Wisdom teeth are considered to be rudimentary formations (for example, like the coccyx, which is a vestige of the tail). According to the theory, when primitive man ate rough food, without proper heat treatment, this required significant chewing efforts from the jaws and teeth. The last teeth (wisdom) relieved the end part of the jaw, significantly improving the situation in terms of chewing efficiency.

Today, people do not need to chew bones and eat raw meat from a freshly killed animal, which is why it is believed that evolution is doing its job: if wisdom teeth are almost no longer needed for chewing, then why leave room for them in the jaw? The evolutionary point of view indicates that over the past long period of time, the human jaw has narrowed significantly, become more compact and no longer so capacious, which creates its own difficulties when eights try to cut through.

The reasons predisposing to tooth impaction include the following:

early loss or removal of baby teeth;
genetic (hereditary) factor;
supernumerary teeth;
poor child nutrition;
past rickets and some infectious diseases.

...And others. In some cases, these factors may well turn a normal tooth germ into an impacted tooth.

Normally, the timing of the onset of wisdom teeth eruption is 14-25 years. Of course, eights can “climb” a little earlier or much later, but the most important thing is that this process should be comfortable. If the wisdom tooth is in an adult long time continues to exist in the bone, under the gum, then it would not hurt to check its condition (on an x-ray you can see how it is located in the jaw and whether problems can be expected in the future).

Below is an example of a wisdom tooth positioned horizontally in the jaw:

It should be borne in mind that some people may completely lack the rudiments of the upper and (or) lower wisdom teeth (according to some data, this is typical for more than 10% of the planet's inhabitants). Accordingly, in this case, the eights will never erupt and will not be disturbed throughout their lives.

Feedback from a dental surgeon:

“Personally, I do not have the rudiments of 2 upper wisdom teeth, but at the age of 18 the two lower eighths fully erupted. The absence of upper wise teeth was discovered by chance, after computed tomography associated with ENT disease. It was possible to examine the photograph in detail. Almost immediately it became clear that there were no rudiments of upper wisdom teeth, which means we should never expect them to appear on the surface.

Svyatoslav, Samara

When the rudiment of a wisdom tooth is still present, a completely logical question arises: won’t the 7 interfere with the normal eruption of the eighth? Such fears are not unfounded, since it is the seven that most often prevents the appearance of a wisdom tooth, creating the preconditions for its retention.

Should the impacted tooth be removed or is it perhaps better to preserve it?

It is quite understandable that few people would want to have a tooth removed, even if it cannot erupt and the gums and jaw constantly hurt because of it. And how nice it would be if the problem somehow “resolved” by itself over time.

Is this possible, and is it possible to do nothing at all if you have problems with an impacted tooth without harming your health?

Well, there is no universal answer here: in each case, the decision about the need to remove a tooth must be made individually.

In the simplest case - if a person has no complaints, as well as correct location wisdom tooth in the jaw (from the picture) - there is no point in removing it. If a wisdom tooth erupts for a long time (does not show from the gums), then this is its “right”, and it is almost impossible to speed up this process.

Now let's look at the cases in which it is highly likely that an impacted tooth will have to be removed. Let's look at situations related only to wisdom tooth retention, without touching on semi-retention for now.

So, today the removal of impacted wisdom teeth is recommended for:

Constant pain;
Pronounced inflammatory phenomena;
The location of the tooth in the follicular cyst;
Inability to provide high-quality orthodontic treatment;
Incorrect position of the tooth in relation to the jaw and (or) neighboring tooth (strong tilt towards the 7th tooth, location partially under it, rotation of the wisdom tooth, upside down position, etc.).

In practice, the situation is usually such that in most cases an impacted tooth will have to be removed in case of a follicular cyst, serious anomalies of location, purulent inflammatory processes (periostitis, abscess, phlegmon, osteomyelitis, odontogenic sinusitis, lymphadenitis) and when correcting the bite. However, the last word always belongs to the dentist, since it is he who is responsible, as a doctor, for the life and health of each patient.

Feedback from a dental surgeon:

“A large group of maxillofacial surgeons are against experiments with waiting for weather by the sea: it is better to remove before any of the impacted teeth ruin the holiday. In general, these guys know what they are talking about: I saw such unfortunate people at my appointments, and I even operated on one of them myself at the age of 55. I took the risk of taking it from myself emergency care, but something didn’t grow together: after 3 hours of work, the roots did not give in either after they were separated with a drill or with the help of a set of elevators. As a result, he sent me to the city, and there, instead of cutting out the patient’s roots, a professor from the Department of Maxillofacial Surgery with students chiselled it with a chisel for about an hour.

But the reason for the arrival of this difficult patient (my good friend) - began inflammatory process in the gum near the projection of the wisdom tooth, although all the teeth on this side were removed long ago. All, but not all: the left lower wisdom tooth did not erupt until the age of 55, and would not have appeared on its own - it’s just that this eighth one, lying horizontally in the jaw, decided to arrange for the patient’s “Kuzka’s mother” to retire. It turned out something like pericoronitis, but there was purulent swelling in the gum with the appearance of a fistula, through which the pus was evacuated when pressed. If there had been no outflow of pus, then perhaps his life would have been saved much earlier. It goes without saying that he recovered from the operation for about a month. That is, about 4 weeks after the professor’s surgery, he began to talk normally, open his mouth and eat, but this is not because the professor and I tried so hard: we just really came across a complex impacted tooth, which turned out to be involved in a purulent inflammatory process.”

Symptoms of difficult wisdom tooth eruption

Impacted wisdom teeth can remain in the jaw for a very long time without any symptoms. In the future, everything depends on the criteria described above: if the tooth does not encounter any obstacles on its way, then it safely occupies its normal place at the end of the dentition.

On a note

Normally, in the absence of complicating factors, the wisdom tooth erupts within 2-3 months, and in severe cases the process may well drag on for 1-2 years. Moreover, if something interferes with the number eight, it can stop its “stroke”: it is no coincidence that many patient reviews say that their wisdom tooth appears to have erupted in several stages.

Often, long before the figure eight appears on the surface, unpleasant symptoms may arise that make a person think about possible removal impacted tooth.

For example, when close nerve fibers To the wisdom tooth, located in the thickness of the jaw bone, they may be compressed, which provokes neuritis or neuralgia - severe pain, which often radiates along the branches of the trigeminal nerve.

In addition, tooth retention can give rise to the appearance of follicular cysts around it, which, increasing in size from year to year, can become a source of serious complications (osteomyelitis, phlegmon, etc.). At acute forms the body temperature rises to high values, and the patient’s condition as a whole can be very serious.

Often, against the background of the inflammatory process, severe swelling is observed in the area of the impacted tooth. Disturbance of facial symmetry coupled with pain and high temperature They make it quite clear that something serious is happening, requiring urgent intervention from a medical specialist.

Now let's assume that the eighth tooth has overcome the bone barrier, and part of its crown has already come out of the gum. At first glance, it may seem that the most difficult thing is over - the tooth has almost erupted, just a little remains. However, in reality, things may not be so rosy.

The photo below shows an example of a semi-impacted wisdom tooth:

Often, food particles and bacteria accumulate under the gingival hood, causing an inflammatory process - pericoronitis. When purulent exudate forms under the gum, symptoms appear that prevent normal life person: swelling in the area of the wisdom tooth, unsatisfactory general condition, fever up to 38-39°C, inability to chew or even open the mouth normally, severe pain, often pulsating and radiating to various parts of the face.

With such symptoms, it is quite understandable that a person wants to immediately remove a semi-impacted tooth and not suffer further. However, in such a situation, there is still a way to help the wisdom tooth erupt without resorting to the last resort - removal. We are talking about excision of the gingival hood.

On a note

There are still many supporters of the method of excision of the hood over a wisdom tooth that has partially erupted. This procedure is most often carried out much faster than removal surgery: anesthesia is given, the overgrown gum is excised with a scalpel, a hemostatic tampon is placed - about 10 minutes for the entire procedure.

However, it also happens that this method, especially if the wisdom tooth is unable to take its place in the row even after excision of the hood, provokes the risks of further complications. Sometimes the hood has to be excised multiple times. That is why opponents of this method suggest immediately removing wisdom teeth if eruption is difficult.

How are impacted wisdom teeth removed and how long can it take?

If removal of an impacted tooth is unavoidable (swollen cheek, severe pain, orthodontic treatment), then a dental surgeon gets down to business.

Let's look at how all this usually happens in practice and, in particular, answer the following burning questions:

Will I have to endure severe pain?
How long does a complex removal usually take?
Will they cut the gum and saw through the bone?
Will there be stitches, or can I do without them?

Let's start with pain relief. Most often, removal of impacted and semi-impacted teeth is carried out under local anesthesia, that is, the person is fully conscious, but the area of surgical intervention does not feel or almost does not feel.

It should be borne in mind that some people “freeze” without problems, while others have to experience for themselves, to one degree or another, what ineffective anesthesia is. And how would dental clinics They didn’t advertise in advertising that all their tooth extraction procedures are carried out absolutely without pain, but let’s be honest – painless removal is the result of many factors, among which the leading role is played by the following:

Doctor's professionalism;
Anesthetic quality;
Patient's condition.

If the dentist is experienced enough, organizes his work correctly and follows the anesthesia technique, then in almost 95% of cases the success of pain relief is guaranteed. Knowing the properties of anesthetics and knowing how to work with them, you can even use an inexpensive domestic drug to provide high-quality anesthesia (another issue is that this may be associated with additional time costs and increased risk adverse reactions, while the choice of imported anesthesia suitable for a given clinical case usually accelerates the onset of persistent “freezing”).

The patient’s condition also plays an equally important role: for example, the presence of alcohol in the blood and severe fear can seriously worsen the conditions of anesthesia - anyone who is going to have a tooth removed (not just an impacted one) should know about this.

Removing (“pulling”) an impacted wisdom tooth can take an average of 10-15 minutes to 2-3 hours.

As for the process of removing the impacted figure eight itself, it usually consists of the following steps:

Preliminary preparation (instructing the patient, removing dental plaque, antiseptic treatment of the gums, etc.);
Local anesthesia (although some clinics may also offer general anesthesia, that is, anesthesia);
Creating access to an impacted tooth (incision of the gum with a scalpel, removal of bone tissue with cutters with cooling. In some clinics a laser scalpel may be used);
Extracting a wisdom tooth using elevators, or sawing it into pieces with burs and gradually removing each piece. Do not be afraid of sawing a tooth out of the jaw, as this almost always speeds up the work by 2-3 times and allows you to achieve the desired result in less time. positive result. Compared to sawing, gouging out an impacted tooth with a chisel is much more unpleasant;
Hemostasis (stopping bleeding). After removal, preparations based on artificial bone (wound plastic), a hemostatic sponge or turundas with an anti-inflammatory, analgesic and antiseptic agent can be placed in the hole after removal.

Sometimes, to ensure successful healing of the wound after removing an impacted wisdom tooth, sutures are placed. In most cases, sutures play a positive therapeutic and prophylactic role, reducing the lumen of the wound and creating a barrier for food and infection to penetrate into the hole.

On a note

Self-absorbing sutures are more expensive than regular ones, but there is no need to contact the dentist again to remove them.

As for bleeding during and after tooth extraction, it is usually mild and goes away quickly. The fact is that adrenaline is specially added to modern anesthetics, which tends to constrict blood vessels, after which it is convenient for the dental surgeon to carry out even complex removal of an impacted tooth, since very little blood is lost.

What awaits you after the operation, especially if the tooth extraction was difficult

After removing any tooth (not just impacted ones), a professional doctor provides the patient with a reminder (most often written) so that all necessary recommendations after the operation are followed.

Typically, the dentist emphasizes that after removal the following are possible:

Painful sensations;
Edema;
Increase in temperature (protective reaction of the body);
Chewing disorders;
Difficulty opening the mouth;
Slight bleeding from the socket;
Temporary loss of ability to work.

Here is an example of such a reminder:

That is why the patient’s instructions include a list of actions and medications to prevent complications. For example, to avoid postoperative swelling, a cold compress should be applied according to a special scheme within 24 hours after removal. To eliminate the risk of infectious complications, the doctor may prescribe antibiotics.

To create a certain level of wound hygiene, special sprays, gels and ointments can be used for topical use.

The possibility of taking painkillers is also obvious: in order not to suffer from severe pain for 1-3 days after surgery, analgesics may be required.

Question 1. What to do if a huge bruise appears on your face after removing an impacted wisdom tooth?

The appearance of a hematoma on the skin in the area of an extracted wisdom tooth is a rare but natural phenomenon. Most often occurs in patients who suffer arterial hypertension. Post-traumatic swelling turns into a “bruise”, which without additional intervention becomes yellow and disappears without a trace.

Question 2. Why did the lip and chin become numb after surgery to remove the lower wisdom tooth?

Since the impacted tooth is often close to the one passing through the thickness lower jaw mandibular nerve, then after its removal temporary numbness (paresthesia) may occur, which is most often associated with compression of the nerve fibers, and less often with their damage. Restoring sensation may take several weeks to several months. Physiotherapy prescribed by a doctor can speed up the process.

Patient review:

“6 days ago I removed the impacted figure eight from below. A woman surgeon with extensive experience removed it. The anesthesia was normal and lasted a long time. The eight had crooked roots, so it had to be cut out. I already deleted the eight, but from above. As usual, there was a slight swelling of the cheek. I waited until nightfall for the frost to go away, got tired, and fell asleep without my hind legs. The next morning, the left side of the chin, half of the lip, the tip of the tongue and the gums near the 5 teeth remained frozen. The numbness feels like goosebumps and tingling. I don’t know what to do now..."

Oksana, Moscow

If after local anesthesia the patient is most often released from the office 10-30 minutes after the operation, then after anesthesia you will still have to “lie down”. In general, today the removal of an impacted wisdom tooth under anesthesia is a common occurrence. The fact is that the dentist himself assesses the complexity of the upcoming manipulation and, according to indications (or at the request of the patient, if it does not involve possible health risks), performs removal under anesthesia.

If sutures (not self-absorbing) were applied, they will need to be removed in the future. Before 6-8 days they are usually not removed. Removing sutures is almost always painless: local anesthesia is enough.

As for the speed of wound healing, this is an individual characteristic. Primary epithelization occurs in a period of 1 to 3 weeks, and the gums completely heal (smooth out) most often in 5-6 months.

Removal of an impacted wisdom tooth may fall under the category that gives a person the right to “rest” at home, that is, to receive sick leave. The timing is determined not only by the operating doctor - often the dentist at the place of residence is also involved in this matter.

Wisdom teeth are the outermost eights of the top and bottom rows. Their appearance completes the formation of the jaws. Their eruption time lasts for more than 20 years. For some, they appear after 20, for others they grow only by the age of 40. Famous phrase the fact that eighth teeth are a sign of life experience and a manifestation of a wise attitude towards life is rather a beautiful legend. However, let's not forget that legends and traditions provide hints and lessons. Let us consider the features of the structure and eruption of the outer molars, the causes of pain and rapid destruction of erupted molars, features of their removal and possible treatment.

Before they erupt, molars go through a long process of formation inside the gums. The unerupted apex sitting in the gum is called impacted. Often the molar is hidden inside the gum for many years. Its eruption is hampered by the wrong direction of growth, incomplete formation of the upper part (crown) or roots, and the lack of need for chewing extreme molars.

Incomplete formation most often refers to eight roots. As a rule, the crown of eights forms inside the gum at the age of 12, by this age the top of the crown is already fully developed. The roots remain underdeveloped. Their slow formation is completed by the age of 25, when the molar has already partially erupted. The photo shows an x-ray of the outer molars, which shows that the root is small and is in the stage of formation.

Impacted wisdom teeth are considered official medicine vestigial organ. Often there is not enough space for him to crawl out through the gums and participate in chewing food. This fact is associated with changes in the nutrition of the human community. The abundance of soft, thermally processed food does not give the gums a full load. As a result, smaller jaws are formed than nature intended. Anthropologists confirm the fact that over the past 2 thousand years the human jaw has become shorter by 4 mm. In archaeological burials of a more ancient period - burial mounds of 6 thousand years ago, the discovered remains of jaw bones are 10-12 mm longer than modern ones.

The extreme eighth molars appear after the age of 20, when the bones are already formed. Often they do not find a place for themselves. At best, the outer molars remain impacted; at worst, they turn in different directions.

Structural features and symptoms of eruption

The structural features and eruption of the outer molars often cause pain during the period when a wisdom tooth is emerging. We list the main differences between eights and other molars, premolars, canines or incisors:

They do not have a milk precursor, so the process of eruption is difficult (compared to the front incisors and canines), and it is often accompanied by painful symptoms.
The extreme molars are multi-rooted. They often have 4 or 5 root shoots. If the roots grow together, the result is a rare single-rooted wisdom tooth.
Their roots are often very curved, which makes treatment difficult (if it is necessary to fill a carious cavity or canal after removing a nerve).
They do not have enough space, so various pathologies of their location are formed.
Chronic calcium deficiency, inherent in representatives of a technically developed society, forms weak tops, prone to chipping, destruction and the development of caries. Therefore, often, when a wisdom tooth is just emerging, its enamel is already mineralized, the top is fragile, and painful symptoms are felt.
Eights are little used in chewing food, so possible self-cleaning mechanisms do not work.
The remoteness of the outer teeth makes it difficult to clean them, as a result of which the surface of the eights often becomes a place for the accumulation of food debris, the development of carious bacteria and infection of the entire oral cavity. Therefore, often symptoms of caries development appear soon after the eruption of the figure eight.
If there is not enough space in the gum when a wisdom tooth is cut, a number of molars, canines and incisors are compressed, the nerve endings are compressed, causing pain in the jaw.

The above factors explain why the eighth teeth in modern people often begin to deteriorate before they erupt. The pain that appears can initially be relieved with analgesics. Subsequently, pain symptoms increase.

Not everyone's picture is so sad. Quite often, when a wisdom tooth is cut, a person does not experience any discomfort and discovers the tip of the new tooth by accident. But some people experience painful symptoms during teething: fever, intestinal upset, weakness, pain.

A wisdom tooth is being cut: possible pathologies of eruption

Possible pathological positions of the extreme molars during eruption are any deviations from the vertical direction that make it difficult or impossible for the independent eruption of the apex of the molar. Deviations of the apex from the vertical axis are called by the following terms:

medial tilt (with a forward bend towards the seven);
distal tilt (tilting backwards);
buccal;
linguistic.

There is also inflammatory disease, associated with prolonged eruption of the apex - pericoronitis. It appears during prolonged eruption of figure eights, when a wisdom tooth comes in for a year or more (two to three years). The gum is injured by the emerging tip; due to constant painful pressure, the gum tissue becomes compacted and forms a “hood” or “pocket” in which food debris accumulates and inflammation forms.

Pain symptoms in the jaw are determined by the pathology present. What to do if pain occurs when a wisdom tooth is cut? What to do - remove, treat or wait?

When is wisdom tooth removal necessary?

It is better to pull out the extreme molars if the following factors are present:

incorrect position in the gum;
injury to neighboring teeth and tissues, changes in their position;
impossibility of treating caries or pulpitis due to inaccessibility of the roots;
wisdom teeth cause inflammation ( medical term- abscess) and suppuration (fistula or phlegmon) of adjacent tissues; in this case, not only removal, but also treatment of the inflammation zone is necessary;
cyst or granuloma on the roots of the figure eight;
pericoronitis;
osteomyelitis of the jaw in the area of the wisdom tooth.

In case of severe pain, inflammation and suppuration, urgent measures are needed (such treatment begins with removal).

When is wisdom tooth removal contraindicated?

We list several factors when treatment is necessary without removing the extreme molar:

Absence of the seventh or sixth tooth. In this case, the figure eight will fill the existing gap in the gum. Over time (several years) it will move the teeth and take up the free space. At the same time, the person will retain a full chewing surface. Also, if prosthetics are necessary, the preserved eighth teeth will serve as supports for a bridge.
Possibility of treatment, confirmed by an x-ray: normal, not curved roots, the cavity of the caries spread is accessible to a medical instrument.
A healthy root located vertically, making it possible to install a crown on the upper part of the eighth tooth.

There are also general contraindications to removal:

severe inflammation of the gums - in this condition, it is necessary to first relieve the inflammation (with antibiotics and antiseptics), and only then remove its cause;
cardiovascular diseases;
acute infections (flu, hepatitis, oral stomatitis);
the initial and last months of pregnancy (a tooth can be pulled out only for special indications);
mental illness.

Is it painful to have a wisdom tooth removed?

Tooth extraction should occur under high-quality anesthesia. The patient and the doctor must have confidence in the effectiveness of the pain medication. Modern anesthetics make it possible to qualitatively and permanently reduce the sensitivity of the gums and oral cavity. Fear of whether it is painful to remove a wisdom tooth should not constrain the patient and complicate the operation.

High-quality anesthesia is provided by drugs based on articaine (ultracaine, ubistezin). Their action time reaches 6 hours.

After the specified period (for other drugs it may be less), when the effect of the analgesic ends, manifestations of pain. Moreover, if the removal was difficult, the doctor pressed on the gums, lips, or adjacent tissues were damaged, pain appears in the tissues adjacent to the cut, as well as at the site of the gum injection (with a syringe needle during injection). Analgesics help relieve postoperative pain. The pain usually goes away after one or two days.

Pain after wisdom tooth removal lasts longer and is often accompanied by elevated temperature, chills. Which once again confirms the fact that the eighth teeth are special, and they should be removed only if there are valid indications.

If there was no abscess in the gum, then the hole after the removal of a wisdom tooth heals within two weeks, but remains soft and reacts painfully to compression. Only after a few months does the gum acquire hardness and the ability to painlessly respond to squeezing food.

If the operation was extensive, the gum was cut, then sutured, then within a few hours after removal, swelling occurs with a visual increase in half of the face. This swelling lasts for several days (one or two, sometimes three), and then gradually subsides.

In the first days after removal, you should not rinse your mouth. After the removal of a wisdom tooth, the hole is filled with a blood clot, which is necessary to tighten the resulting cavity. If necessary, instead of rinsing, oral baths are performed (an antiseptic infusion or drug is kept in the mouth without internal movement).

Long-term non-healing of the socket after the removal of a wisdom tooth indicates the presence of remnants of dental tissue (chipped enamel, broken parts of the apex). If the upper tooth has been removed, the remains often come out on their own, under the influence of gravity, within a few days. If a lower molar was to be removed, then such a hole must be cleaned for further healing.

Antibiotics are usually not used after tooth extraction, except in special cases when significant inflammation of the gums or periosteum is being treated.

Why do people try to preserve wisdom teeth in folk medicine?

According to Slavic legends, wisdom teeth grow in those who have acquired spiritual strength and the protection of their ancestors - the guardians of the clan. Their removal does not affect physiologically, but deprives a person of spiritual strength and the protection of his ancestors. That's what the legends say. Therefore, when wisdom teeth erupted, Old Russian healers “charmed” them from damage (in modern methods This effect is called structuring water to treat a specific disease or impact at the wave level). In order to remove toothache, healers used antiseptic rinses.

According to Zoroastrian views, eighth teeth are not formed in those people who have had consanguineous marriages in their family.

From the point of view of modern physiology, Dr. Voll's research is interesting. He says that every organ human body connected to several other organs. In Dr. Voll's research, wisdom teeth are associated with the psyche and its disorders.

Upper wisdom teeth and sinusitis

When your wisdom tooth hurts constantly, you need to visit the dentist and take an x-ray. The dentist examines and sanitizes the wisdom tooth. To treat or remove is a complex issue decided jointly by the patient and the doctor. An x-ray will give a clear picture of the location of the apex and roots in the jaw and determine the possibility of treatment. The choice of “treat or tear out” decision is determined by how appropriate it is to preserve and treat the figure eight.

Wisdom teeth are more difficult to remove than other multi-rooted molars for two reasons. Due to the extreme location, these molars are the most distant from the center; for the operation, the patient must open his mouth wide. The second reason for the difficulty is curved roots. The most difficult removal occurs in figure eights with significant bends in the roots, similar to hooks.

Removing the upper wisdom tooth is also considered difficult. There is a cavity near their roots maxillary sinus. If the roots are long, they can penetrate into maxillary cavity. Painful symptoms occur if pulpitis develops or the upper tooth needs to be pulled out.

Difficult removal of a wisdom tooth from above involves possible perforation of the maxillary sinus. Treatment of perforation requires surgical intervention. The patient is cut with inside gums and suturing the perforated canal between the oral and maxillary cavities.

An untreated upper molar often causes sinusitis. The onset of the disease is accompanied by symptoms characteristic of sinusitis: headache, nasal congestion, pulsating sensations in the area of the diseased tooth root. Treatment of such sinusitis begins after the removal of the wisdom tooth, which supplies toxins and causes inflammation.

On average, wisdom teeth are cut at an age from 16 to 22 years old, but there are exceptions to this rule. In some patients, the “eights” began to appear at the age of forty. It's connected with anatomical features jaw structure. With age, the jaw gradually decreases in size, so there is simply no room left for these teeth. Often they are cut incorrectly or not at all. Let us consider in more detail how the eruption of a wisdom tooth differs from other teeth.

When the “eights” erupt

Normal bite healthy person consists of 32 teeth, we learned this well from school. Basically, by the age of 10, all the teeth have erupted in the mouth, except for the last eighths, which are called wisdom teeth. They usually erupt between the ages of 16 and 22 years. Moreover, if in the body young man There is not enough calcium and other microelements, growth slows down.

Dentists consider it normal even for such rare cases when “eights” grow even in forty-year-old patients. There is no need to panic if you are already 23 and your wisdom teeth have not yet erupted - they may be a little late. But it still makes sense to visit a doctor to take an x-ray and rule out the possibility of abnormal growth.

Provisions

You are very lucky if your wisdom teeth erupted as they should have, without deviation from the vertical. Often, even during the formation period, they occupy an incorrect position in the gum and begin to grow with a deviation from the vertical.

The following positions of wisdom teeth are distinguished: vertical, horizontal, lingual-angular, buccal-angular:

Vertical is correct, that is, the tooth grows without deviations from the vertical axis.
Horizontal is the most difficult, because in this case the tooth cannot erupt, and once it begins to grow, it literally grows into the roots of the neighboring one, destroying it. The “figure eights” located horizontally in the gums must be removed, as they injure the gums, causing inflammation, destroying the adjacent tooth and causing the patient a lot of suffering.
Lingual-angular The position of wisdom teeth, like the buccal-angular position, is most common. In the lingual-angular position, the tooth erupts at an angle toward the tongue, as if inward, and in the buccal-angular position, at an angle outward, toward the cheek.

Impacted wisdom teeth

If the “eights” have partially erupted or have not erupted at all, then the doctor diagnoses wisdom tooth impaction, and the unerupted tooth itself is called impacted. This phenomenon often occurs, since such teeth no longer perform their main function in chewing hard food, a person has somewhat changed his eating habits.

Partial eruption may cause the patient a feeling of discomfort. If there is severe pain in the impacted tooth, but all the others have erupted normally and are performing their functions well, the doctor may decide to remove it.

Complications of eruption

The growth of a wisdom tooth is often accompanied by a number of complications, especially if it is positioned incorrectly in the gum or only partial eruption occurs, that is, the tooth is impacted.

Since the “eight” takes a long time to erupt, already at the eruption stage, especially if partial eruption occurs, it is affected by caries. This is due to the fact that the eighth teeth are located in a hard-to-reach place in the oral cavity and are difficult to clean from plaque. As a result, the tooth has not yet had time to erupt, but is already almost completely destroyed by caries.
A partially impacted “figure eight” can provoke the development of pericoronitis - inflammation of the gingival hood that covers it from above. Food debris accumulates underneath it, and pathogenic bacteria actively multiply, which causes an inflammatory process. Over time, serious complications such as periostitis and osteomyelitis may occur.
Not less problems delivers a fully impacted wisdom tooth. It can cause severe facial pain and neuralgia, with pain radiating to the ear, throat, head, and even in the chest and heart area. These must be removed.
If the figure eight grows horizontally in the jaw, it gradually destroys the roots of neighboring teeth.
Often, an impacted 8th tooth causes the formation of a cyst, which resolves on its own after the tooth is removed.
There are known cases when an impacted wisdom tooth “dormant” in the patient’s jaw for many years, and then suddenly “came to life” after dentures were installed on the jaw. As a result of constant injury to the gums, it “woke up” and began to erupt, causing a lot of inconvenience to the patient. Agree - it’s very unpleasant when you suddenly discover that you have a wisdom tooth protruding under your denture. Therefore, dentists recommend removing them.

How to cope with pain

Pain is an invariable companion to the eruption of figure eights. To facilitate the teething process, it is recommended to chew solid foods, but only if you do not have pericoronitis; if you have pericoronitis, solid foods can only increase inflammation and pain.

Helpful and careful soft massage gums with your fingers.

If your gums are inflamed, you should rinse your mouth with herbal decoctions:

calendula,
daisies,
sage,
or ready-made mouth rinses.

You can also use it to relieve pain local remedies- such as gel metrogil, Kamistad, anbesol. They have both analgesic and anti-inflammatory effects.

The eruption of any tooth is accompanied by unpleasant sensations. The wisdom tooth is no exception. When its progressive growth begins, it necessarily injures the gums. But the appearance of pain is not always considered normal. If the pain does not go away for a long time and even increases, then you should immediately consult a doctor.

Timing of wisdom tooth appearance

Unfortunately, there is no exact timing for the eruption of the third molar (wisdom tooth). They range from 18 to 35 years old. But in the practice of dentists there are cases when “eights” appeared much later. Indeed, his growth is not predictable. It is also possible that their eruption is incomplete (semi-retinated teeth) or completely absent (impacted).

There is an opinion that the sharp growth of the wise tooth provokes some changes in the human body. Such changes include chronic somatic diseases, cessation of growth and development of organs and systems, formation nervous system, stress, the beginning of decalcification of bone tissue of the entire skeleton. Therefore, it is difficult to answer unambiguously at what age the tooth comes out.

Causes and mechanisms of pain

A wisdom tooth can remain in the bud stage for a long time. When the time comes, its cells begin to divide, and it tries to erupt above the alveolar process. Bone tissue and mucous membrane stand in the way of the growth of the figure eight. The bone tissue slowly begins to reabsorb, allowing the tooth to emerge relatively painlessly. The mucous membrane does not always have time to thin out in time without causing problems.

Due to the features anatomical structure problems most occur in the lower jaw. As a rule, this is where there is enough space for its location. Therefore, the appearance of pain may be associated with tooth pressure on neighboring areas, in particular on the 2nd molar. To obtain accurate data, it is worth conducting an x-ray examination.

The mucous membrane in the area of the 3rd molar has a larger layer and is quite elastic. As the tooth grows, it presses and injures it from the inside. It changes in color, increases in volume and becomes painful. Such symptoms are usually caused by pericoronitis. This is an inflammation of the mucous membrane associated with teething.

These manifestations are typical if the appearance of the figure eight is delayed. Prolonged trauma provokes the development of pathogenic microflora and the occurrence of inflammation.

Problems associated with wisdom teeth

Cutting through the figure eight is a complex and often lengthy process. Patients often observe that the gums are not just inflamed, but have even partially moved away from the tooth. This can be both normal and pathological. It is considered normal when the tooth has partially erupted and the gum covers half or a third of it. The mucosa is pink, without morphological elements and not increased in volume.

At pathological condition General and local symptoms are revealed. Common ones include fever, malaise, headache, and lack of appetite. Locally, regional The lymph nodes, the gums are very swollen, painful when eating and talking. In addition, the patient may complain that the gums and throat hurt. This condition indicates the addition of a bacterial infection.

What to do if pain occurs?

The best decision would be to see a doctor. Only he can make an accurate diagnosis and prescribe the correct therapy.

In the absence of a bacterial infection, certain measures are recommended to speed up the eruption of wisdom teeth. This way you can chew solid food on the problematic side. But you should approach this wisely and do not overdo it, otherwise it will have the opposite effect and solid food will cause injury.

Finger massage helps a lot. The movements are carried out with the tip of your finger; first wash your hands thoroughly. The massage should be light; before manipulation, fingers can be lubricated with clove or sea buckthorn oil.

To relieve pain, analgesics are taken orally. Locally, the mucous membrane is lubricated with ointments with an analgesic effect (Metrogil, Anbesol, Kalgel, Kamistad). You can use aerosol anesthetics or applications with an anesthetic solution.

If a hood of inflamed mucous membrane forms over the tooth, you should immediately consult a doctor. At the appointment, the dentist opens the source of inflammation and treats the wound. Recommends what to rinse with at home. These could be decoctions medicinal herbs Calendula, Sage, Oak bark or St. John's wort. From medicines solution of Chlorhexedine, Miramistin, Stomatofit.

In case of severe inflammation, sulfonamides Biseptol, Co-trimoxazole, Sulfadimezin are prescribed internally. Antibiotics are prescribed only in severe cases. If the 3rd molar is not growing correctly or there are problems associated with complicated caries, then the doctor decides to remove it. Sometimes it is advisable to remove the seventh tooth and allow the eighth to develop normally. This is done when the 2nd molar is severely damaged, displaced, or causes the development of a pathological focus.

To reduce the risk of developing serious inflammation associated with the eruption of wisdom teeth, it is recommended to follow all the rules of personal hygiene for oral care. Special attention It is worth paying attention to the postmolar area. Thorough rinsing of the mouth after eating is mandatory. When brushing your teeth, you need to thoroughly clean not only your teeth, but also your gums. After brushing, use dental rinses.

In many cases, the eruption of wisdom teeth is problematic and takes a long time. This event is planned by nature for adulthood (17–25 years), when a person’s jaws are already fully formed. The process is accompanied by pain, inflammation of the gums, headache, enlarged lymph nodes, and fever.

This combination of unpleasant symptoms forces the patient to seek help from a dentist to find out what is preventing the figure eight from coming out normally and how to resolve the situation. The presence of these signs indicates an atypical location of the wisdom tooth. For eights, horizontal growth into the root of an adjacent tooth, a tight fit to the seven, pressure on this tooth, or an inclined direction towards the cheek is a common phenomenon.

In addition to these features, third molars differ from other teeth by additional specific characteristics. Unfortunately, these differences are not for the better, since they are clear indications for tooth extraction.

Incorrect placement of wisdom teeth is one of the most popular complications, which is diagnosed in almost 70% of patients.

Even a wisdom tooth that has not erupted can cause damage to a neighboring tooth. The crooked third molars put pressure on the second molars, which can lead to resorption of a healthy tooth. Dentists recommend immediately getting rid of such a figure eight that is interfering with a neighboring tooth, since in the future you will have to remove the non-functional wisdom tooth, and along with it the destroyed seven, which was damaged by it. Such an unerupted figure eight often causes facial and jaw pain. Symptoms spread to the ear, neck, and head.

A similar picture is observed with a wisdom tooth that has erupted partially or completely. The third molars were initially laid in an oblique position and emerged towards the dentition. The violation could be caused by a simple lack of sufficient space for a new tooth, this is especially true for people with a full set of teeth.

A recumbent wisdom tooth directed towards the seventh tooth creates pressure on the root system, which causes pain. Ignoring this moment and a strong desire to preserve your natural tooth, albeit crooked, will end with a natural phenomenon - the root of a healthy seven will eventually collapse. Against this background, additional complications of a purulent-inflammatory nature and gumboil may occur.

If the wisdom tooth fits tightly to the side walls of the second molar, then this arrangement also cannot be called normal, since the enamel of a healthy neighboring tooth is destroyed and a carious cavity is formed. If a wisdom tooth grows horizontally, it harms the entire dentition, causing crowding.

Very often, a horizontal wisdom tooth is directed towards the cheek area. This situation is also serious complication, although it does not harm neighboring teeth, as it might seem at first glance. The delicate mucous membrane is constantly damaged by the sharp edge of the crown. This process cannot be tolerated - the pain does not subside and develops in the mouth. acute inflammation, and the wound becomes an open source for infection.

Possible positions of the figure eight when it climbs into the wrong place.

If a person postpones a visit to the doctor, the body gradually adapts to what is happening and changes the structure of the mucous membrane in the area of contact - soft fabrics thicken, pain intensity decreases. This condition does not indicate recovery, but indicates the activation of the process of rebirth. Such a formation can be benign or malignant.

Larisa Kopylova
Dentist-therapist
To prevent these difficulties, dentists recommend immediately removing teeth with abnormal development. Moreover, it is not necessary to wait until they begin to erupt; the procedure can be carried out before they appear.
To find out how your own wisdom teeth work and what surprises to expect from them, you can undergo an examination using modern diagnostic equipment. This issue can be addressed even in adolescence. If the investigation reveals an atypical location, it is best to eliminate the source of future problems at this stage. At a young age, such manipulations are much easier to tolerate.
How does the removal work?
The presence (not erupted, lying horizontally), as well as fully erupted, but with an inclination into adjacent molars, is an indication for removal. In this case, the operation will be performed using a complex removal method.
The doctor does not proceed blindly to the operation, so before the manipulation the patient is given an x-ray. The picture shows all the nuances and features of the figure eight’s growth, which allows the doctor to draw up a preliminary action plan, prepare tools, and also prevent possible complications. If it puts pressure on a nearby tooth and tries to grow in the wrong direction, it will be clearly visible.
According to many dentists, the sooner the figure eights are removed, the better. With age, the roots grow, as well as the surrounding tissues become denser, which can cause complications. In addition, in youth the healing processes are much easier and faster compared to older people.
But this factor is not an obstacle, since the operation is performed under local anesthesia, so the person remains in the surgeon’s chair without experiencing any discomfort. Temporary soreness usually appears after removal.
General technological stages of complex removal consist of the following actions:
injecting an anesthetic drug into the gum near the tooth that is not going in there, waiting 5-10 minutes for the drug to take effect;
with an impacted figure eight, the doctor makes an incision with a scalpel in the gum;
depending on the situation, it is sometimes necessary to resort to sawing out the bone tissue in the jaw to provide access to the roots. Actions are carried out carefully, with maximum precision, so as not to damage the seven;
the cut is made with a bur, and the tooth is removed with dental forceps or an elevator;
the doctor can apply slight pressure to loosen the tooth, this technique will make it easier to remove from the jaw;
as a rule, if a wisdom tooth lies horizontally, it is difficult to extract it in its original form, so the surgeon takes out its fragments in parts;
After successful removal, the surgeon proceeds to suturing the gum and applying a gauze pad to the fresh socket. The wound can be closed with suture material, which does not require the removal of sutures, since it completely dissolves after the function is completed. If stitches were applied, the doctor will schedule a second appointment to remove them.

Upper and lower wisdom teeth can present many surprises.
At the end of the procedure, the dentist applies ice to the patient to reduce the likelihood of swelling and gives a number of instructions to follow at home, which should be strictly adhered to. In addition, the doctor warns of the appearance of natural pain, possible fever, and secondary bleeding from the socket. All these processes are considered normal and if the recommendations are followed, everything is quickly restored.
What happens after deletion
A complex surgical intervention to remove a horizontal figure eight growing into a tooth is a traumatic process with damage to soft and bone tissues and nerve endings. The patient does not feel anything while the anesthesia continues. Upon arrival home, in most cases, a person develops unpleasant symptoms.
The following manifestations are considered normal:
deterioration general condition, weakness;
the appearance of edema in the surgical area;
slight increase in temperature;
soreness;
secondary bleeding, which has to be spat out frequently.

Larisa Kopylova
Dentist-therapist
During natural healing, all symptoms gradually disappear on their own. If pain rapidly increases, swelling spreads, or purulent masses appear in the socket area, you should consult a doctor, since such signs are already considered a deviation from the norm and indicate the development of an inflammatory process that must be removed immediately.
A list of tips will help you survive the removal procedure as comfortably as possible when the figure eight lies flat:
It is better to remove impacted eights in the first half of the day, preferably in the morning. After removal, the hole may bleed for quite a long time; if the operation is performed in the morning, then in the remaining period of time, it will have time to last until the night’s rest;
Before the planned procedure, you should definitely eat a hearty meal. This move significantly reduces the amount of saliva produced; in addition, after the operation you cannot eat for some time;
It is advisable to have a source of cold with you so that immediately after removal you can begin to constantly apply it to the sore area on the way home - it has been tested in practice, this method prevents the occurrence of edema;
you will also need plain water to rinse your mouth and clean napkins to wipe the bleeding wound;
in the first days it is better not to load the jaws, so it is advisable to eat food with a soft consistency;
All tablets prescribed by your doctor should be taken exactly as written in the prescription. Often these are painkillers Nimesil in powder, Nise in tablets.

X-ray of an abnormally growing wisdom tooth.
Blood that appears periodically from the hole can be lightly pressed with a sterile gauze swab (can be moistened with Chlorhexidine) and held for 10–15 minutes. This will help stop the bleeding;
It is advisable not to eat after surgery for as long as possible - the minimum threshold is 3 hours, but if possible, it is better to abstain;
throughout the entire healing period, all food should be soft, non-irritating to the mucous membranes, and at a comfortable temperature;
At home, you need to apply an ice compress to your cheek. The manipulation should be carried out in certain cycles of 5 minutes with breaks, that is, you cannot keep the ice constantly;
Any heating of the operated area is strictly prohibited - the inflammatory process is inevitable;
the same rule applies to baths, saunas, solariums, and taking a bath;
sports activities, physical exercise must be temporarily postponed;
it is necessary to control the process of formation of a blood clot, it must appear in order to protect the hole from infection and promote rapid regeneration. Sometimes a person himself becomes the culprit for the disappearance of a clot out of ignorance. For example, you cannot rinse your mouth intensively, actively exercise hygiene procedures or intentionally delete it;
You can brush your teeth immediately after wisdom tooth removal, but you can do this very carefully, without touching the operated area. In the following days, adhere to the same rule, but try to perform the most thorough hygiene, since the development of microorganisms in the mouth is unacceptable;
To maintain the cleanliness of the oral cavity, you can perform antiseptic treatment with rinsing solutions based on Miramistin, Chlorhexidine, Furacilin. You just need to constantly remember blood clot. To preserve it, it is best to make baths - simply take the prepared liquid into your mouth, hold it for 2-3 minutes, and then spit it out.

If a wisdom tooth grows into a tooth, it does not pose a threat only in its absence. Therefore, such wisdom teeth should be removed without hesitation.