PULLING WISDOM TEETH: WHEN DO THEY HAVE TO GO?

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Wisdom teeth over x-ray
wisdom teeth over x-ray

Wisdom teeth are at the very back of the dentition. But when it comes to causing problems, they are way ahead. Because these almost superfluous relics from bygone times can cause inflammation of the gums or put other teeth in distress. If a wisdom tooth causes problems, it has to be cast-off to prevent complications. Wouldn’t it be better to pull your wisdom teeth preventively? Opinions differ about this in medicine.

Wisdom teeth – what is it actually?

Most people have four so-called wisdom teeth in their permanent set of teeth, which are the last in the row of teeth (“eighth”). Some have more of it, some less or none at all. These rear molars are the last (if at all) to break through the gums of all teeth, usually between the ages of 17 and 25. They have a different shape and a different number of roots, which can grow together or be bow like a hook, which often makes their removal difficult.

So that a wisdom tooth can come to the surface, there must be enough space between the front edge of the ascending jaw branch and the next molar tooth. Otherwise, part of its crown or the entire tooth will be covered by the branch of the jaw and will not be able to occupy the intended place.

If it remains partially or completely stuck in the jaw beyond the usual period of time, one speaks of a partially retained or retained (Latin: retinere = to hold back) tooth, if its eruption is prevented by an obstacle (e.g. another tooth) it is referred to as an impacted tooth (pinched) wisdom tooth.

What problems can it trigger?

When wisdom teeth erupt, the other teeth have to move together so that everyone has room. If the jaw is not large enough, it can cause crowding (crowding), shifts, or deformities that come from teeth. This often results in tooth damage, nocturnal teeth grinding, or temporomandibular joint problems.

Incompletely erupted wisdom teeth, on the other hand, often cause the formation of hood-shaped gum pockets that are difficult to clean, in which food residues and thus bacteria accumulate, which cause inflammation (pericoronitis) to abscesses. If wisdom teeth only breakthrough in one jaw, however, they lack their counterpart, so that they extend beyond the chewing surface and interfere with chewing.

Wisdom teeth that have broken through crookedly or tilted not only create constant pressure on the neighboring tooth but also promote the development of caries in the interdental space and the areas of both teeth that are difficult to reach when brushing your teeth.

When does it need to be extracted?

Retained wisdom teeth can remain in the jaw for life without symptoms. If they find too little space there, however, they can shift and, when pressure is applied, they can shift other teeth or damage the roots of neighboring teeth in such a way that they fail in the worst case.

Wisdom Tooth

Besides, a continuously growing cyst (cavity filled with fluid) can form in the upper part of a wisdom tooth, which only becomes noticeable when it becomes infected, displaces the bone, or can even lead to a fracture or even the development of a tumor.

Last but not least, wisdom teeth can trigger pronounced toothaches and represent foci for various health disorders. In all of these cases, there is no way around removing the “culprits”.

Should one remove wisdom teeth as a precaution?

There are different opinions in medicine on whether wisdom teeth should be cast-off even if they do not cause any problems. Advocates of prophylactic removal consider it sensible, as the rest of the dentition can protect from all sorts of possible damage and the formation of cysts and fractures of the jaw is stay by.

The opponents see the intervention as an unnecessary risk due to the lack of complaints. B. for a possible nerve injury, which manifests itself as numbness in the lip and chin area. And they point out that with intact wisdom teeth, potential “replacement teeth” for lost molars or bridge abutments for dentures are sacrificed.

A dentist or maxillofacial surgeon should ultimately decide after a detailed examination of the jaw whether the wisdom teeth have to be removed. At the latest when wisdom teeth cause health problems, it is necessary to use the pliers.

If you want to keep your wisdom teeth, for the time being, you should have them checked regularly by the dentist. Also because they are more susceptible to tooth decay and can be a cause of inflammation of the gums.

Pulling Wisdom Teeth: Risks & Complications

Extraction of wisdom teeth carries dangers like other surgical interventions:

  • Intraoperative bleeding or postoperative bleeding for up to three days afterward
  • Wound healing disorders or infections
  • Pain for up to a week afterward
  • Swelling or bruising
  • An anesthetic intolerance

Albeit rarely, there are also specific risks such as

  • Damage to neighboring teeth
  • An opening of the maxillary sinus or arthritis
  • Nerve injuries in the lower jaw with numbness
  • A fracture of the lower jaw (with extensive bone removal or osteoporosis)
  • A temporary lock of the jaw (difficult opening of the mouth)

Who pulls wisdom teeth?

Dentists or oral surgeons are responsible for removing wisdom teeth. How the tooth extraction takes place depends on the position and nature of the respective wisdom tooth. If it is regularly in the row of teeth, the wisdom tooth can be pulled.

However, it is slowly moved back and forth with controlled force using levers or pliers. Thus, to expand the alveolus (tooth socket) in which it sits and to move it out.

Otherwise, surgical removal (osteotomy) is necessary, in which the gums are cut open and fold away to expose the tooth.

Then, if necessary, the bone covering the tooth is milled away until the extraction opening is large enough for the tooth to fit through. If it is too small, the tooth is very firmly anchor in the jaw, displace up in the jaw, or of an unusual shape, the tooth divide up or remove in layers before it is removed.

Depending on the effort required and possible complications, the procedures mentioned last from a few minutes (extraction) to several hours (surgery). The osteotomy usually performs under local anesthesia. B. for patients with fear of dentists or with a very extensive treatment the possibility of performing the procedure in twilight sleep or general anesthesia.

Who pays for wisdom teeth extraction?

The cost of the procedure will get cover by statutory health insurance if the attending dentist or oral surgeon determines a medical need for the extraction of the wisdom tooth. Otherwise, costs of up to 800 euros per tooth can be expected. Above all, however, the payment for anesthesia must be justified and submitted by a doctor.

When should one have wisdom teeth pulled?

Anyone who decides to have a preventive operation is best to arrange between the ages of 16 and 18 when the roots of the wisdom teeth have not yet been completed and the risk to the nerve running along the lower jaw is lowest. In principle, all wisdom teeth can cut off within one session.

However, the procedure in two sessions also offers advantages. Such as being able to chew almost unrestrictedly on at least one side during the healing process.

What do you have to consider after pulling it?

To ensure good wound healing and to reduce the consequences of the procedure, a rest phase of approx. Two to seven days should observe after the tooth extraction. To ensure adequate recovery, you should also get sick leave if necessary.

Painkillers help with postoperative pain. But it is important not to take aspirin, as the active ingredient acetylsalicylic acid promotes bleeding.

For the first 24 hours, it helps to cool the wound every 20 minutes with a cool pack wrapped in a cloth to relieve pain and swelling. On the day of the operation, patients should only eat soups and pasty foods (e.g. applesauce, mashed potatoes). When caring for your teeth, you should initially avoid the teeth in the wound area. Do not rinse your mouth for about two days to protect the blood clot that is closing the wound. Otherwise, inflammation can occur.

In the following days, too, it is important to avoid caffeine that increases blood pressure (coffee, energy drinks), anticoagulant alcohol. Or we can say – dairy products, tobacco smoke, physical exertion (sport), and excessive heat exposure (sunbathing, solarium, sauna) to avoid secondary bleeding or wound healing disorders to provoke.

However, if bleeding does occur, it is best to bite a swab or a rolled-up handkerchief. If the bleeding does not stop, or if you notice signs of infection such as fever, you should see a dentist immediately.

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