Causes of wisdom tooth retention and dystopia
Impaired eruption of wisdom teeth is associated with a number of local factors. These include a lack of available space in the jaw and its underdevelopment, as well as an overly dense mucosa surrounding the tooth. The process is frequently accompanied by inflammatory phenomena in the area of the unerupted molar.
Pericoronitis: clinical presentation and management
Pericoronitis manifests with local symptoms: pain in the second molar, pain upon swallowing or in the tongue, swelling of the mucosa over the tooth, and restricted mouth opening.
- Local therapy: irrigation under the mucosal "hood" with 0.05% chlorhexidine solution, 3% hydrogen peroxide, or iodine and calendula solutions.
- Surgical treatment: the scope depends on the patient's general condition, the type of inflammation, and plans for extracting the causal tooth.
- Timing of surgery: tooth extraction itself in the presence of pericoronitis is usually performed after the inflammatory symptoms subside and a course of antibiotic therapy is completed.
Instruments and extraction technique
Elevators operating on the principles of a physical lever are actively used for luxation and extraction of teeth.
- Straight elevator: used in the mandible for luxation of the third molar. The instrument is inserted into the interdental space between the second and third molars, directing the working part toward the tooth being extracted.
- Safety: the clinician must control the lingual surface of the teeth with the index finger of the left hand to prevent soft tissue trauma in case of slippage.
- Limited mouth opening: when the tooth is positioned correctly but mouth opening is limited, bayonet forceps curved by plane or by edge are used.
Potential intraoperative complications
Removal of lower molars and wisdom teeth can be accompanied by severe complications:
- Soft tissue laceration: occurs during "blind" tooth mobilization. Prevented by mucosal separation and treated by suturing.
- Fracture of the alveolar process: frequently occurs due to placing forceps beaks on the socket edges or rough use of elevators in the maxillary tuberosity region.
- TMJ dislocation: occurs due to wide mouth opening and pressure on the jaw, most commonly in elderly individuals. Manifests as the inability to close the mouth.
- Mandible fracture: an extremely rare complication caused by excessive force when using a Lecluse elevator against the background of pathological bone processes.
Always position the elevator inward: the working part toward the tooth, the cheek controlled by a couple of fingers, and the fulcrum resting exclusively on the alveolar wall, never on the adjacent tooth!
Class and exam questions
When is wisdom tooth extraction performed in acute pericoronitis?
Third molar extraction in the presence of inflammation is usually performed after inflammatory symptoms subside and a course of antibiotic therapy is completed.
Why is it prohibited to use the adjacent tooth as a fulcrum for a straight elevator?
This is a gross violation of the biomechanical rule: the fulcrum must be exclusively the alveolar wall, otherwise the adjacent tooth can be damaged.
What are the main causes of temporomandibular joint dislocation during extraction?
Dislocation occurs due to the patient's wide mouth opening and excessively strong pressure exerted by instruments on the jaw, especially in elderly individuals.
What else to study on this topic
- Differential diagnosis of follicular jaw cysts
- Features of ameloblastoma of the angle and body of the mandible
- Radiological picture of tooth root perforation into the maxillary sinus
- Structure and varieties of angled elevators
- Clinical manifestations of jaw osteoblastoclastoma
Master the entire topic in the course "Surgical Dentistry"
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Wisdom Tooth Extraction" and 866 more pages of the subject
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- AI tutor answers questions on the topic anytime
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Other topics in the section "Chapter 5. Tooth Extraction Surgery (A.M. Panin, V.V. Afanasyev)"
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