WISDOM TEETH : FACT OR

MYTH ??

DR. ALI WAQARRESIDENT FCPS – II ORTHODONTICS

UCMD UOL LAHORE

HAPPY 18 YEARS

INTRODUCTION

The third molar has been the most widely discussed tooth in the dental literature, and the debatable question “….. to extract or not to extract” seems set to run into the next century. - Faiez N. Hattab, JOMS, 57: 389-391 (1999)

DEFINITION

A tooth that has failed to erupt completely or partially to its correct position in the Dental Arch and its Eruption Potential has been Lost

Erupt between 18 – 25 years of age

COMMON IMPACTED TEETH

Mandibular third molars Maxillary third molar Maxillary canine Mandibular premolars Maxillary premolar Mandibular canine Maxillary central incisor Maxillary lateral incisor

ORTHOPANTOMOGRAM (OPG)

TYPES

ANGULAR

HORIZONTAL

VERTICAL

PARTIAL ERUPTION

CLASSIFICATION According to Long axis of the impacted tooth in relation to the

long axis of the 2nd molar Winter’s classification (1926)

PELL & GREGORY'S CLASSIFICATION

POSITION A

POSITION B

POSITION C

THEORIES OF IMPACTION ORTHODONTIC THEORY

Jaws develop in downward and forward direction.

Growth of the jaw and movement of teeth occurs in forward direction

Any thing that interfere with such moment will cause an impaction (small jaw-decreased space)

Dense bone decreases the movement of the teeth in forward direction.

PHYLOGENIC THEORY

Nature tries to eliminate the disused organs i.e., use makes the organ develop better, disuse causes slow regression of organ.

More-functional masticatory force – better the development of the jaw

Due to changing nutritional habits of our civilization, use of large powerful jaws have been practically eliminated. Thus, over centuries the mandible and maxilla decreased in size leaving insufficient room for third molars.

MENDELIAN THEORY Heredity is most common cause. The hereditary transmission of small jaws and large teeth from parents to siblings. This may be important etiological factor in the occurrence of impaction

PATHOLOGICAL THEORY Chronic infections affecting an individual may bring the condensation of osseous tissue further preventing the growth and development of the jaws.

ENDOCRINAL THEORY Increase or decrease in growth hormone secretion may affect the size of the jaws

RELATIONSHIP OF INFERIOR ALVEOLAR NERVE TO THE ROOTS OF THIRD MOLAR

SURGICAL MANAGEMENT

Steps in surgical removal

Anesthesia Incision and mucoperiosteal flap Removal of bone Tooth removal Wound debridement Arrest of haemorrhage Wound closure Postoperative follow-up

COMPLICATIONS

INFECTIONS

Pericoronal infection

Acute / chronic alveolar abscesses

Chronic suppurative osteitis

Necrosis

Osteomyelitis

PAIN

Slight and restricted

Severe or excruciating

Intermittent, constant or periodic

Referred to ear, the post auricular area, any part of the area supplied by the trigeminal nerve. (Eg. Temporal pain)

FRACTURES Impacted tooth proves that weakening of the

mandible occurs due to displacement of bone.

OTHER COMPLICATIONS Ringing, singing or buzzing sound in the ear

(Tinnitus aurium) Otitis Dimness of the vision Iritis Pain simulating that of glaucoma