Management of Impacted Teeth and Wisdom Teeth

At Joe Radakovich DMD in Portland, we believe that educating our patients on all of the oral health issues that can arise goes a long way. When you know what can happen and how you are more likely to take steps to prevent issues from arising. One of the reasons to always stay current on your bi-annual cleaning and examinations is so that teeth that are at high risk of impaction are caught before they are allowed to do damage to your mouth. Teeth are said to be impacted when they are not in a normal position, and their eruption into the mouth will be abnormal or destructive. Wisdom teeth and canines are the most commonly impacted teeth.

Third Molar Caries

The third molars, which are also known as wisdom teeth, are commonly impacted teeth and must often be removed either due to impaction, spacing issues, or both. Cavities in the third molars are quite common because it can be hard to brush and floss so far back in the mouth. Pericoronitis and infections are often a problem the plague those with third molars.

Ludwig’s Angina

An interesting phenomenon that those who keep their third molars sometimes experience is the spread of infection to other healthy teeth in the mouth. Ludwig’s angina explains an issue where poor hygiene of the third molars result in cavities and periodontal disease around the second molars. In cases like these, the removal of the third molar can help to boost the health of the whole mouth.

Second Molar Caries

Third molars can bring with them various forms of disease and other health concerns like cysts and tumors. These issues can easily spread the infection to the second molars, and eventually other teeth in the mouth. Issues like cysts and tumors can also wreak havoc on the bone in your jaw. Removal of wisdom teeth can prevent these issues from occurring.

Dentigerous Cyst Development

This series of radiographs shows the development of a dentigerous cyst over a ten-year period. Note that the third molar was migrating distally, out of range of the bitewing films. A secondary infection of the cyst caused symptoms that led to a periapical film and panorex of the area in question. This illustrates the destructive nature of benign cysts. The photo to the right shows development of a dentigerous cyst in a 45 year-old female over a three-year period.

Potential Problems of Impacted Teeth

Impacted teeth can lead to other dental problems.
			Third molars can sometimes contribute to mandibular fractures because their sockets can serve as the start of a fracture plane.

Mandibular Fracture Through Third Molar Socket

You should always consider having your third molars removed sooner rather than later, because the risk of complications from removal rises with the age of the patient. Those who are young can recover quickly from surgical procedures and can often avoid serious complications like mandibular fracture through the third molar socket.

Third Molar Root Development Around Inferior Alveolar Nerve

Periodontal healing of the second molars is also better and more predictable in the late teens and early twenties than later in life. If the decision to leave an impacted tooth in place is made, the patient should be made aware that periodic radiographs and other appropriate examinations should be done to monitor the condition of the tooth and surrounding structures.

Early removal of impacted third molars is usually indicated. We cannot predict who will develop significant pathology, but the severity of some of the potential pathology warrants prophylactic removal of the third molars in the late teens or early twenties when the morbidity of the procedure is minimal.

Guided Eruption of Impacted Canines

Canines are often impacted or fail to erupt from the gumline. In cases like these, we are sometimes able to help the canine erupt with some help from braces or brackets on the surrounding teeth. We will expose the canine by making an incision in the gums above where the canine sits. We will then attach a bracket to the top of the tooth. We will attach a chain to the canine that is meant to guide it slowly into the mouth. As the canine moves, we will remove links from the chain to further it’s progression.

Wisdom Teeth Extraction

During the procedure, we will perform a surgical extraction of the wisdom teeth to remove them from your mouth. Before you go to sleep, a small rubber cushion is placed between your teeth, and this holds your mouth open. We will suture the site closed and pack it with gauze before you leave. Unless you are told otherwise, your stitches will dissolve after about a week.

Recovery from Tooth Extractions

It is important that you take it easy for at least 24 hours following a tooth extraction. Make sure to change the gauze if the bleeding has not slowed or stopped after a half hour or so. Take all medications that are prescribed to you as instructed.

Questions About Your Wisdom Teeth?

If you have any questions about impacted teeth or whether your wisdom teeth may need to be extracted, please give us a call at (503) 455-4673 to schedule an appointment at our Portland, OR office. We can help you determine the best course of action and whether or not your wisdom teeth will need to be removed.