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wisdom/impacted

Wisdom tooth or third molars are the last teeth to develop and erupt into the oral cavity. They are called "wisdom teeth" because they usually appear during late teens or early twenties, which has been called the "age of wisdom". The normal position of wisdom teeth is behind the upper and lower second molars. They erupt normally at the age of 18 - 21 years. A person will have four wisdom teeth: upper left, upper right, lower left, and lower right. Sometimes the jaws are not large enough to accommodate the wisdom teeth. This prevents the eruption of the teeth in the correct position, or they may not be able to erupt completely, or they may never erupt. When a wisdom tooth is blocked from erupting into the mouth, it is said to be impacted. Theories postulate that in modern (more evolved) human beings the jaws are smaller and less developed than those of our prehistoric predecessors, mainly because of our relatively soft diet. The cooked and soft foods does not require big strong jaws to chew, unlike the uncooked fibrous foods eaten by prehistoric man. Theories also suggests that as the human race continues to develop and evolve, there will be some point in the future when human beings will no longer have wisdom teeth. In fact, even now in the general population some people don't have wisdom teeth.

Classification of Impacted Wisdom Tooth:
Wisdom tooth may get impacted either because there is not room enough in the jaw for the tooth to erupt normally, or else because the angulation of the erupting tooth is not correct. A tooth may be partially impacted, meaning it grows and breaks through the gum only partially, or it may remain totally impacted if it fail to break through the gums.

wisdom/impacted wisdom/impacted wisdom/impacted wisdom/impacted
Apart from the wisdom teeth, other teeth can also get impacted. Most common among these are the maxillary (upper) canine, followed by the lower canine and premolars.

Why should impacted teeth be extracted?
Many problems with wisdom teeth can occur with few or no symptoms, so there can be damage without you knowing it. Wisdom tooth either partially or fully erupted can often be very difficult to clean. Accumulation of plaque will result in tooth decay, periodontal disease (gum disease), or reoccurring infections. Impacted wisdom teeth often grow at an awkward angle making their removal difficult. This can be removed only through a minor surgical procedure.

Wisdom not is not an important tooth. The wisdom teeth are not needed for chewing food. Theories postulate that in modern (more evolved) human beings the jaws are smaller and less developed than those of our prehistoric predecessors, mainly because of our relatively soft diet. Theories also suggests that as the human race continues to develop and evolve, there will be some point in the future when human beings will no longer have wisdom teeth. In fact, even now in the general population some people don't have wisdom teeth.

What are the steps involved in a surgical removal of a impacted tooth?
Local Anesthesia: Before extraction of the tooth the dentist will anesthetize (numb) the tooth and the area surrounding it (jaw bone and gums), using an local anesthetic, usually lignocaine with 2% adrenaline. It takes around 5 - 10 minutes for the local anesthesia to act and make the area numb. The numbness may last for 2 - 3 hours.

Some people place themselves in a position of creating a self fulfilling prophecy. They expect the injection to hurt and whatsoever the dentist says they are not ready to accept nor understand. They don't give the process a chance, thus making a guaranteed unpleasant experience for both themselves and the dentist. The more cooperative you are when the dentist performs the injection the better it will be for you. The discomfort of the injection is related to the rate at which the anesthetic solution is injected. Slower the rate, lesser the discomfort. If you are being a poor patient the dentist's natural instinct will be to speed up the injection process and to finish it off quickly. Additionally, when a dentist performs an injection they must place the anesthetic solution in the proper location. If the dentist is focused more on your behavior, as opposed to only on performing the injection, it will increase the likelihood that the injection will be slightly off target and additional injections will be required to numb the area properly. During the injection relax completely, do not exert or use force by tightening the muscles of your face, hands and legs. Concentrate on your breathing, and breathe in and out normally. Remember, the injections are never that painful. Surely you will feel a prick but nothing more. Do not fear the unknown. If you are uncooperative the pain will be 10 times more.

Reflecting the Gingival tissues: The dentist checks for the proper numbness around the surrounding tissues. If it is an lower tooth, part of your tongue will also feel numb. If the tooth is underneath the gums the dentist will first make an incision in the gums and then the gums around the tooth is separated from the tooth with the help of a periosteal elevator. If you feel any pain during this procedure communicate with your dentist and he may inject more local anesthetic to numb the area further.

Surgical removal of the tooth: To remove an impacted tooth the dentist must gain access to it through the bone. If the tooth is encased in bone then the dentist will remove a portion of the bone which lies over and around the tooth. Sometimes to minimize the amount of bone to be removed around the impacted tooth the dentist will section the tooth into parts, for easier removal.  When your dentist performs the extraction expect to feel a lot of pressure. You will feel a pressure, but no pain. The reason you feel pressure during the tooth extraction is because our body have different types of nerve fibers, each of which carry different types of sensations. The local anesthetic is very effective at blocking pain transmitting nerve fibers, but the nerve fibers which transmit pressure sensations are not so profoundly affected. Expect to feel a pressure during your tooth extraction but don't assume this indicates that you will soon be feeling pain, because it doesn't. If you do happen to feel pain during the extraction you should let your dentist know so they can numb the area some more. But more anesthetic injections will never decrease the pressure sensation you experience.

What are the post-extraction care to be taken?
What is a Dry Socket?

* My Homepage * Know your teeth * Know your Gums (Gingiva) * Eruption Dates * Six Golden Rules * Brushing\Flossing Technique * Wisdom tooth * Tooth Decay * Extraction * Dental Implant * Surgical Extraction * Orthognathic Surgery * Asymmetry of the face * Gummy Smile * Prognathism{Long Jaw} * Beggs\Straight wire{Orthodontia} * Bleaching{Tooth Whitening} * Habit Breaking Appliances * Serial Extractions * Interceptive Orthodontics * Discolouration\Veneers * Composite\Amalgam Fillings * Root Canal Treatment{RCT} * Crown{Porcelain\Castmetal} * Flap Surgery/Splinting * Bridges{Porcelain\Castmetal} * TMJ (Joint) Disorders * Bell's Palsy {Facial Paralysis} * Ankylosis{Difficulty in mouth opening} * Cleft Lip and Palate * Trigeminal Neuralgia * In a Lighter vein


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Dr Antony George, Trichur Institute of Head And Neck Surgery (TIHANS),
Shornur Road,Trichur,Kerala-680001,India.
Ph: 0091-0487-335145, 335185
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updated Aug2002.