Wisdom teeth or third molars (as they are known in medical terms) are the last series of teeth that are born through the gum.

They usually appear when the person is aged between 17 and 25 years, children do not have these teeth.

There are 4 wisdom teeth, two upper (one right and one left) and two lower teeth.


Causes of Wisdom Tooth Included

An included tooth is a tooth that does not pierce the gums and only partially emerges.
Usually, this occurs when there is not enough space for the wisdom tooth.
It remains locked against the tooth that is in front of it.
Often the position of the wisdom tooth included is horizontal, but it can be vertical or oblique.
Sometimes even an overlying gum may be responsible for the inclusion of a tooth because it remains trapped in the jaw.
The tooth may become impacted or bent when attempting to leave.
The healthy and correctly positioned wisdom tooth does not cause any problem during the rash , can easily break the gums and come out completely.


Symptoms of wisdom tooth being born

  • Irritation : due to insufficient space in the mouth, sometimes a wisdom tooth is trapped and causes irritation.
  • Pain : An infection located around the tooth, known as pericoronitis can cause pain in the affected area. A terrible pain is the most frequent symptom of infection in the tooth.
  • Fever : Many times, because of the infection, the body temperature rises and the person may feel tired .
  • Difficulty swallowing : the person may suffer from a block to open the jaw and difficulty swallowing.
  • Pus : Sometimes an infection causes the formation of pus in the cavity or near the gum line.
  • Swelling of the lymph nodes : Due to an infection, swelling of the lymph nodes under the jaw that causes pain in the throat may occur .
  • Inflamed and red gums : Because of the tooth being born, the surrounding gingiva is usually red or inflamed.
  • Difficulty in brushing teeth : Teeth that are being born cause problems in brushing and flossing.
  • Bad breath : An infection can cause halitosis .



Complications of wisdom tooth included

The tooth can even cause as many problems as:

Damage to other teeth
The wisdom tooth may push the second molar causing damage or increasing the risk of infection.
This pressure can also cause dental crowding that causes malocclusion.

Partially included wisdom teeth have a higher risk of caries  compared to other teeth.
The causes are:

  • Difficulty in cleaning the tooth,
  • Food and bacteria easily enter between the gum and the wisdom tooth.

Spread of infection
Sometimes the infection can spread from the affected area to other parts of the head and neck.

is a gum infection that is located above the wisdom tooth.

Jaw fracture
The presence of the wisdom tooth favors a fracture of the mandibular angle because the third molar creates an area with less resistance.
The tooth takes the place of the bone, so the bone component is very small and also the resistance.

Cysts : Very rarely, we can observe cysts around the retained tooth. A tooth that does not come out (which is included in the chin) can cause the formation of a cyst.


Diagnosis of the wisdom tooth included

Usually the dentist makes a visit and then prescribes a radiograph to visualize the position of the third molar.
In the case of a lower wisdom tooth, the dentist may need tomography of the lower dental arch to avoid complications.


Intervention by the dentist

When is it necessary to remove wisdom tooth?
If included wisdom teeth do not cause symptoms, they should not be removed.
This is because there are no proven benefits and there are risks of complications.
The dentist may recommend removal if:

  • The absence of space for eruption in the dental arch is evident
  • There are caries,
  • In case of abscess,
  • The wisdom tooth is included or grows horizontally and damages neighboring teeth. In some cases, the wisdom tooth favors the development of caries or the reabsorption of the root of the second molar.
  • Cysts or tumors connected to the wisdom tooth
  • Infection or gum disease ( periodontal disease ) at the third molar level.


Wisdom tooth extraction procedure included

At the outset, the patient prepares for the procedure.
The dentist chooses the most appropriate technique based on the tooth being extracted.

Successively the surgeon administers a local anesthetic to subdue the region where the wisdom tooth is removed.
Sometimes (especially if the patient is very nervous and does not cooperate or if there is a simultaneous extraction of several wisdom teeth) this procedure can be performed under general anesthesia.

When the area is numb, the surgeon makes an incision to expose the area and obtain the visibility of the tooth.
The incision should be large enough to allow access to the dental instruments.

Since this point begins to bleed, sterile cotton is used to stop bleeding .
If the retained wisdom tooth is too deep, a drill may be needed to open the jaw and create space to remove the tooth.
The surgeon breaks the tooth during removal to avoid damage to the jaw.
For extraction, the dentist performs an osteotomy with the drill, that is, removes a part of the bone, to avoid the formation of cysts or dangerous infections.

Usually, the wound is very large because of the incision and in most cases it is necessary to put the stitches .
These may be absorbable but if they are not of this type, after about a week the patient must return so that the suture wires are removed.


Risks of wisdom tooth extraction

dry alveolitis occurs when the blood clot (which is essential for healing) does not develop in the cavity or if the blood clot in the cavity disappears.
Dry alveolitis can cause a lot of toothache and even a bad smell in the mouth.

Another risk is numbness that can affect anyone due to nerve damage, especially if the intervention is wrong.
This disease is called paraesthesia, where part of the mouth or even the chin lose sensitivity due to nerve damage.

Another rare complication that can arise from this extraction is a disease called trismus , in which the patient has difficulty opening the mouth.

Wisdom tooth extraction can also cause bleeding that continues for at least a day.

During breastfeeding it is possible to perform anesthesia for the extraction of the tooth, but it is necessary to ignore the next “feed” to avoid the risks.

Postoperative infection
In rare cases, a tooth infection may occur after removal of the tooth, but the dentist prescribes antibiotics to prevent the disease.
The most common symptoms of infection are:

  • Swelling
  • Fever
  • Toothache
  • Taste bad or salty in the mouth, with or without secretions of the operated area
  • Mandible opening limited.

fracture A jaw fracture may occur due to a wide opening of the mouth during surgery.
Since during the operation the mouth should be wide open, the mouth muscles may develop a contracture causing discomfort around the jaw.

Nerve damage
The inferior alveolar nerve carries sensory signals from the lower lip and chin, while the lingual nerve brings information about the sensitivity d to the front of the tongue.
A wisdom tooth in the lower jaw is very close to these two nerves, particularly with the main branch of the inferior alveolar nerve.
During extraction, the nerve may have an injury if :

  • The dentist does not perform the maneuver correctly,
  • The drill causes a nerve injury.

Permanent paraesthesia may occur at the level of the teeth of the lower dental arch and the lower lip (on the same side).

The loss of sensitivity in the lower lip is the symptom that causes the patient more problems and also causes a deviation of that part of the lip down.
Although the nerve fibers are not damaged, the proprioceptive (sensory) stimulus is absent and this causes the lowering of a part of the lip at rest.
However, in front of a mirror, the visual system can solve this problem.

The trigeminal nerve may be damaged during removal of a lower wisdom tooth.

Air embolism
The embolism gas is one of the most serious complications.
This is a rare complication that occurs when a mixture of air and water on pressure moves from the jaw to the veins and at the end to the great vessels that go to the heart.
This can also cause cardiac arrest or death, depending on the size of the air bubbles.
Source : Magni G et al. – Nonfatal cerebral air embolism after dental surgery.


Cost of wisdom tooth extraction

The initial cost of the process begins with the consultation and the radiography , which costs about 500 reais without coverage with health insurance.
In some states of Brazil the surgery for the extraction of the wisdom can be done by the Unified Health System (SUS).
Extraction of wisdom teeth can range from 600 to 1500 reais, including:

  • Query
  • Sedation
  • Radiography
  • Possibility of oral surgery
  • Medicines
  • Hospitalization.

The cost of extraction can vary from 120 to 500 reais per tooth (excluding consultation costs, radiography, medications, etc.) and extraction of all four teeth could cost 1500 reais.

  • Simple extraction: 200 reais
  • Surgical extraction: 300-800 (with intravenous sedation of 600 to 900, with sedation with nitrous oxide 150-400 reais).

Recovery after wisdom tooth extraction

Here are the steps and actions to perform for the postoperative recovery:

  • Bleeding continues for at least one day after extraction. Do not remove the cotton and keep the pressure with your teeth in the extraction area for about an hour after removal.
    This helps blood clotting and stop bleeding.
  • For 48 hours after extraction do not eat any hot or hard food. In fact, most dentists recommend a minimal movement of the jaw. You can eat cold and soft foods like ice cream.
  • Do not make strong gargling for 24 hours after extraction because they can prevent the formation of blood clots and bleeding continues.
  • Avoid physical contact with the affected gum area with your tongue or fingers.
  • After the operation, rest as much as possible.
  • The anesthesia takes about 4 hours to pass. When the effect ends, you begin to feel pain, albeit with a lesser intensity.

Periodically change the cotton gauze and place over the affected gum area with a new one.
After 48 hours, gargle with salt water to prevent infections.
Apply a layer of ice outside on the affected area that may help decrease the pain that may occur within the first few hours after the anesthetic effect.

Obviously a prescription pain reliever greatly reduces pain. Take these painkillers and antibiotics that the dentist prescribes.
During sleep keep the head elevated, so that the blood flow towards the affected area reduces and causes less pain.

After two days, you can start eating all kinds of food. Exercise your jaw by opening and closing your mouth. At first it is painful.
During brushing the teeth do not brush the affected area because it damages the  recovery achieved until then.
Avoid  smoking cigarettes for about 24 hours after surgery because it can compromise the formation of clots and prolong the time needed for complete healing.


Natural Remedies for Toothache Caused by Wisdom Tooth

  • Peppermint leaves contain essential oils that can reduce pain and inflammation. Prepare a mint tea, expect to cool and wash in the mouth.
  • Place a black tea bag near the affected area for temporary relief.
  • You can apply cotton soaked in clove oil to reduce pain.
  • Gargle with warm water and salt to eliminate bacteria.
  • Some people chew a clove of garlic covered with coarse salt.
  • Placing a small piece of cucumber on the tooth to be extracted may help.
  • You can reduce pain by avoiding very hot, spicy or sweet foods .

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