Impacted wisdom tooth refers to the condition whereby the 3rd molar is improperly positioned and not fully erupted in the mouth. The most common presentation for wisdom teeth problem is the infection of the gum that partially covers the wisdom tooth. This piece of gum tissue is called the operculum and with food retained inside the pocket between the tooth and the gums, it is not difficult to imagine why this is a common problem.
The impacted 3rd molar or wisdom tooth is a common problem encountered. There are many theories but the most popular one is that the jaw size of the modern man is much smaller as the diet becomes more refined and there is less need to grind our food. This has resulted in insufficient space for the 3rd molar to erupt and hence it often come out in a slanted and buried position trapped next to the 2nd molar.
Gum infection in wisdom tooth. The most common cause of pain in the wisdom tooth due to food stagnation and inflammation of the gums around the last molar
Read more about Wisdom Tooth Surgery or 3rd Molar Surgery.
Impacted wisdom teeth can result in food trapping causing the tooth in front to decay (see the black area inside the adjacent tooth) and the patient may ultimately have to extract both the molars. It is hence advisable to have impacted wisdom teeth to be removed before it cause further damages to the gums, bone and teeth in front.
Wisdom tooth left inside the jaw can develop into cyst which will weaken the jaw leading to fracture
Huge cystic lesion on impacted wisdom tooth
Sometimes patients going for braces treatment will also need their wisdom teeth removed. Though generally safe, surgical removal of the wisdom tooth has risk of damage to the inferior dental nerve which could cause numbness of the lip as well as damage to the lingual nerve resulting in numbness of the tongue. It will be important that difficult cases of impacted wisdom teeth to be removed by experienced surgeon to minimise the risk of damage to the IDN which may result in permanent numbness. Typically a surgical training programme in the UK would require a trainee to have operated on many wisdom teeth removal before graduation and eventually become a consultant. Dr Fan had operated on thousands of wisdom teeth cases some of which were very difficult and challenging with high risks of nerve damage.
Complications of wisdom teeth surgery
Lip numbness is uncommon but can happen to patients after wisdom teeth surgery when the inexperienced surgeon had damaged the inferior dental nerve. Some patients had numbness on the tongue due to damage of the lingual nerve. These are difficult problems to treat and so it is important for the surgeon to assess the level of difficulty (and hence refer to a specialist if necessary) and proximity of the nerve to the tooth to prevent damage. Numbness can be permanent.
In our clinic, we use the cone beam CT scanner to visualise the inferior dental nerve to plan for safe surgical removal of the 3rd molar. A clinical assessment will be made at our clinic and the surgery is explained to the patient by clear animation videos with our specialised Consult Pro software.
Dr Fan had been referred to treat some of these cases of damaged nerves done by surgeons or dentists. Most of them were avoidable if proper assessments were carried out and the operating surgeon/dentist do not perform surgery beyond his/her own capability.
Other complications egs
Wisdom tooth pushed into maxillary sinus by inexperienced dentist
Fractured root pushed into sublingual space by another dentist
The buried upper canine is quite common and most require surgical intervention to allow the patient to continue with orthodontic treatment. Exposure of the buried tooth and attaching a gold chain to “pull” it down can be achieved orthodontically.
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Dr Victor Fan
MB BCH; BAO (UK)