Wisdom Teeth Extraction

As we all know, the last teeth to erupt in our mouth are the third molars. They usually begin to erupt between the ages of 17 and 25. Whether these teeth should be left in the mouth or extracted is controversial. If they erupt in the correct position and do not damage the surrounding tissues, there is no harm in keeping this tooth in place. Considering the future damages, teeth fused to the jawbone (seen by x-ray) may be extracted. In cases of limited space behind the teeth, the tooth can be obstructed by the gum, bone or other adjacent dental obstacle.

When should the wisdom teeth be extracted?

1. DECAY
Saliva, bacteria, and food particles accumulate in the nest opened by the newly emerging tooth, threatening both the wisdom tooth and the molar tooth next to it. It is quite difficult to notice and treat this type of decay. Serious situations may occur, leading to pain and infection, resulting in abscesses.

2. GUM DISEASE (Pericoronitis)
A focus of infection is formed in the gum of a partially dislocated wisdom tooth, where bacteria and food debris accumulate. This causes bad breath, pain, edema and trismus (inability to open the mouth completely). Infection can spread to the cheek and neck through lymphatic system. The area around the wisdom tooth that had this disease once, is a prone to getting infected easily every time. (See, Gum diseases)

3. PRESSURE PAIN
If pressure is applied to neighboring teeth while erupting, a pain may also be felt due to pinching. In some cases, this pressure causes abrasion.

4. ORTHODONTIC REASONS
Many young individuals are undergoing orthodontic treatment to correct the distortions in their teeth. Since the erupting pressures of wisdom teeth will also be reflected on other teeth, the distortions may increase.

5. REASONS ABOUT PROSTHESIS
In a mouth with prosthetic planning, it is a requirement to take the wisdom teeth into account. Because, after removing the wisdom tooth, it will be necessary to make a new prosthesis according to the changed mouth structure.

6. CYSTS
Cysts caused by an impacted tooth have been observed. The cyst causes bone destruction, jaw enlargement, and displacement or damage of the surrounding teeth. To prevent bone destruction, teeth should be extracted, and the cyst should be aspirated. Rarely, if this cyst spreads to very large areas, it can turn into tumors or cause spontaneous breaks in the jawbone (See, Dental Abscess).

Why should a poorly positioned wisdom tooth be removed, although it does not cause any discomfort?

Impaired position of the tooth alone is enough for infection. In such a case, the problems mentioned will definitely be experienced. Moreover, such problems develop suddenly, at an unexpected time.

• Wisdom teeth are found in areas hard to reach by brush or dental floss. Bacteria, acid and food residues that cause decay over time are collected in this region. If the tooth decays and is not restored with the filling, the tooth becomes inflamed in a short time.
• As these teeth are difficult to keep clean, accumulated bacteria and food residues cause bad breath.
• A tooth impacted in the horizontal (deviated from the vertical) position under the gingiva creates a pressure that will result in the movement, tightening and distortion of other teeth.
• Bacteria that accumulate under the gum covering the impacted tooth cause infection.

When is the best time to remove wisdom teeth?

The tooth impacted in a poor position should be extracted between the ages of 14 and 22, whether cause complain or not. Operations at a young age are technically easier and recovery is quicker. Operations over the age of 40 become quite difficult. Also, with increasing age, side effects increase, and the recovery period is extended.

Can teeth be extracted in cases of acute-active infection (pericoronitis)?

Usually no. If the infection is interfered, it spreads to the surroundings; and healing becomes slow and difficult. Infection is controlled by local oral hygiene, antibiotics, and sometimes extraction of wisdom teeth on the opposite jaw.

Are the wisdom tooth extractions different from other tooth extractions?

• Depending on the position, shape and size of the wisdom tooth, the degree of difficulty of the process to be applied varies. There may be a slight swelling, pain, and bleeding after a simple extraction. Some complex extractions that require more specific operations can also be applied. The precautions taken by your dentist and the recommendations aim to minimize the side effects.
• Following this extraction, a healing disorder called “dry socket” may occur. Blood does not accumulate in the extraction cavity and pain may develop. The situation improves in a few days. However, this event may not be encountered if the dentist's recommendations are followed.
• Since the bone structure intensifies and flexibility decreases in older ages, the extraction becomes difficult and recovery slows down.

• The wound should not be tampered with. Otherwise; pain, infection or bleeding may develop.
• Chewing on the affected side is forbidden for 24 hours.
• Do not smoke for the first 24 hours. (Smoking increases bleeding and impairs healing.)
• Do not spit. Otherwise, the bleeding will increase, and the clot may dislocate.
• Bleeding should be checked. If the wound was not stitched, a buffer is made with sterile gauze. The buffer should be kept in the mouth for half an hour, to allow the clot formation. If bleeding continues after removing the tampon, a new one is placed.
• Management of swelling: After the operation, circulation is slowed by applying a cold tampon to the area and swelling of the face is prevented. The application should be as follows: 20 minutes cold buffer - 20 minutes intervals - again, 20 minutes cold buffer. (Periods are continued.)
• After the first 24 hours, it is necessary to wash the mouth every 2 hours. The mixture is prepared by putting 1 teaspoon of salt in 1 cup of warm water.

Apical resection, is the operation of cutting the inflammated root tip of the teeth, removing pathological formations caused by it; and at the same time, clearing the root canal or ducts from bacteria, followed by freezing.

• The canal treatment is not fully performed due to excessive curvature, perforation or calcification in the root canal of the tooth root,
• Root canal cleaning and filler application cannot be performed successfully in the teeth whose root tip is completely closed.
• When the root canal cannot be reached over the tooth (in the presence of crowns or bridge prostheses, i.e. coatings), canal treatment cannot be performed,
• If the tool is broken during root canal treatment, if the broken tool must be removed, when it is necessary to remove the tool,
• In cases where cystic formations occur at the root end of the tooth,
• It is performed in cases where the tooth root is broken in the 1/3 end of the bone.

• The cyst is a pathological space that grows from the center to the periphery, surrounded by a wall. The pressure created by the cysts while growing, causes resorption of the adjacent teeth at the roots.
• Cysts can develop from cell debris that have settled in tissues during the embryological development process, as well as pathological changes occurring in the root tip region as a result of irritation from the infected root canal, or from remaining of this lesion in the jaw bone after extraction of the teeth with a cystic lesion at the root tip.
• The basic principle in cyst operations is the removal of the entire cyst with its wall. Neighboring roots of the teeth that are not associated with cyst lesion should be preserved and the teeth in the cyst should remain in the mouth with the apical resection method.
• In some types of cysts, drain is placed inside the cyst in order to assist the eruption of the impacted teeth. This drain is changed every week, reducing the pressure in the cyst, creating new bone around the cyst and the eruption of the teeth within the cyst.
• Cyst treatment should not cause functional or aesthetic problems. Therefore, reconstruction of large cyst cavities with appropriate bone grafts (bone powder) and membranes (barrier) is required.