Wisdom teeth - malocclusion and teething - should they be removed or not?

What does gum healing depend on?
How is tooth extraction performed?
Postoperative period
Stages of healing
Possible complications

How and how long the gums heal after wisdom tooth removal depends on many factors; myths and facts about third molars can be read here. On average, the wound healing process lasts 3 weeks; after 21 days, you can safely eat all foods and load the gums. But complete filling of the tooth socket with bone tissue occurs only after 4-5 months.

Indications for removal of eighth teeth

wisdom teeth

A pronounced tilt of the figure eight towards the seventh tooth or cheek.
Hypercementosis (excessive deposition of secondary cement, in which the tooth root thickens and becomes deformed).
Incomplete eruption of the tooth or its location in the bone (retention).
Destruction of the crown or roots of the figure eight, as well as neighboring teeth (after injury or caries).
Granuloma (granulation in the form of cystic sacs with pus located in the periodontium).
Rotation of the tooth around its axis or horizontal position (dystopia).
Deformation of the roots (they can bend in every possible way, even twist into a spiral or form an angle of 90°).
The close location of the roots of the upper eights to the nasal maxillary sinuses.
In the presence of pericoronitis (an acute inflammatory process in the area of the eruption of the figure eight, accompanied by pain and an increase in ESR in blood tests).

Occurrence of complications

difficult access;
frequent retention;
unpredictable structure;
features of the location of the mandibular alveolar nerve.

Are common

Painful sensations

Swelling of the tissues of the face and neck

swelling of the lymph nodes;
discomfort when swallowing;
painful sensations during mouth movements, radiating to the ear.

Hematomas

Alveolitis

complications after wisdom teeth removal

the gums swell and turn red;
local pain and headache are observed;
sore throat;
the temperature rises, muscle aches appear;
lymph nodes become inflamed, most often the submandibular ones.

increased persistent temperature;
poor general health;
severe migraine-like pain;
nausea;
other signs of intoxication of the body.

Increased body temperature

A slight increase in body temperature to 37.5-38 °C also often occurs in the postoperative period. This complication occurs due to a reaction to inflammation. The temperature should completely return to normal within the first day, and if it continues to rise and rise, it means that more serious pathologies have arisen and you need to go to the hospital again.

Bleeding

rupture of large vessels;
capillary fragility;
hypertension.

Damage to the roots of adjacent teeth

Flux

redness, suppuration and swelling of the gums;
severe shooting pain;
temperature increase;
weakness.

Others

displacement of the seventh tooth (2 molars);
mouth rupture; cut gums or cheeks;
jaw injuries.

Possible complications

Many factors, including food getting into the socket, can cause complications after surgery. To avoid them, it is important to follow all recommendations and rules of oral hygiene.

If they are not followed, the following complications are possible:

alveolitis,
bleeding,
formation of pus,
osteomyelitis,
paresthesia.

In case of severe and prolonged pain, severe swelling, numbness of the upper and lower jaw, as well as increased body temperature (more than 38 ° C) - these are the most common signs of complications, if they occur, you should immediately consult a doctor!

What to look for

The most serious consequences that can occur after wisdom tooth removal:

Alveolitis. This is an acute inflammatory process. It begins in the tooth socket and gradually spreads to other gum tissues. The most common reason for the development of alveolitis is improper care after removal.
Paresthesia. Develops when the root of the jaw nerve is damaged or irritated. Manifested by a feeling of tingling, burning, numbness.

To avoid developing serious problems, monitor your oral health. The first symptoms are not difficult to replace:

Bleeding from the socket. This is not always a sign of complications. Immediately after removal this is a normal reaction of the body. In the first minutes after tooth extraction, bleeding will be slightly heavier. The dentist treats the wound with antiseptics and packs it. After some time, the bleeding stops. Slight bleeding persists for 2-3 hours. This is also normal. You should pay attention to bleeding if it is profuse and begins several hours after removal. In this case, contact a specialist immediately.
Swelling and pain. This is also a natural reaction. Pain occurs as the anesthetic wears off. Normally it lasts 2-3 days. At the same time, the gums swell slightly. You should sound the alarm if the swelling transfers to the cheek. In complex cases, the tumor can be very large. Severe swelling is one of the symptoms of alveolitis.
Fever. On the first day after removal, the temperature rises to 37 degrees. Such an increase is within normal limits, especially if the operation was complicated. When the temperature lasts more than a day or rises strongly, this is a symptom of inflammation. To prevent the inflammatory process from spreading to neighboring tissues, visit a dental clinic.
Suppuration. The inflammatory process, accompanied by suppuration, has pronounced symptoms. Suppuration is indicated by a putrid odor from the mouth and an unpleasant taste. When examining the tooth socket, you may notice gray plaque or white purulent contents. In this case, you need to go to the dentist immediately.
Headache. Immediately after wisdom tooth removal, headache is normal. It is caused by stress and anesthetic drugs. If the headache is severe and is accompanied by fever, swollen lymph nodes, and weakness, we recommend visiting a doctor.

Prevention

Preventing dry socket is always easier and cheaper than treating dry socket. To do this, you need to follow a number of preventive measures. Namely:

If possible, limit physical activity for several days after tooth extraction;
do not touch the removal site with your hands or tongue;
do not chew on this side;
eliminate the use of tobacco and alcohol;
do not eat too hot, cold or spicy foods;
It is advisable to grind food into puree.

Expert of the article Bolshakova Evgenia Vladimirovna Dentist-hygienist

More than 11 years of experience

Why complications arise

Removal of a wisdom tooth performed by an experienced surgeon in a healthy person rarely leads to complications. There may be some discomfort, but it goes away quickly. Serious consequences can occur for various reasons. The most common is improper care. Provoking factors may be:

Dental diseases. Caries on neighboring teeth, inflammation of the mucous membrane and other diseases can lead to the transfer of pathogenic microflora into the socket. As a result, the wound becomes inflamed.
Reduced immunity. Removing a wisdom tooth is a surgical procedure. When immunity decreases, recovery takes longer.
Systemic diseases. Hypertension, blood clotting problems and other cardiovascular diseases can lead to various problems, such as bleeding from the socket.

Medical errors can also lead to complications after wisdom tooth removal:

Violation of operation regulations.
Violation of antiseptic rules.
Not completely removed root, etc.

Removing a wisdom tooth is a complex operation, so you should not trust your health to an inexperienced dentist. Our clinic employs highly qualified surgeons. Therefore, you do not have to worry that serious pathologies will develop due to medical errors.

How to care for a hole

Immediately after the procedure, you can apply ice to your cheek to relieve pain and swelling. For severe pain, you can take an analgesic. During the healing period, follow these simple rules:

Do not rinse your mouth with any solutions unless prescribed by your dentist.
The tooth socket should not be touched with hands or a toothbrush.
Avoid physical activity and do not go to the sauna until the wound is completely healed.
Take medications prescribed by a specialist.
Do not drink alcohol, as it can cause bleeding.

The surgeon will give you detailed recommendations after the operation. If you notice symptoms of complications, contact your dentist immediately. At our clinic, please contact the doctor on duty for help.

Complications after wisdom tooth removal can occur almost immediately after the operation. Some of them are natural, since removal is a complex surgical procedure, “eights” are located in hard-to-reach places, and they have large roots. But sometimes complications can make themselves felt within six months, and they provoke diseases of the gums, adjacent teeth, bones and even joints. To prevent such problems, you need to know the first signs of pathology and urgently contact an experienced dentist.

Main consequences after wisdom tooth removal

Dry socket is a consequence that occurs due to the doctor using anesthetics and vasoconstrictor drugs at the same time. As a result, the arteries become spasmed, and a blood “sac” (clot), which is required for natural wound healing, does not form in the socket. .
Pain in the socket area is a common condition that can last up to five days. If the pain does not go away, and after five days it becomes more active, you should urgently consult a doctor.
alveolitis - inflammation that occurs due to the presence of infection in the oral cavity, tooth fragments;
pointed edges of the alveoli are a consequence of unprofessional removal of the “eight”;
osteomyelitis of the socket is a consequence of poor wound treatment in the first hours and days after surgery;
exposure of the alveolar zone - an injury against which part of the bone is exposed;
neuropathy of the alveolar nerve - when, during the elimination of the “8”, the nerves of the lower jaw were affected.
The formation of abscesses and phlegmon is a common phenomenon that develops as a result of infection during surgery or wound treatment. An acute inflammatory process develops in the tissues, and a sac with purulent contents forms. The patient feels severe pain, the tissues in the surgical area become denser, the pain becomes throbbing and acute, the body temperature rises, the head feels dizzy, and the cheek puffs out.

Frequent complications after removal of a wisdom tooth in the upper jaw: alveolitis (inflammation of the socket), hematomas (when the doctor damages a vessel), bleeding (this area is abundantly supplied with blood), damage to the bottom of the sinus. jaws, swelling and inflammation of tissues.

Common complications after removal of a wisdom tooth in the lower jaw: gumboil, damage to adjacent nerve endings, bleeding, stomatitis, cysts, etc.

Signs of complications after wisdom tooth removal:

the wisdom tooth socket becomes brown, sometimes acquiring a bluish tint;
increased pain;
swelling;
increased body temperature;
heavy bleeding;
dry socket;
weakness;
weak appetite;
pain when swallowing food and drinks;
difficulties opening and closing the mouth, etc.

In case of all the complications listed above, you must definitely contact an experienced, trusted dentist. The doctor will conduct an examination, determine the problem and prescribe adequate treatment.

Treatment of dry tooth socket at home

If the pain from dry socket inflammation is too severe, you can take painkillers. In the first two days, apply cold compresses to the inflamed side at intervals of 20 minutes, then change to warm ones.

Drink more fluids, especially water. It removes harmful substances from the body. Avoid alcohol.

Rinse your mouth with a salt water solution. This clears the wound of dead cells and relieves inflammation. But you should not apply pressure in the area of the hole - you can provoke the displacement of the blood clot. You should rinse your mouth after every meal and before going to bed.

You can also apply a drop of clove oil to the wound to relieve pain. Rinsing with sage and chamomile flowers, a decoction of burdock leaves and aspen bark, and anise infusion will also have a positive effect.

If after all the treatments the pain has not subsided, the swelling has not subsided, and your health has only worsened, then you should urgently consult a doctor. There is a high probability that the process of rotting has begun.

In the dental office, the doctor, under anesthesia, will clean the hole or prepare the gums - depending on the degree of neglect of the case. Fill it with antiseptic gel.

When is the wound guaranteed to heal after removal of the “8” (wisdom tooth)

The resulting hole “heals” and heals within two to three weeks. The healing process begins with the formation of a blood clot, and epithelium forms on the surface of the wound. After complete healing, weight bearing on the operated area is allowed.

If the wisdom tooth was removed by a surgeon without complications, the wound will heal in about 15-18 days.

If certain problems arose (for example, the tooth had several roots), this period may increase to 25 days.

Only a dentist can evaluate the process of healthy or pathological wound healing. Ideally, it is recommended to visit a specialist’s office 5-7 days after removal of the “eight” to avoid complications.

Diagnosis and treatment methods

Diagnostics at a dentist's appointment will help confirm the symptoms of a dry socket. After an examination, the doctor will prescribe treatment. As a rule, it depends on the stage of inflammation. In the case of a mild form, drug treatment with antiseptics and anti-inflammatory drugs is possible. At the middle stage, you will need antibacterial therapy, as well as cleaning the hole from pus and filling it with an anti-inflammatory drug. All actions are performed under anesthesia. If necessary, antibiotics are prescribed.

At the third stage, the most advanced stage, the patient may need hospitalization and even surgical intervention. With proper care and no complications, the hole heals within seven days. And a month later there is no trace left of her.

How to remove a tooth

There are two extraction methods used in dentistry: simple and complex. Their choice depends on which teeth are being removed - premolars and molars with tangled branched roots are removed using a complex method. It is very difficult to pull out such elements entirely due to the fact that the tooth socket is penetrated by retaining ligaments and alveolar processes. Errors during the procedure or insufficient experience of the specialist lead to serious complications. Therefore, even despite the acute condition, always find out in advance where you can have a tooth removed from a good doctor with positive recommendations.

Factors complicating the operation:

complete destruction of the coronal part;
high fragility;
acute inflammatory diseases;
Unerupted or misaligned wisdom teeth.

The technology of the procedure depends on which teeth are removed. In some cases, tissue incision and suturing are performed.

Wisdom tooth removal

Wisdom teeth are considered full-fledged elements of the oral cavity. They are involved in chewing food (if they are located above each other and have contact), and can act as a support for bridges and removable dentures in the future. There are specific indications for extraction in their case. For this reason, the decision about whether wisdom teeth need to be removed is made only by the attending physician.

The most common problem with eighth teeth is their growth. Only some teeth form and grow completely without complications, but often these processes are accompanied by a number of difficulties:

semi-retinated or impacted elements that have formed in the bone tissue, but have not erupted or only partially erupted. Their position can be vertical, horizontal, or with their roots outward. Because of this, neighboring elements suffer, constant pain appears;
violation of position (dystopia). Since wisdom teeth erupt without predecessors (baby teeth), and the jaw bone is already formed and does not develop, the position of the elements is often incorrect. They injure the mucous membrane, overlap other crowns, and put pressure on neighbors. This leads to inflammation. The doctor will determine whether the position can be restored with orthodontic treatment or whether it is better to remove the wisdom tooth;
appearance of a gingival hood. When slowly cutting through the mucosa, an area is formed in which bacteria and food debris accumulate, which are difficult to clean. This leads to acute inflammation, which can provoke the appearance of pus;
destruction, caries. Elements may appear immediately underdeveloped with carious lesions.

The doctor determines whether wisdom teeth should be removed or not based on complaints and the clinical picture. Problems with even one or two teeth interfere with the normal functioning of the entire dental system. Pain appears when opening the mouth and chewing. The bite and position of the incisors may even change.

How a wisdom tooth is removed depends, as in the case of permanent elements, on the condition of the dental system. In the absence of contraindications, manipulation is carried out with ordinary forceps.

Root removal

How is the root of a tooth removed if the tooth is completely destroyed? Despite this situation, extraction is not always recommended. If, after diagnosis, the doctor determines that the root can be used for an inlay, then the tooth is restored with a crown. But if there is pain, an unpleasant smell and taste, or swelling has developed, then dental care is required urgently. In this case, the question of whether to remove the roots of the teeth is decided in favor of the operation, since the neglected condition can also lead to the loss of neighboring elements.

Regardless of the chosen technique, pain relief and X-ray control are required after removal. This allows you to make sure that there are no root fragments in the cavity, since it is often loose and can crumble under slight pressure from the forceps.

Treatment in the clinic

The optimal solution for treating a diagnosis of dry socket or alveolitis is a visit to the dentist. It is better to go to the same doctor who performed the tooth extraction, since he already knows the course of the operation, did the diagnostics and remembers the characteristics of your body.

Whatever clinic you choose to contact, study its website, the doctors who work there and reviews.

At the RUTT dental center we use the latest equipment and advanced materials. The experience of our doctors is confirmed by numerous diplomas, certificates and awards. You can be sure that you will be in the hands of a reliable specialist.

Recommendations after removal

Regardless of which tooth you removed or just its root, you must follow the rules of the rehabilitation period. Then healing takes place quickly and without complications.

Do not eat for 2-3 hours after surgery.
Eliminate hot and solid foods from your diet for 7 days.
Carefully walk around the socket when brushing your teeth.
Do not pick out the blood clot and try not to disturb the hole with your tongue until it is completely healed.
Don't rinse your mouth.

The Vimontal Clinic carries out operations of any complexity using advanced equipment. This allows you to provide assistance with maximum comfort and safety.

Doctors providing this service

Modern surgical dentistry makes it possible to avoid tooth extraction in most cases, but tooth extraction is still sometimes necessary.

An operation to remove a tooth should be performed only as a last resort, when other methods to save the tooth are no longer possible or when the tooth may cause other, more serious complications.

Indications for tooth extraction

A fairly common indication for tooth extraction is the need to sanitation the oral cavity in the presence of chronic periodontitis in the acute stage, when it is impossible to eliminate the inflammatory focus at the apex of the tooth.

In some cases, tooth extraction is performed to avoid more serious complications. For example, if you have teeth that can cause a cyst, inflammation or neuritis of the trigeminal nerve. If a tooth constantly injures the tongue or the mucous membrane of the cheek, and also interferes with a normal bite, it is also better to remove such a tooth. Multi-rooted teeth, which are the cause of odontogenic osteomyelitis, are removed. When fitting a removable denture, sometimes it becomes necessary to remove teeth, but there must be strict indications for this.

Surgical operations to remove a tooth are performed under effective anesthesia, taking into account all contraindications.

Teeth are removed when they are severely damaged by caries, affected by advanced periodontal disease (“sick gums”), have been broken so that they can no longer be restored, are incorrectly positioned in the mouth (for example, an embedded wisdom tooth), or in preparation for orthodontic treatment.

Before starting tooth extraction, the dentist examines the oral cavity, takes x-rays of diseased teeth, and evaluates their condition.

After a tooth is removed, the teeth adjacent to it begin to gradually shift, sometimes quite significantly, and this can greatly affect the general condition of the teeth. Removing even a single tooth can create serious chewing problems. To avoid these complications, the dentist will recommend replacing the extracted tooth with an artificial one.

Considering all the advances in operative surgery today, most patients prefer to replace the existing dentition defect by placing a dental implant (advantages of using dental implants), dental bridges or removable partial dentures.

Wisdom teeth removal

The removal of wisdom teeth is due to slightly different reasons. Naturally, the above reasons for tooth removal also apply to the removal of wisdom teeth, however, this case has its own characteristics.

Problems with wisdom teeth often arise as soon as they erupt. They erupt at the age of 18-25 years (sometimes much later), when the dentition is formed by 28 teeth, which leads to incorrect placement of wisdom teeth in the dentition (the lower wisdom teeth are more often displaced), immersion (incomplete eruption with a tilt in the vertical, horizontal, distal or medial direction). In addition, misaligned wisdom teeth can cause damage to adjacent teeth, putting pressure on them and causing root damage and resorption, as well as displacement and malocclusion.

There are no dental rules determining the most acceptable age for wisdom tooth removal. However, practice shows that the sooner you get rid of these teeth, the fewer complications you can expect from them in the future.

If the wisdom tooth is in the wrong position or has not fully erupted, this leads to pericoronitis (inflammation of the tissues surrounding the tooth), because Part of the tooth is located under the gum and food debris accumulates in the gum pocket, which is an excellent breeding ground for various microorganisms. Wisdom teeth are often affected by caries, because... Between it and the second molar, food debris also accumulates and plaque forms due to the fact that this space is difficult to clean with a toothbrush. In this case, caries affects not only the wisdom tooth, but also the second molar adjacent to it.

refrain from eating for 2-3 hours after removal;
do not drink alcohol or take a sauna on the day of surgery;
do not touch the hole with your tongue or any objects;
do not eat hot food;
do not rinse your mouth.

Stages of wound healing

The duration of the recovery period is due to the fact that after extraction, complex rehabilitation processes must occur in the gum, affecting not only soft tissues, but also the bone structures of the jaw.

Gum fusion

Immediately after extraction, the gums begin to heal - instead of the tooth that the doctor removed, a blood clot forms. It hermetically fills the empty hole, preventing infection from entering the wound or bleeding from developing. The clot contains white blood cells - T- and B-lymphocytes, neutrophilic leukocytes, immune proteins (antibodies and interferon). They complement the barrier function of the gum mucosa and do not allow bacteria to multiply.

Up to 3-4 days, the patient can see a wound with smooth edges, inside of which there is a dark gray-brown substance - a blood clot. You cannot remove a blood clot from a wound, so as not to cause bleeding or the development of alveolitis (inflammation of the gums at the site of tooth extraction).

On the 3-4th day, white films may appear on the surface of the gums - this is considered a good sign, because it means that the gums have begun to heal. Films should not be removed under any circumstances.

The gums heal completely in about 2-3 weeks. Outwardly, this manifests itself as the absence of a wound in the gum, its pale pink color, no different from the surrounding mucous membrane, and painlessness in the area of the extracted tooth. But sometimes the timing of regeneration may shift:

Most often, wisdom teeth have many roots, which are strongly curved and difficult to remove from the alveoli. If the removal was long, the period of primary healing may shift by 4-5 days and amount to about 25 days.

Infection and the development of inflammation in the wound can extend the rehabilitation period by another 1-1.5 weeks. The reason for this may be the absence of a blood clot or the patient’s attempts to remove it from the wound at home.
Bone density in the area of the extracted tooth. Wisdom teeth wounds in the upper jaw heal faster because the strong outer layer of bone is thinner. Thanks to this, the removal of a wisdom tooth in the upper jaw is usually less traumatic, and the size of the wound is not as extensive as in the lower jaw.

Upon completion of this stage, the patient can begin preparing for prosthetics, since the gums have healed and are able to withstand the chewing load. But the bone tissue that will replace the cavity from the extracted tooth has not yet formed.

Formation of primary bone (callus)

After the gums heal, the hole begins to fill with coarse-fiber (unformed) bone tissue. This process takes 1.5-2 months, and as a result, a bone is formed with an irregular arrangement of hard bone cells in it.

It replaces the scar tissue that previously formed deep in the gums and serves as a framework for the formation of mature bone with an ordered structure of the beams.

Formation of secondary (mature) bone tissue

Gradually, the callus is replaced by mature tissue, in which the beams occupy an ordered position, the same as the bone of the sockets of neighboring teeth. The trabeculae of the mandibular bone are usually placed obliquely or horizontally, or in the form of loops, and have medium-sized cells with spongy substance.

In the bone of the upper jaw, the cells are small, mostly located vertically. This stage lasts up to 4 months from the moment of extraction.

Fusion of the gum with the periosteum

The gum at the extraction site is immovably fused with the periosteum of the jaws. Attachment of the gums to the regenerated bone begins no earlier than 4 months after tooth extraction. However, gums may take longer to heal: if complications develop, this stage may be delayed for a period of six months to 10 months.