L25 Management of third molars

Question 1

What can exacerbate pericoronitis?

Answer 1

Trauma from opposing upper tooth

Question 2

What are the tx options for pericoronitis?

Answer 2

• Curettage the pocket and irrigate with Chx
• Flap cauterisation (uncommon)
• Grinding opposing tooth or extracting to reduce trauma to the operculum
• Remove the flap (operculotomy)
• Extract the tooth

Question 3

Should you extract a tooth in an episode of acute pericoronitis?

Answer 3

NO- high predisposition to acute alveolar osteitis

Question 4

What pathology would indicate third molar extraction?

Answer 4

• Resorption
• Caries
• Cysts

Question 5

How would you describe the position of an impacted wisdom tooth?

Answer 5

Question 6

What needs to be included in a pre-op assessment for wisdom tooth extraction?

Answer 6

• Angulation of tooth (vertical impaction = challenging)
• Caries, restorations, fractures
• Number of roots and pattern (conical, divergent, hooked)
• Root relation to ID nerve
• Pathology, ankylosis, resorption
• Height of mandible in relation to wisdom tooth crown
• Bone (age related changes, ankylosis)
• Adjacent teeth

Question 7

What features indicate a tooth closely associated to the ID bundle?

Answer 7

• Deviation of roots
• Deviation of canal
• Narrowing/constriction of tooth roots
• Dark+bold apices of tooth
• Visible on OPT or CBCT

Question 8

Describe the principles of surgery.

Answer 8

• 2 sided or 1 sided flap
• Elevator held 45 degrees to the tooth
• Divide tooth vertically along long acis or horizontally, use a drill or osteotome

Question 8

Describe the principles of surgery.

Answer 8

• 2 sided or 1 sided flap
• Elevator held 45 degrees to the tooth
• Divide tooth vertically along long acis or horizontally, use a drill or osteotome

Question 9

What are the post-op complications?

Answer 9

• Inflammation
• Pain, maximum 12-18 hours post surgery, lasts 5-7 days
• Pre-emptive analgesia and regular post-op analgesics recommended
• Trismus for first week
• Maximum swelling 3-4 days post durgery
• May be neck bruising

Question 10

When is ibuprofen contraindicated?

Answer 10

• 3rd trimester of pregnancy
• Cardiac disease
• Renal disease
• Asthma
• Lithium/digoxin/warfarin

Question 11

What is the average infection rate post-operatively for wisdom tooth removal?

Answer 11

<10%

Question 12

What is recommended post-surgery?

Answer 12

• Regular analgesics
• Corsodyl to reduce risk of post-op infection or inflammation
• Abx if surgery lasts more than 30 minutes (anaerobic gram positive cocci and anaerobic gram negative rods, penicillin effective)

Question 13

Which nerve is most commonly damaged in lower wisdom tooth removal?

Answer 13

Lingual nerve

Question 14

When do you follow up after wisdom tooth surgery?

Answer 14

2-3 weeks post surgery