Management of patients with 3rd molars Flashcards
What is impaction?
impaction occurs where there is prevention of complete eruption into a normal functional position of one tooth by another due to lack of space (in dental arch), obstruction by anothe tooth or development in an abnormal position
What does a complete impaction refer to?
when the impacted tooth is entirely covered by soft tissue and partially or completely covered by bone within the bony alveolus
What does a partial eruption refer to ?
when an impacted tooth has failed to erupt into a normal functional position
What is clinical emergence?
this is a term preferred to descrive the event of the clinical appearance of a tooth in the oral cavity
What is eruption?
- physiological process
- associated with root development
- eruption is often complete well before apex closure
Although ankylosis is rare with wisdom teeth, when can it occur?
tends to occur after middle age
When is a tooth considered to be ectopic ?
if it is malpositioned due to congenital factors or displaced by the presence of pathology
When does third molar emergence normally occur?
between 18 and 24 years old
eruption is not uncommon outside of these limits
Impaction is an abnormality of development which predisposed to pathological changes such as …
- pericoronitis
- caries
- resorption
- periodontal problems
What are the indications for the removal of impacted 3rd molars?
- overt or previous history of infection including pericoronitis
this generally excludes transient/self-limiting inflammation that may be associated with normal eription of any tooth
- unrestorable caries
- non-treatable pulpal or periapical pathology
- cellulitis, abscess and osteomyelitis
- periodontal disease
- orthodontic abnormalities- before commencement of maxillary retraction
- prophylactic removal in the presence of specific medical and surgical condition
- faciliation of restorative treatment including provision of prosthesis
- internal/external resorption of tooth or adjacent teeth
- pain directly related to a 3rd molar
- tooth in line of bony fracture/impeding trauma management
- fracture of tooth
- diseae of follicle including cyst/tumour
- tooth/ teeth impeding orthognathic surgery or reconstructive jaw surgery
- tooth involved in/within field of tumour resection
- satisfactory tooth for use as donor for transplanatation
When should an impacted tooth not be removed? What should be done instead of removal?
totally covered by bone and does not meet any indications for removal
- monitor by clinical and radiographic examination
State two instances in which there is a high risk of consequential local disease in third molars
- vertical or distoangilar impacted tooth is at or close to occlusal plane but half/more than half of the occlusal surface has been covered by soft tissue for an extended period of time - pericoronitis
- when partly erupted impacted wisdom tooth in mesioangular or horizontal impaction has a contact point at or close to the amelocemental junction of the second molar; the risk of caries of the second molar increased
When may consideration be give for earlier (rather than later) third molar removal ?
patients with borderline indications for 3rd molar excisions and whose occupation will necessitate long periods away from civilisation e.g. astronauts, nuclear sub marines, explorers
What instances may permit the removal contralateral/opposing 3rd molars?
- treatment under GA
- selected by the patient
- no evidence of increased post-operative complications such as sensory nerve impairment
What does DSD refer to ?
Days of standard discomfor
