Third Molar Assessment Flashcards
what are some common things that can happen with third molar?
impaction: against adjacent tooth, bone or soft tissue
- food packing
- caries
- abnormal path eg. cuts
what type of impaction is this ?
mesio-angular impaction
- food trap causing inflammation
what are the different types of impaction can you get on mandibular third molar teeth ?
what are the different types of impaction can you get on maxillary third molar teeth?
- vertical
- disto- angular (most common)
- mesio angular
what are the signs and symptoms
what can happen to third molars and why are they a problem ?
Pericoronitis (can get with any tooth)
Infection
Caries
Pathology (cysts / tumours)
Resorption (internal / external)
Trauma
Orthognathic surgery
what is pericoronitits?
An infection of the soft tissue around the crown of a partially
erupted tooth.
Usually cased by normal oral flora.
Common.
what are the causes of pericoronitits ?
- Compromised host defences eg. diabetes or meds
- Poor oral hygiene
- ‘Trauma’ – often from opposing dentition
- Food trapping under the operculum
- Bacterial infection
- Prevotella intermedia
- Fusobacterium species
- Anaerobic streptococci
- Poor oral hygiene
what are the local symptoms of pericoronitis?
Pain
Halitosis
Swelling
Erythema
Bad taste
what are the systemic symptoms of pericoronitis ?
Trismus
Pyrexia
Lymphadenopathy
Malasie
Dysphagia
when should we be concerned if a pt has periocoronitis?
if infection spreads to submandibular or submental region making it difficult to swallow
how do we locally manage periocornitis ?
Irrigation with saline
Oral analgesia (paractemol / NSAIDs if no C/I)
Oral rinse warm salt water / CXD m/w – check sensitivities
how do we manage pericoronitis systemically ?
ABCDE to check if theres any life threatening signs
Irrigation with saline
Oral analgesia (paractemol / NSAIDs if no C/I)
Oral rinse warm salt water / CXD m/w – check sensitivities
PLUS
Broad spectrum antibiotic for 5/7
Amoxicillin 500mg TDS
Penicillin V 500mg QDS
Metronidazole 400mg TDS
how do we asses pts with third molar problems ?
when we asses third molars what are the the 3 factors we need to consider?
why is age important?
Increased morbidity with age
physiological changes
co-morbidities
recovery period
polypharmacy
why is social history important>?
Smoking
Vaping
Alcohol
Diet
Occupation – “If you can’t bite you can’t fight”
= we remove third molars before hand for ppl who can’t access dental care to prevent problems in the long run eg. armed forces
Access to care
Post-operative Care
why is drug history important ?
Steroids
Bisphphosphonates
Biologics / Immunomodulators
Antiplatelets / Anticoagulants
why is BMI important?
increased can lead to issues like: diabetes, hypertension, cardiovascular diseases and small mouth and difficulty with access
why is ethnicity important ?
dense bones from afrocarribean
why is capacity important?
need this for consent
why is anxiety important?
- use MDAS
why is the tooth itself important ?
how does it appear?
Fully erupted
Partially erupted
Presence abscence of disease / infection
what are the 2 nerves we need to be mindful about when extracting ?
IAN
lingual
descrie IAN ? innervation?
- enters mandibel thru mandibular foramen
- this nerves runs thru mandible and then crosses mandible then goes from lingual to buccal
- provide sensation to lower teeth, gums, lip skin of chin
describe lingual nerve ? innervation?
- runs alongside IAN but is more superficial
- innervates tongue
what runs alongside IAN?
what is important about the apices of the upper molars ?
run next to maxillary antrum
how do we assess abnormal x rays
what are some red flags in xrays
what are we looking at then looking at xrays ?
what are we looking at when assessing third molar xrays ?
- Relationship to vital structures
➢ Configuration of roots
➢ Condition of the surrouding bone
➢ Apical
when would we consider a CBCT?
why is surrounding bone important when imaging?
what is the depth of impaction?
- where we would place instrument
who are at risk of third molar complications?
Underlying systemic disease
Increased age
Infection
Anatomical position of tooth / root morphology
Local anatomical relations
Status of adjacent teeth
Reduced access
Dense bone
Lack of PDL space – ankylosis
Pathology
Poor patient cooperation / compliance
