wisdom teeth Flashcards
what is the overall risk of LN and IAN damage in high risk M3Ms extraction?
5% (1 in20)
when would you expect maxillary 3Ms extraction to be straightforward?
if buccally placed (thin buccal bone) and if conical roots
if roots are curved you can expect tuberosity # and posssible sinus involvement
What are NICE indications for the removal of 8s (2000)
unrestorable caries
non treatable pulpal or periradicular pathology
cellulitis, osteomyelitis, abscess
follicular disease incl cysts (dentigerous, OKC, ameloblastma)
fractured tooth
resorption of adjacent teeth
if the tooth is in the resection area of a tumor or reconstructive surgery
plaque retention and food trapping are not indications, but risk factors for pericoronitis
1st episode of pericoronitis (unless particularly severe) is also not indications, but second or subsequent is an inditcation
what are the risks associated with the removal of 8s
pain
swelling
trismus
infection
time off work
cost
nerve damage
What are the possible reasons to why older patients may suffer more complications after the removal of 8s as compared to young patients?
polypharmacy
reduced healing potential with age
less elastic bone/more diseased tooth
Clinically symptom free impacted wisdom tooth?- what do you do?
monitor regularly
with radiographs, as you want to see any possible damage to the 7s
it is not NICE compliant for the extraction
clinically symptom free unerupted wisdom tooth with the evidence of cystic change- what do you do
cystic change is a NICE indication for the removal
Acute pain from the lower left side. Evidence of pathology at the furcation of 1st molar and resorption of roots of the 2nd molar- what do you do?
resorption of the 2nd molar indicates the extraction, but how do you make sure that the 8 is responsible for the pain
Painful lower left wisdom tooth- first episode, no signs and symptoms of systemic infection, localised infection draining pus- what do you do?
Debride the area
analgesic advice
it is not NICE compliant indication for extraction
painful lower left wisdom tooth- first episode
evidence of serious spreading infection- what do you do?
spreading infection indicates extraction
Ludwig’s Angina
what are possible radiographic criteria for high-risk IAN injury?
darkening of the root
deflection of the root
narrowing of the root
dark and bifid apex of the root
interruption of white line of canal
diversion of canal
narrowing of canal
What does impaction mean?
When complete eruption is prevented, but root formation is complete
Can be associated with pathological changes, but impacted wisdom teeth can also be disease free and asymptomatic
Local vs general factors failure of eruptio
Local:
Displaced follice
Crowding, space loss
Supernumerary
Pathology eg cyst, tumour, fibrous dysplasia
General:
Down’s syndrome
Skeletal disorders- rickets
Developmental conditions- cleidocranial dysostosis
Causes of nerve damage
Direct mechanical trauma- tear, sectioning, crush, stretch
Neural chemical trauma due to Intracellular components released during trauma eg haemoglobin irritates neural tissue
Ischaemic injury due to entrapment within a bony canal (IAN) with continued bleeding or scar formation
Neurapraxia
Contusion, continuity is maintained (of epineural sheat and axons)
Eg blunt trauma, traction, local ischaemia
Should recover spontaneously
