:: Extractions

     One of the main goals of modern dentistry is the prevention of tooth loss. All possible measures should be taken to preserve and maintain your teeth because the loss of a single tooth can have a major impact upon your dental health and appearance. However, it is still sometimes necessary to remove a tooth. Here are some of the reasons a tooth may need to be extracted.

:: Severe Decay :: Advanced periodontal disease :: Infection or abcess :: Orthodontic correction :: Malpositioned teeth :: Fractured teeth or roots :: Impacted teeth

Wisdom tooth extraction or Impactions
    Many people require removal of their third molars also known as wisdom teeth. As with any surgical procedure, there are some possible risks and complications. The decision on third morlar removal should be decided by a patient and their dentist.
Is it necessary to remove wisdom teeth?
Wisdom teeth are a valuable asset to the mouth when they are healthy and properly positioned. Often, however, problems develop that require their removal. When the jaw isn't large enough to accommodate wisdom teeth, they can become impacted (unable to come in or misaligned) Wisdom teeth may grow sideways, emerge only part way through the gum or remain trapped beneath the gum and bone.

Extraction of third molars is generally recommended:
· When wisdom teeth only partially erupt;
· When there is a chance that poorly aligned wisdom teeth will damage adjacent teeth;
. When a cyst (fluid-filled sac) forms, destroying surrounding structures such as bone
   tooth roots.
   The most common reason people choose to remove their wisdom teeth is that their mouth is too small for these teeth to normally erupt behind the second molare into a good position. This can result in one of the following situations: 

1. Complete Bony Impaction when the wisdom teeth are completely covered in bone. When the tooth is completly covered with bone it will remain completly covered with its "developmental sack" in which all teeth develop. Later in life, this sack may undergo changes and enlarge and develop ionto a cyst. This cyst will enlarge at the expense of the bone of the jaw. These cysts should be removed and and examined by a pathologist.

2. Partial Bony Impaction whenThe teeth begin to erupt but are not able to erupt completely. In this situation, the upper third molars usually are poisitoned towards the cheek while the lower third molars usually lean forward with only part of the crown sticking through the gum. This situation can to decay and gum disease around the second molar directly in front of it.

   The most common complication of the partial bony impaction, is that the flap of gum tissue which partially covers the erupting third molar, creates a pocket where bacteria that are present in the mouth can grow and and cause an infection known as pericoronitis. The swelling and infection can become very serious. The treatment for pericoronitis is extraction of the third molar tooth.
   Some dentists believe that wisdom teeth may push the other teeth in the mouth forward and cause crowding and misalignment of the lower front teeth. Not all dentists believe that this actually happens.
The risks and complications involved in the removal of third molars are:

PAIN
  Surgical removal of the third molars can lead to some discomfort and pain. This is usually treated with pain medication.

INFECTION
  Because of the large number of bacteria present in the mouth post surgical infection is always possible. Patients are usually placed on prophylactic antibiotics to prevent infections from developing.

SWELLING
  Following surgery patients may experience swelling and bruising. These symptome vary between patients.

BLEEDING
  Some post surgical bleeding is considered normal. This is usually minimal and is easily controlled with the pressure of biting on gauze.

INVESTIGATION
  Examine the area and take X-rays if needed. X-rays can show where your wisdom teeth are and if they are impacted.

TREATMENT
  You can sometimes relieve minor irritation by rinsing with warm salt water (1/2 teaspoon of salt in 8 ounces of water) or by taking over-the-counter painkillers.
If the tooth continues to cause pain, it is infected or is interfering with nearby teeth; the usual treatment is for the tooth to be extracted.This can be done in our clinic with a local anesthetic, depending on how far the tooth is under the gum. Extracting one tooth can take 5 to 30 minutes, depending on the position of the tooth.
  We have an oral and maxillofacial surgeon to have an impacted tooth removed. It is not uncommon to have all the wisdom teeth removed to prevent problems in the future. This usually is done in the surgeon's office with sedation and local anesthesia.
Before the extraction, our oral surgeon will talk to you about the procedure and what type of anesthesia and sedatives he or she will use. You will not be able to eat for six hours before surgery and should take all your medications on schedule. Someone should drive you to the appointment and take you home.
  Follow the oral surgeon's instructions carefully to minimize problems.
If the impacted tooth is not causing irritation or affecting nearby teeth, you won't need immediate treatment. However, it is recommended that the tooth be extracted to avoid problems later.
  Although not all impacted teeth lead to problems, many will. In addition to causing pain and possibly infection, impacted wisdom teeth can decay just like teeth that have emerged through the gum. An impacted wisdom tooth also can lead to the development of a follicular (dentigerous) cyst, which can damage nearby teeth and has the potential to destroy nearby bone.
  Often, it is better to have wisdom teeth extracted before age 21, sometimes as early as age 16. The surgery often is less complicated, and the area, including the surrounding tissue and bone, heals better than if they are removed later in life.

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