Parents are usually at some point have to decide whether to agree or disagree on the operation to remove wisdom teeth, which will almost certainly be offered to the adolescent. In the U.S., this operation is considered to be preventive. Its purpose - to avoid future problems.
Immersed wisdom teeth
To indicate the position of embedded wisdom tooth dentists use special terms. The most common type of embedded wisdom teeth - teeth with medial immersion. The term "medial" means that the wisdom tooth is angled forward, toward the front of the mouth.
Other types of immersion (indicated here by the degree of frequency of occurrence in medical practice) - teeth with vertical immersion, horizontal immersion and distal immersion.
Teeth are also divided on the teeth and bone tissue immersion. The term "bone immersion" means that the wisdom tooth in the jaw bone. "Tissue immersion" says that the wisdom tooth went through the bone, but was unable to fully pass through the gums.
To have or not have?
Wisdom teeth . The third large molars, in the extreme dentition. Often referred to as "eighths." Erupt is usually the most recent 17-25 years of age, often - later.
They may not be? Can. For some people, they really do not pawned. If the wisdom tooth is not visible in the mouth, it does not mean that it is not under the gumline. Panoramic picture will help determine if they are shot at a doctor can make a forecast, whether they erupt properly or adversely affect the adjacent teeth. Is it true that they are not needed? It is not true. Their main function, like any other tooth - the chewing of food. If they are involved in chewing, without causing negative impacts on the surrounding tissue, there is no need to remove them. Then why do so many of them disposed of? Modern food is mild and does not require a major effort during chewing. Not receiving a large load, the bones of the jaws do not grow so much, and eighth teeth are simply not enough space. Then they are cut, "crooked", begin to injure the cheek (frequent biting), "abut" in adjacent teeth, causing them to geometrically impossible to properly clean (brush is missing), and even shift the teeth that are visible with a smile (teeth skuchivayutsya "bump "to each other) can form a cyst or tumor. Difficulties may begin at the stage of the eruption - the gums above the tooth swells, it hurts to touch, there are pains in swallowing and opening the mouth, sometimes the body temperature rises, there are chills and weakness.
Revision of finding teeth on each other has not been confirmed scientifically, and not all dentists accept it.This does not mean that the teeth never shifted and become irregular, just this type of bias does not necessarily caused by the growth of wisdom teeth, at least, the study did not find such a relationship is likely, it's just a coincidence. This is partly supported by the fact that people whose wisdom teeth are absent (congenital absence of wisdom teeth) also observed a defect crowded dentition. Although it happens infrequently, the yield on the surface of properly oriented wisdom tooth can damage the second molar (wisdom tooth facing). This phenomenon is somewhat similar to the precipitation of primary teeth. When the baby teeth fall out, it seems that they have no root. This is not the case, once the baby tooth root, but way out of permanent teeth has led to bone resorption (disappearance) of the root, so fallen stripped of his baby tooth. The same thing happens when properly oriented wisdom tooth trying to come out, it can cause root resorption of second molar. In the worst case would have to remove both the tooth and prevents the normal development of the wisdom tooth, and the damaged second molar.
So, there is a need for these teeth in humans of the 21st century? A moot point.
Removal of submerged bottom teeth is fraught with complications more severe than removal of the upper.
Evolution
Evolution - a complex process, described by many distinguished from each other's theories, which are re-examined in light of emerging genetic discoveries. One common and widely accepted explanation of dental evolution states that the molars evolved when human ancestors roamed the earth on four legs - more than 100 million years ago. These animals are opposed to the environment by using only one head, and the use of the forelimb movement was limited to banal. The head has been moved back, and jaw and teeth are pushed forward. The teeth were the main tool of survival used in the catching, killing and eating of raw production, and in rivalry and clashes with enemies, while collecting, handling and eating plant foods, ie,large jaws were an advantage for the survival of the species. The dependence of the survival of the teeth began to decline with the transition to upright posture. The front appendages are formed in the arm to use items for hunting, gathering food and fighting - the tasks that were previously handled almost exclusively by teeth. This skill is developed further in the last million years, leading to the creation of a strong offensive and defensive weapons, and portable instruments, which further reduced the dependence of survival on the teeth. The discovery of fire and the development of utensils allowed early humans to cook and soften your food to ensure the survival of man, even if he did not have teeth at all. As a result of biological and cultural evolutionary change dependent on all types of teeth, especially the third molars (another symbol of wisdom teeth), greatly diminished. Contemporary anomalies eruption of wisdom teeth may be associated with a decrease in the size of the jaw, which happened in a long time. However, the exact causes of these abnormalities and the mechanisms that control them, still remain unsolved.
Development
Review of biological events that lead to the development of third molars, sheds light on why these teeth are often developed with morphological deformity. Third molars - the only teeth, the formation of which is wholly occurs after birth. All the remaining teeth begin to develop before birth or, as in the case of permanent second molars, come to the stage of tooth germ shortly before birth.
By the end of the 17th century, people have experienced a huge increase in the prevalence of dental disease, most likely as a result of rapid changes in lifestyle and diet. From that time until the advent of modern dentistry in the early 20th century significantly increased prevalence of dental diseases associated not only with the wisdom teeth, but also with other teeth. Today, despite advances in the prevention of dental disease, the location of wisdom teeth is often difficult to care for them, and stunted growth of these teeth is much more inflammatory than the other teeth. It is difficult to estimate the actual incidence associated with the presence of third molars in modern humans because of the lack of reliable information.Most studies were short or were superficial study of clinical cases.
Some scholars argue against the conventional practice of removing healthy or not emerged from the gums wisdom teeth. These arguments are based on the possible complications after surgery. In short, the debate about whether to remove, when to remove and how best to treat wisdom teeth, are continuing.
Treat or remove?
Some patients receive functional benefit from the treatment of third molars, for example, when the third molar tooth is used as an abutment for fixed or removable denture. This situation often occurs when a loss of functional teeth. Some people have wisdom teeth removed rank second molars.
Other patients are removed. This procedure - the most common surgery in the practice of oral and maxillofacial surgery. The pain and morbidity associated with the removal of wisdom teeth - a well known fact. Their surgical removal, even used as a model for evaluating the action of analgesics, steroids, antibiotics, anesthetics and general sedation.
When you remove the third molar complications can occur during and after the surgical procedure. Removal of partially or fully-formed wisdom teeth - invasive surgical procedure, which is traumatic for the dentoalveolar tissue and psychological well-being of the patient. Pain, bleeding, swelling, infection, alveolar osteitis, damage to the inferior alveolar nerve and the adjacent tooth - here are some of the complications frequently encountered. Opening of the maxillary sinus, displacement of the broken roots, broke off the hill of the upper jaw also occur, but less frequently. Even death during the removal of wisdom teeth was recorded in the literature.
The expediency of removal do not cause anxiety impacted third molars as a preventive measure discussed in dentistry for many years, but there was no unanimous decision is not developed, the decision about whether to remove third molars, commonly based on the experience of practitioners. The Conference of the National Institutes of Health (National Institutes of Health) concluded that the wisdom teeth are an anomaly.Supporters of conventional surgical removal of wisdom teeth suggest that early removal is preferable to the potential degeneration and disease of the teeth afterwards. On the other hand, doctors who do not support the prophylactic removal of normal, it is believed that the risk of pathological degeneration and inflammation less than the risk of surgery.
A study recently published by the American Association of Maxillofacial Surgeons (AAOMS), was devoted to the question of the relationship between third molars and periodontal disease. AAOMS notes that formed on a partially erupted third molars bacterial biofilm and periokoronit, comparable with periodontitis. In addition, 25% of patients with asymptomatic wisdom teeth show signs of gum disease.
At a meeting of experts in the field of AAOMS Oral and Maxillofacial Surgery presented data collected in the 10 years of data to support the practice of removing wisdom teeth. According to Lewis Rafetto, DDS, head of the Working Group on the issue of AAOMS third molars, the purpose of the association was to once and for all resolve the matter through a large-scale evidence-based research. "We wanted to hear the perspective of different people - he says. - The meeting was attended by researchers from the UK, Canada, the countries of Scandinavia, as well as throughout the United States. In addition to dentists, the meeting was attended by epidemiologists, periodontists, representatives of insurance companies, experts in the field of public health, the people associated with the oral and maxillofacial surgery, and a military representative.
Larry J. Moore, president of AAOMS, argues that the basis for the research project was based on the need to prove common among oral surgeons view about the justification of practice removal of wisdom teeth.
The downside
In 2008, the American Public Health Association (APHA) issued a decision stating: "The available information about the risks associated with wisdom teeth, are not sufficient grounds for their prophylactic removal."
Meanwhile, the official position of the ASA for patients (no version for dentists) are not supported, but does not challenge this practice: "Wisdom teeth - it's not bad when they are healthy and properly arranged," however, "is often a problem." The organization recommends removing third molars only in the case of partial eruption - there is a chance that the wrong location, they can damage adjacent teeth or cause the development of cysts, and if they are severely damaged carious process; bitten cheek, hygiene difficult or displace other teeth in a row. We should also mention the prophylactic removal of wisdom teeth in patients who have traumatic sports. The American Academy of Sports Dentistry, presented the report, clearly demonstrates the dependence of mandibular fractures by the presence of eight teeth.
Although the AAOMS convinced of the correctness of his position, there are studies with conflicting conclusions. Among the critics of the practice of removing wisdom teeth the most active in the last 30 years is Jay Friedman, DDS, MPH. Visiting meeting of AAOMS, he contested a number of statements made there. Dr. Friedman is the author of several works, including the APHA policy statement and the feature article which was published in the American Journal of Public Health. In it Dr. Friedman notes that the annual 10 million operation to remove wisdom teeth, which are accompanied by costs and injuries, at least two-thirds are superfluous, and are associated with lifelong discomfort and health problems for tens of thousands of people.
There is another important point. Removal of wisdom teeth is very expensive. Only in the United States the cost of the operations to extract the third molars each year is estimated at more than $ 2 billion, excluding the cost of examination, radiographs, medications, anesthesia, surgical costs. The time lost for work, which ranges from one to six days, not to mention the loss in wages, are also worth a lot. The costs of insurance companies to remove third molars exceed the cost of any other surgical procedure, medical or dental. So to the supporters of the procedure is quite possibly not care about the health of the nation, and the desire to preserve the revenue stream.
The Future of wisdom teeth and the ability to change
Logic dictates that with dentistry in the 21st century should be applied scientific discoveries. One theoretical possibility - a deliberate slowing down of development before birth, when the fabric of wisdom teeth do not yet exist. Gordon, Laskin and Selinger and colleagues have made progress in preventing the development of using kriogenetiku during the experiments. Their study focused on how to stop the development of small permanent molars after initiation when considerable tooth tissue has formed. Since the "tab" third molars occurs at or near the surface of the jaw bone, in millimeters lower than the oral mucosa, and their location relative to available in childhood. In the more common mammals in which there is a third molar, the stage of development of these teeth are quite comparable to those in humans. Earlier studies have shown that selective developmental delay wisdom teeth can be achieved in several minimally invasive techniques that use electrosurgery and laser energy.Lack of allocation of certain growth factors derived from the presence of vitamin A derivative retinoic acid and ordinary food additives, according to the primary scientific literature, has had a tremendous impact on the initiation of tooth germ and early development of the tooth. It is possible to selectively stop the development of wisdom teeth, affecting the movement of a thin epithelial dental lamina or the initiation of tooth development of the embryo in the earliest stages of development using an extremely small amount of therapeutic agent injected locally. Since the third molar is missing from the birth to almost five years, there is a good time to get rid of wisdom teeth before they mature. Potential elimination of problems caused by third molars by preventing their development is an area for research, which is worthy of consideration. Over the past 30 years have witnessed great interest in biomolecular research related to the development of teeth. The result has been an intensive study of growing new teeth. It's time to look for methods to stop if necessary and their development.
At what age is better to remove wisdom teeth?
As to at what age is better to remove wisdom teeth, there are no strict guidelines. However, the unspoken opinion - up to 35 years. Statistics show that the increased risk of complications is associated with age.The doctor will not take the time to remove wisdom teeth as long as at least two-thirds of the tooth is not formed. On the other hand, if the doctor will wait for the moment when the root of the tooth is completely formed, remove the tooth will be even more difficult. Usually between the ages of 18 and 24 is considered ideal for the surgery to remove wisdom teeth. At this age, it is likely that the roots of wisdom teeth is not yet fully formed and the bone surrounding the tooth, less dense. In addition, young people above the ability to recover compared with older people, so the healing process will be easier.
Dr. Silvestri, Dr. Singh, the translation of Egorov
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