Common Problems Affecting Wisdom Teeth

Common problems affecting wisdom teeth
Common problems with wisdom teeth include: -
• Pericoronitis
• Impacted wisdom teeth
• Decay of the wisdom tooth or the tooth next to it
• Cyst formation

Investigations: -

Having competed the normal clinical investigations, radiographs may need to be taken.

The best view to use is a periapical of the TIQ.   A parrelling technique should be used to give the most useful result.   The geometrically accurate projection shows true relationships between the tooth and the adjacent structures.

Oblique laterals may be taken to show both the upper an lower molars and may be especially good if looking for a cyst.   However, the distortion suffered means the relationships show are not accurate.

OPG – Excellent for the view of the surrounding bone when adjacent lesions are present (cysts).   Excellent for multiple 3rd molar extratcions and to assess the ease of extraction

Likely treatment for decay of wisdom tooth or 7’s

These teeth can often be treated wih simple restorations

Likely treatment for wisdom teeth with cyst involvement

Firstly the symptoms may need to be treated as the patient may present with an infected cyst which can cause pain swelling and discharge.   Most cysts will not have been 2ndry infected howver so may present as painless swelling.   Its also worth being mindful that Mandibular cysts can lead to pathogenic fractures.

Specialist treatment   is needed and involves: -

• Enucleation with primary closure – this is the most common treatment
• Enucleation with packing and delayed closure – this is used for badly infected cysts, particulrily large ones.   Pack with whiteheads varnish or BIPP Bismuth iodoform paraffin paste
• Marcipulisation – This is the opening of the cyst to allow continuity with the oral muscosa.   Healing is slower than with enucleation and the cavity persist for some time.   It is useful to allow tooth eruption through the cyst or where enucleation is C/I