Exodontia.Info
Wisdom Teeth Treatment Options
Improved & Targeted Oral Hygiene

A wisdom tooth that is only partially through the gum or
has a flap of skin overlying it (an
operculum), can be
prone to decay, gum disease or inflammation-infection of
the tissues surrounding the tooth’s crown.

If the
wisdom tooth does not need to be removed (see the
NICE Guidance on the Extraction of Wisdom Teeth), then
it can be kept but will need targeted oral hygiene.

This involves very scrupulous cleaning around the tooth
(+/-
operculum) possibly using such adjuncts as antiseptic
mouthwashes or gels (
Corsodyl is very good for this).

Problems with the procedure:

Future flare-ups with the wisdom teeth can still occur
especially if stressed, moving house, sitting exams etc.

May be regarded just as a stop-gap measure,
delaying the day that the tooth may need to be
removed.

The
NICE Guidelines emphasise the link between the
presence of
plaque and peri-coronitis (inflammation /
infection around the crown of the wisdom tooth,
NICE
Guidance on the Extraction of Wisdom Teeth, 1.4
)


Operculectomy

If the flap of gum overlying the wisdom tooth (the
operculum) is causing the problem, then this can be
removed by a number of means (‘cold steel’, glacial acetic
acid, laser or cautery).

Problems with the procedure:

It possible that this may grow back and the
operculectomy may need to be repeated.

In the area where the
operculum is removed, runs the
Lingual Nerve that supplies sensation to the tongue
(and if this is effected by the
operculectomy, a numb
tongue may result as well as loss of taste on that side
of the tongue; the numbness can last up several
months) and sometimes aberrant blood vessels (that
can be surprisingly vigorous in bleeding).

Coupled with this, it can be quite sore afterwards and
there may be limitation of mouth opening.

If the wisdom teeth flare-ups have been quite
episodic, then it may be hard to know if the
operculectomy has in itself, been successful.

An
operculectomy is sometimes considered if the upper,
opposing wisdom tooth is traumatising the
operculum.  
SIGN suggests pain associated with the lower wisdom
tooth is commonly exacerbated by the upper wisdom tooth
biting on the gum flap (
operculum), causing pain and
discomfort.

Alternatively, if the upper wisdom tooth is easy to remove
and is non-functional, then immediate removal of that tooth
will often dramatically relieve the pain from the area.  This
is particularly useful where there is likely to be delay in the
removal of the lower wisdom tooth and can be regarded
as an interim measure (after referral but prior to surgery).


Exodontia / Tooth Extraction

Wisdom teeth are removed only if the reason for removal
is mentioned in the
NICE guidelines.

Wisdom teeth cannot be
prophylactically / preventively
removed.

Just because wisdom teeth are present, it does not mean
they have to be removed.

The guidelines boil down to waiting for some pathology
to develop – decay, gum disease,
infection around the
tooth crown, cyst development etc.  This is regarded by
some as
supervised neglect.

Problems with the procedure:




  • temporary local swelling



Patients should not be exposed to these risks of a surgical
procedure unnecessarily.


Coronectomy

If the roots of the wisdom tooth seem to be in very close
proximity to the nerve that supplies sensation to the lip and
chin (the
Inferior Dental Nerve) or if the tooth itself is deep
within the lower jaw so that total removal of the tooth may
be impractical / ‘tricky’ /
damage the nerves / lead to a
possible
broken jaw, then only the crown of the tooth may
be removed (
coronectomy / intentional partial
odontectomy).

Problems with the procedure:

If, when the tooth is being decoronated, the roots are
found to be mobile, then the roots have to be removed as
well (hence, the original problems of nerve damage etc are
not circumvented).

The roots left behind often migrate away from the nerve so
that if they give any more problems, the roots can be
removed with reduced risk to the nerve.
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Last Updated 11th August 2010