Removal of a wisdom tooth on the lower jaw

Quite often, wisdom teeth cause problems to a person. They erupt at approximately the age of 20-25 years, when the dentition has already formed and in most cases their appearance is accompanied by complications. The extreme molars do not serve any useful function, so dentists often recommend that patients have them removed.

It should be understood that wisdom tooth extraction is a rather complicated procedure for both the doctor and the patient, especially the removal of molars on the lower jaw.

When you need to remove the bottom "eight". Indications

Wisdom teeth are distinguished by late eruption, which occurs at 20-30 years of age. During this period, the dental system is practically formed and the third molars often do not have enough space in the dentition. Eruption causes various complications and in most cases requires removal of the molar. In addition, in humans, with evolution, a decrease in the size of the jaws occurs, since, due to the nature of nutrition, the chewing load is constantly decreasing.

Most people do not take good hygienic care of their last teeth. They are located at the end of the dentition, and it is often technically impossible to clean them well. This leads to the accumulation of plaque, damage to the enamel by the carious process and its complications (pulpitis, periodontitis). Root canal treatment is very difficult due to difficult access. Therefore, eights must be removed in 90% of cases.

Removal of a fully erupted wisdom tooth

Removal of the lower wisdom tooth is indicated in the following cases:

Excessive pressure on neighboring teeth, which can lead to their destruction;
Injury to surrounding tissues;
Constant biting of the mucous membrane of the cheek;
Carious lesion that cannot be eliminated due to difficult access;
Complications of caries: pulpitis, periodontitis, periostitis;
Dystopia – location of the molar outside the dentition;
A tooth that is a chronic source of infection;
Formation of perihilar cysts, granulomas;
Malocclusion and displacement of other teeth.

Removal of third molars

It is not always necessary to remove eights. If they have enough space in the jaw, they have normally located roots, grow vertically and erupt without complications, they can and should be preserved.

Indications for removal:

complicated eruption, which is accompanied by swelling of the gums, severe or aching pain, inflammation, suppuration;
incorrect location of dental roots, in which they interfere with the growth of neighboring teeth or gradually move or rotate them;
incorrect position in the gum tissue - inclined or horizontal;
absence of an antagonist tooth (for example, if the molars on the upper jaw have erupted correctly, but on the lower jaw they grow at an angle), violation of occlusion;
small jaw size, in which there is no room left for the third molars, and they displace the entire dentition during eruption;
inflammatory process in the root area, infectious, carious lesions, other dental diseases of third molars.

Removal of the lower impacted figure eight

A common complication is wisdom tooth retention, which is incomplete eruption. It can erupt above the gum as part of the crown or as one or two bumps. In this case, the second part of the crown will be covered with a gingival hood. With insufficient hygienic care, food accumulation, gum inflammation, and pericoronitis (inflammation of the hood) occur. In the case of pericoronitis, the dentist excises or cuts the gingival hood. But if the situation is constantly repeated and bothers you, then it is better to remove such a tooth. Chronic inflammation of the gums is a source of infection that spreads throughout the body and can provoke an exacerbation of other diseases.

Indications for removal

The dentist decides whether or not to remove a tooth, adequately assessing the situation in the mouth.

Direct indications are:

advanced caries that cannot be treated;
lack of a crown, with roots not suitable for implantation;
crown fracture exposing the pulp;
the dental unit is a source of infection, as a result of which complications develop (tonsillitis, periostitis, sinusitis, osteomyelitis of the jaw, abscess and phlegmon of the cheek);
unsuccessful treatment of periodontitis;
unerupted or incompletely erupted teeth are the cause of frequent inflammation, damage to nearby tissues and teeth;
severe mobility with an extreme degree of periodontal damage that cannot be treated;
purulent periodontitis, which is not relieved by conservative methods;
crowding of teeth.

Anesthesia

Before the operation, complete anesthesia of the required area of the jaw is carried out. The most commonly used is local anesthesia, which is carried out using a carpule syringe and an anesthetic. Anesthesia of the lower jaw occurs 8-10 minutes after the injection. The duration of the analgesic effect depends on the drug used and is 2-4 hours. The operation itself is completely painless, but after the anesthetic wears off, the patient begins to feel pain. Therefore, after the procedure, the specialist gives prescriptions about the need to use medications (painkillers, anti-inflammatory, antimicrobial agents).

Easy removal

Simple extraction is the extraction of a tooth without the use of additional tools or techniques. A simple operation is observed after complete eruption, correct positioning of the molar, and the absence of serious pathologies. The doctor applies forceps and, after rocking movements, removes the molar from the jaw

The following stages of the procedure can be distinguished:

Anesthesia;
Selection and preparation of tools;
Tooth ligament separation;
Application and fixation of forceps;
Luxation of a molar;
Extraction from bone;
Checking the hole;
Stop bleeding;
Recommendations for the patient.

Difficult removal

Removing a wisdom tooth in the lower jaw is often difficult. The operation differs in its duration, the use of a special instrument, and the use of a drill. Often the tooth is sawed and removed in parts. In this case, the figure eight is incorrectly positioned or impacted. Removal consists of the following steps:

High-quality pain relief;
Preparation of tools and auxiliary materials;
Separating the tooth ligament or creating access;
Application and fixation of forceps;
Extraction of a molar in whole or in parts;
Inspection of the bone socket, cleaning it if necessary;
Stop bleeding;
Stitching;
Prescriptions and recommendations for the patient.

What is complex wisdom tooth extraction?

Tooth extraction is called complex if the tooth has several roots, and the operation will require an incision into the soft tissue of the gums and, possibly, the periosteum. Another difference from classic removal is the need to use additional tools (except for forceps and an elevator). The difficulty of performing surgical intervention is due to the difficulty of accessing the extreme elements of the dentition, the root features of the “eights” and the specifics of the clinical case (they are often dystopic or impacted).

Important: you cannot postpone the removal of the defective “eight”. This can lead to suppuration and, as a consequence, to the formation of an abscess and the development of sepsis.

Possible consequences after removal

Complications can occur after any surgical procedure. These include: bleeding from the wound, suture dehiscence, inflammation of the socket (alveolitis), increased body temperature over 38 degrees, numbness of the jaw, bone fragments or tooth remains in the socket.

A normal reaction of the body in response to surgery is the appearance of pain, discomfort, unpleasant sensations in the surgical area, a slight increase in temperature, swelling of the angle of the jaw, and facial asymmetry. These symptoms occur due to soft tissue injury, damage to blood vessels and nerve endings. The pain should subside over time and disappear after 5-10 days.

If after 3-4 days the pain does not decrease and the symptoms of inflammation increase, you should consult a dentist. The most unpleasant complication is alveolitis - inflammation of the socket of an extracted tooth. It manifests itself as acute pain, redness and swelling of the gum tissue, a significant increase in temperature, and general symptoms. The wound may discharge purulent contents or necrotic plaque. In this case, treatment by a dentist is necessary.

Consequences and possible complications

It is necessary to separate the consequences of the operation and complications after it. All patients experience consequences to one degree or another - this is a normal reaction of the body to intervention, but it is better to avoid complications.

Consequences include:

painful sensations;
bleeding gums within 3-5 hours after surgery;
swelling of the gums, cheeks;
bruises on the face in the area of intervention;
rise in temperature.

Complications may be as follows:

prolonged bleeding
- due to the fact that the tissues around the lower “eights” are saturated with blood vessels. In this case, the doctor may apply additional hemostatic measures;
alveolitis
- inflammation of the wound surface associated with infection in the hole. It is characterized by the following symptoms: fever, bad breath, swelling, pain. Requires additional wound treatment and antibiotics;
paresthesia
- loss of facial sensation. Usually the lips, cheeks, and tongue suffer - they do not feel touch, do not distinguish between hot and cold. Loss of sensitivity is associated with damage to the facial nerve and may go away on its own within 1-2 weeks, but in some cases requires additional therapy;
dislocation of the mandibular joint
is a rare but possible complication associated with excessive efforts made by the surgeon to extract the tooth. The dislocation can be corrected immediately.

Attention!!!

Removing a problematic lower molar is a full-fledged operation, so special attention should be paid to the recovery period. It is necessary to strictly follow the doctor’s recommendations and carefully care for the oral cavity, then the likelihood of developing the complications described in the previous section will be minimal. Standard assignments include:

taking painkillers and antihistamines
antibacterial rinses
cold compresses on the cheek in the area of intervention (reduce hematomas and reduce the risk of re-bleeding)
prohibition on eating during the first hours after surgery
ban on smoking, drinking alcohol, physical activity
ban on visiting the sauna and swimming pool, taking hot baths

If the doctor did not make mistakes during the operation, and the patient does not violate the recovery regime, then very soon there will be no trace of unpleasant sensations.

Prevention after surgery

After the last molar is removed, the specialist gives instructions that must be strictly adhered to. This is done to prevent complications, speed up wound healing and restore the body. The doctor recommends:

Do not eat food for several hours after surgery;
On the first day, you can apply a cold compress to reduce swelling and inflammation;
For the first two days, you should not rinse your mouth, so as not to remove the blood clot from the hole from which healing will occur;
Hygienic care can be carried out as usual; teeth in the surgical area should be brushed very carefully;
Take painkillers and other medications prescribed by your doctor;
From the second day, the mouth can be rinsed with antiseptic solutions, decoctions of medicinal herbs, and mouth rinse;
It is recommended to eat soft foods, avoid too hard, spicy, hot foods;
Bad habits (smoking, drinking alcohol) should be eliminated;
During the week you cannot visit the sauna, bathhouse, or gym.

Removal techniques

The dental surgeon determines the extraction tactics individually for each patient. Takes into account the location of the tooth, the type of pathological process, and the degree of spread. Before extraction, the doctor sends the patient for an x-ray. The goal is to obtain accurate information about the roots and structural features of adjacent teeth and the jaw apparatus in which the pathological unit is located.

Simple operation

In the case of a conventional location, removal occurs in a simple way, which takes no more than 10 minutes, taking into account the effect of anesthesia. The dental surgeon performs the operation according to the following scheme:

a preliminary survey of the patient about allergies to anesthesia drugs, chronic pathologies and the medications he uses;
administration of a drug for superficial sedation in order to normalize the mental state and ensure a comfortable extraction process (at the request of the patient or according to indications);
injection of a local anesthetic into nearby tooth tissues (gums, cheek), usually using ultracaine, which is considered hypoallergenic;
after 4-5 minutes, the surgeon begins the removal process by loosening the tooth in the surrounding tissues;
after ensuring mobility, the specialist separates the tooth from the gum and with a sharp movement turns it out of the alveolar socket;
the wound is treated with an antiseptic solution;
a tampon with a medicinal substance is applied to the wound, after which the bleeding stops for several minutes;
if after tooth extraction the wound surface is too large, the doctor will apply several stitches, which will prevent the possibility of postoperative infection and bleeding in the future;
the patient receives recommendations and goes home after stabilizing his physical and emotional condition.

After removal using a simple method, the patient feels well. If the wound bothers you after the anesthesia wears off, it can be easily eliminated by following your doctor's recommendations.

The hard way

When the doctor sees abnormalities on the x-ray, removal will be carried out in a complex way. The experience and skill of the doctor matters.

Stages in complex removal:

taking anamnesis;
choice of anesthesia;
mandatory administration of sedatives to relieve tension in the patient;
injection of local anesthesia into 5-6 areas surrounding the tooth to be removed;
the doctor makes an incision in the gum to access the tooth and roots;
drilling into several parts using a drill for easy removal and prevention of injury;
the tooth is separated from the gum in parts and removed;
a mandatory revision of the resulting hole is performed;
the wound is treated with an antiseptic and sutured;
To prevent infection and bleeding, the doctor places a drug or PRP membrane in the wound. They dissolve along with the sutures.

Extraction during the normal course of the process takes 20-30 minutes. If the operation is complicated, the procedure may take up to 2 hours. After a complex removal, the wound is wider, the tissue is more traumatized, the pain is more pronounced and lasts longer.

It is important that removal is carried out carefully, taking into account future implantation. Therefore, it is better to entrust the operation to an experienced maxillofacial surgeon who will not damage the alveolar ridge. In this case, you will not have to build up bone tissue before installing the implant and eliminate possible complications. Average surgeons usually do not stand on ceremony during operations. The result is broken bone structures of the jaw, wandering remnants of roots, unremoved cysts growing into the maxillary sinus, perforations, fistulas, osteomyelitis and much more. Not to mention the shocking post-operative pain that overtakes the patient after such punitive surgery. Only the maxillofacial surgeon has enough theoretical and practical skills to perform tooth extraction without complications.

Bleeding

If bloody discharge appears from the socket of an extracted wisdom tooth, you should call your doctor and report the situation. Minor gum bleeding can occur due to tissue injury, high blood pressure, or problems with blood clotting. In most cases, this does not threaten health and goes away on its own. If bleeding is severe or frequently repeated, you should inform your doctor and come for an examination. To prevent complications, you should rest more for several days, avoid physical activity, and monitor your blood pressure.

Pain in the socket

Everyone experiences pain after removal surgery and worries for several days. The intensity of pain will depend on the traumatic nature of the operation and the complexity of the surgical interventions. During the postoperative period, the dentist recommends using painkillers. If the pain does not disappear, but intensifies after 3-4 days, this may indicate complications. A professional examination and consultation with a doctor are required.

When should a wisdom tooth in the lower jaw not be removed?

There are no absolute contraindications to removal, but there are relative ones:

The figure eight does not need to be removed if it is correctly positioned, functions and does not injure surrounding organs;
The operation cannot be performed without preliminary preparation if the tooth is located in the area of the tumor or puts pressure on a large vessel or nerve;
For some diseases, it is necessary to prepare the body for surgery (rheumatism, diabetes, blood diseases, etc.)

You can carry out high-quality removal of a wisdom tooth of any complexity at the Berezka dental clinic. Specialists perform various surgical procedures effectively, safely and painlessly. All manipulations are carried out professionally and taking into account the individual characteristics of each patient.

Indications and contraindications for surgery

Indications

Surgery is necessary if the wisdom tooth:

Dystopic (the direction of growth is changed towards adjacent teeth, tongue or cheek)
Impacted (not fully or not fully erupted)
Has roots that are too long (this may initiate their penetration into the maxillary sinus or fusion with the jaw)
Caused inflammation of the “hood” of the gums or periodontal tissue (pericoronitis)
Caused the formation of a follicular cyst, phlegmon, gumboil or fistula
Destroyed due to the development of caries or other dental disease
Caused inflammation of the trigeminal nerve
Became a source of permanent injury to the oral mucosa
Interferes with the eruption of other molars with a narrow jaw

Absolute contraindications:

Malignant tumor in the root zone
Hemangioma (benign formation)
Serious chronic cardiovascular problems

Relative (temporary) prohibitions:

Infectious diseases, including those of the oral mucosa
Having had a heart attack or stroke
Taking anticoagulants
Exacerbation of psychoneurological diseases
Pregnancy and breastfeeding (except for emergency indications)