06 Feb WISDOM TEETH.
What is the Agenesis?
As we all know, the natural dentition of an adult person consists of 32 pieces. It is very common that some of them are naturally missing, resulting in the process known as Agenesis. In the case of third molars, these are the first in frequency of this event. A person may have the four molars or miss one or more of them. However, it is necessary to make panoramic X-rays to know for sure if they are present or not, because in many occasions they are there, but they do not make their appearance in the mouth. This may be because they are in anomalous, impacted positions, included in the bone or retained.
Not every time the presence of this molar has to result in a pathological consequence. It frequently erupts and positions itself in a normal way, intervening in the function of the masticatory system as its fellows. It is necessary to take into consideration that the hygiene of these is more difficult being frequent the appearance of caries. This is due to its position, at the end of the arcade.
When these are impacted, retained, semi erupted or trapped in the bone, it is when they begin to get abnormal and pathological conditions.
The retention and impact of them has its origin in several processes. The first of these is the presence of small maxillary bones. This fact does not allow them to appear in the mouth, being inside the bone or only half way out (semieruption). Another condition is that, due to its complex position and its variation during the eruption path, they are impacted against the distal face of the second molars. The last reason is that some of the crown areas are retained by partial or total maxillary bone coverage. Although there is room in the mouth to house them, this is more frequent when the eruption path is anomalous. This is because insufficient vertical pressure is exerted for the proper bone involution that leads to the tooth eruption.
What problems can arise from this?
- Mechanical complications. They are given, normally, by an incorrect eruptive trajectory. They provoke, as a result, alterations in the gingiva, cheek and distal area of the second molar. The tooth can have caries, resorption crown-radicular or lysis, being able to generate pain and the loss of the piece.
- Infectious complications. They take place when the wisdom tooth is semi erupted. The area that is partially covered by the gum and bone is deprived of adequate hygiene. It also acts as a retentive element of bacterial plaque and remains of food. The retention situation, coupled with complicated and difficult hygiene, causes infections, such as caries that can reach the nerve area. It causes big pain and drainage, as well as halitosis, and inflammation of the surrounding tissues, in the process called «Pericoronitis«.
- Trauma complications. The eruption and the consequent eruptive force generate bone resorption to develop and erupt. This may lead to weakness in the mandibular angle, resulting in a possible spontaneous fracture or easier fractures in low-intensity trauma.
- Neuromuscular complications. The force exerted during the development or eruptive attempt of the molars may give inflammation, pain and even hypertonia or severe contractureof the masticatory muscles. All this generates that the subject who suffers this situation avoids chewing in the affected area. This causes muscular decompensations that may alter the temporo-mandibular joint (jaw-skull joint). Likewise, this inflammation and pressure can generate a total or partial compression of the nerves whose paths are close to the area giving sensory alterations.
- Tumor complications. These are the least frequent. The epithelial tissue surrounding the third molar has a high transformation potential. It can generate from benign cysts to malignant tumours as angle ameloblastomas. This is why special emphasis should be placed on correct cleaning and curettage, as well as drying of the tissue during the extraction process.
How to prevent problems?
Once we have explained all the complications, it is necessary to see the ways in which they can be prevented. It is therefore pursued that you do not have a severe condition as a result of the molars.
The best prevention goes through an early diagnosis of the situation. That’s why you need to go to your dentist for periodic checkups. Thus, when the time is right, it can be corrected by a small surgical process, avoiding any complication.
The best time to proceed to surgical extraction is at an early age. This is because we have more flexibility of adjacent bone tissue, as well as incomplete formation of the roots, being further away from the inferior dental nerve. It seeks to avoid the possible damage of it. If third molars are in the mouth well positioned, they must also be checked.It is intended to evaluate the presence of caries, being able to be restored with ease. If these are semi erupted, the situation may have two variants. One is the removal of the tissue covering the area to prevent infection. The other, the integral elimination of the molar with the surrounding tissue.
«Whatever your situation is, in SJD dentists we want to help you have the best treatment and handling possible in this situation. Come on, we‘ll wait for you at our clinics.