1. THIRD MOLARS

2. •There are many good reasons for removing
wisdom teeth also known as third molars, there
are also some risks and complications that are
possible when extracting these teeth and
sometimes there are some good reasons for
leaving them alone. The decision on a specific
course of action must be determined by a well
informed doctor and patient working together.
•Consider first the many reasons that people
choose to have their third molars extracted. By
far one of the most common findings is that the
mouth is just too small for these teeth to fully
erupt into a good functional position. This leads
to one of several situations

3. •1. The teeth remain completely buried in the bone of the
upper and lower jaws in which they developed, a condition
known as impaction. In the case of the fully impacted
tooth, it may continue to sit in the bone, surrounded by
the normal cyst in which all teeth develop. It may also
happen that the normal cyst, later in life, enlarges and may
even develop changes in the cells that line the cyst. When
such cysts get large enough, they should be removed and
examined by a pathologist.
•2. The teeth begin to erupt but are not able to assume
their correct upright position. Most commonly the upper
third molars will tend to face out towards the cheeks while
the lower third molars will lean forward with just a small
portion of the crown protruding through the gum. Teeth
that are partially erupted lead to two problems.

4. •A) First they make hygiene of the second molars difficult
leading to increased possiblity of decay and gum disease
(periodontal disease) around these important teeth.
•B) Second the pink flap of gum tissue which partially
covers the erupting tooth creates a warm, moist and dark
pocket where bacteria which normally live in the mouth
can use the food you eat to flourish, multiply and cause an
infection known as pericoronitis. In fortunate cases, the
swelling and pain of this condition will be relieved when
the infection drains back into the mouth. In those less
fortunate, the swelling persists, does not drain back into
the mouth but rather extends laterally and if not treated
can become a very serious infection. The treatment of
choice for pericoronitis is extraction of the offending
tooth. Antibiotics, operculectomies and other adjuncitve
treatments may be helpful from time to time but the
problem has a propensity to return as long as the
conditions which allowed it to develop in the first place
continue to exist.

5. •It is easy to understand why many people choose to
hedge their bets and have their wisdom teeth extracted
while they are young and healthy and the teeth are
surrounded only by a small normal developmental cyst
rather than have to undergo a more extensive surgical
procedure later in life when their recovery may not be as
easy and their general state of health may not be as good.
Finally, some dentists subscribe to the theory that wisdom
teeth may push the other teeth in the mouth forward and
cause crowding and misalignment. You should be aware
however, that not all oral surgeons believe this to be the
case.
Now however, it is important to consider the possible risks
and complications involved in the removal of third molars.
There are some risks/potential complications which are
common to all surgical procedures however major or
minor they might be. These are:

6. •PAIN
Removal of third molars is a surgical procedure and some
discomfort should be expected. It is also reasonable to
expect that this discomfort will be taken care of by the
pain medication prescribed.
INFECTION
In the absence of preexisting infection it is uncommon to
see an infection resulting from the removal of third molars
however, there are more bacteria per square inch in the
oral cavity than anywhere else in the human body and so
often patients are placed on antibiotics prophylactically
during the initial healing period.
SWELLING
Post operative swelling and bruising are both within the
spectrum of normal. The exact amount of each of these
varies from patient to patient as does the time required
for complete resolution of these symptoms. Surgical
edema is a normal consequence of surgery and also
normally resolves without extraordinary measures

7. •BLEEDING
It is not possible to do surgery without some bleeding but when you
leave your surgeon's office you should expect that the minimal oozing
you are experiencing can be easily controlled by biting on clean gauze
or a tea bag. Bleeding that cannot be controlled in such a fashion
warrants an immediate call to the surgeon.
and the risk of the ANESTHETIC itself.
Most wisdom teeth COULD be removed without any anesthesia at
all...but that would make for a very unhappy patient and an equally
unhappy doctor. For patients whose medical condition contraindicates
general anesthesia, third molars can safely and effectively be removed
with local anesthetic only. Local anesthestics as used in the oral
surgeon's office are among the safest of drugs around and true allergic
reaction to a properly administered local anesthetic is so rare as to be
worthy of publication in scientific journals. Most persons prefer,
however, to be "asleep" for the removal of their third molars. There
is a somewhat greater risk for this than for the use of local anesthetic
alone and if this is your desire, your oral surgeon should discuss your
medical history and your particular risks with you prior to your
procedure. You should be aware that in the young healthy individual,
those risks are often minimal and acceptable but they do exist and
should be discussed with the doctor.

8. •Finally there are some risks/complications that are unique to
the removal of third molars.
•The upper third molars have roots which often are separated
from the maxillary sinuses by only a very thin layer of bone.
Occasionally, a small communication is established between
the sinus and the oral cavity when one of the upper third
molars is removed. If this is the case, the normal procedure is
for the area to be sutured closed, the patient to be informed
of the finding, appropriate antibiotics and decongestants to
be prescribed, the patient to be instructed to avoid Valsalva
maneuvers (tasks which build up pressure in the sinus like
nose blowing and bearing down forcefully) and the patient
reappointed for followup. Most often this results in an
uneventful healing period with no further treatment being
required. Occasionally, the area will heal open rather than
closed in which case an additional small surgical procedure
will be required to close the communication

9. •The lower third molars often have roots that lie very near or even
wrapped around the inferior alveolar nerve. This is the nerve that
supplies feeling to the lip, teeth and part of the gums on each side of
the mouth. Occasionally, when a lower third molar is removed, that
nerve will be bumped or bruised and if so a change in sensation may be
noted on that side. It is important to understand that this is a sensory
nerve and does not affect the ability to move the parts of the oral
cavity to which it gives sensation (feeling). In most cases, the nerve
heals itself but, because nerves heal slowly, it may take six months to
one year before return of normal sensation. Very rarely, the damage to
the nerve is permanent. Likewise, the lingual nerve, which supplies
sensation to the tongue and the tongue side of the gums often lies in
close proximity to the surgical site and may be disturbed in the process
of removing these lower third molars. Once again, most alterations in
sensation are temporary but ocasionally the change may be
permanent.
Finally, the normal precautions, risks and benefits of extraction of any
tooth (which are beyond the scope of this discussion) also apply here
and should be discussed with the surgeon prior to beginning any
procedure.

12. •Thanks
•DEEMA MAJID
ALGRBI