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Extraction of the third molar

Clínica dental Madrid Dr. Estévez, dentista en Madrid, me duele la muela del juicio

surgerythird molarsIt is the most frequent surgical technique performed in the oral cavity if we except for extractions of erupted teeth. But this does not mean that it can be said that it is an elementary intervention or one with a low profile of difficulty. Its range of clinical variability and potential complications reach the most extreme limits.

Many patients require the removal of their third molars, also known as wisdom teeth. Like any surgical procedure, there are some risks and complications. The decision on the extraction of the third molar must be decided by the  patient and his dentist.


Is it necessary to remove wisdom teeth?


Wisdom teeth are a valuable asset to the mouth when they are healthy and well positioned. Often, problems arise that require its removal. When the maxilla is not large enough to accommodate the wisdom teeth, causing malalignment. Wisdom teeth can grow sideways, emerge only part way through the gum, or remain trapped under the gum and bone.


General recommendations for the extraction of third molars:


  • When the wisdom teeth only partially erupt.

  • When there is a chance that misaligned wisdom teeth will damage the adjacent teeth.

  • When a cyst forms, it can damage surrounding structures, such as bone roots of teeth.


The most cause of wisdom teeth extractions is that the mouth is too small for them to erupt normally behind the second molars in a good position. This can cause the following situations:


1. When the wisdom teeth are completely covered by the bone. In this situation it will remain completely covered with its "developmental pocket", this pocket can undergo change and develop a cyst. This cyst will enlarge at the expense of the jaw bone. These cysts must be removed and_cc781905-5cde-3194-bb3b- 136bad5cf58d_examined by a pathologist.


2. When the wisdom teeth are partially impacted, they start to come out, but are not able to fully erupt. In this situation, the upper third molars are usually placed towards the cheek, while the lower third molars are generally tipped forward, causing decay and periodontal disease around the second molar.

The most common complication of partial bone impaction is that the flap of gum tissue that partially covers the third molar eruption creates a pocket where bacteria that are present in the mouth can grow and cause an infection known as pericoronitis. It is characterized by inflammation of the gum that surrounds the retained tooth. Inflammation and infection can become very serious. The treatment for pericoronitis is the extraction of the third molar.


Some dentists believe that wisdom teeth can push the other teeth in the mouth forward and cause crowding of the front teeth. From our point of view, it is one more factor, not the most decisive.


The risks and complications of third molar extraction are as follows:


PAIN: The extraction of third molars can cause some discomfort and pain. This is normally treated with pain medication.


INFECTION: Due to the large number of bacteria present in the mouth, post-surgical infection is always possible. It is necessary for the dentist to prescribe antibiotics to the patient to prevent the development of infections.


SWELLING: After surgery patients may experience swelling and  bruising. These symptoms vary between patients.


BLEEDING: Some post-operative bleeding is considered normal. This is usually minimal and is easily controlled by biting down on a gauze pad.


Most wisdom teeth can be removed with local anesthesia alone, but many people prefer sedation during surgery.

Risks and complications of third molar extraction:


Upper third molars have roots that are often  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 the upper third molars are extracted. If this happens, the normal procedure is to close by suture, the patient must be informed of the incidence, prescribe antibiotics and decongestants. 


Mandibular third molars in some cases have roots that lie very close to or even wrapped around the inferior alveolar nerve. This is the nerve that provides sensation to the lips, teeth, and tongue on each side of the mouth. Occasionally when a mandibular third molar is removed, that nerve can be struck or bruised, this can cause a loss of sensation on that side. It is important to know that this is a sensory nerve and does not affect the ability to move the parts of the oral cavity that it gives sensation to. In most cases, the nerve heals slowly, it may take six months to a year before normal sensation returns. Very rarely, nerve damage is permanent.



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