Wisdom teeth.... controversial and problematic

What are wisdom teeth?

“Wisdom teeth,” a rather curious name for teeth if you think about it, is the folklore name for third molar teeth, which usually makes their appearance later in life. Wisdom teeth are the upper and lower third molars, located at the very back of the mouth. They are the third, final set of molars to come in, and they usually sprout during the late teens to early twenties. They are called wisdom teeth because usually they come in between ages 17 and 25.

In the time before modern dentistry, wisdom teeth were usually present. Due to lack of good dental hygiene and non-availability of preventive measures, leading to extensive tooth loss thus there by creating plenty of room to welcome these third molars. Today, dental technology is more advanced than ever, and adults are able to repair and keep more teeth than they were even only 50 years ago.

Though it is not possible to predict the normal eruption of wisdom teeth, as adequate space availability seems to be paramount to allow for successful eruption. Imaging techniques and radiographs are most important to assess the same. However, the fact they can erupt does not guarantee they will. If the normal eruption is compromised, often, removal is necessary to prevent problems. Roughly 60 to 70 percent of all wisdom teeth will be impacted

Why “wisdom teeth” are so problematic?

Wisdom teeth are not, in and of themselves, problematic. It’s the impact they have on the rest of your mouth and your oral hygiene that’s the issue. You may have a problem if any of the following occur:

• Your wisdom teeth break through your gums only partway because of a lack of space. This can cause a flap of gum tissue to grow over them. The flap can trap food and lead to a gum infection.

• They come in crooked or facing the wrong direction.
• Your jaw isn't large enough to give them room. Your wisdom teeth may get stuck (impacted) in your jaw and not be able to break through your gums.
• They are so far back in your mouth or crowded that you have trouble cleaning around them.

• A cyst forms. This can damage the bone or roots.

Effect Of Impacted Wisdom Teeth

The most common consequences of impacted wisdom teeth are periodontal (gum; “perio” – around; “odont” – tooth) problems and are the most frequent consideration for their removal. Their presence can adversely affect the periodontal tissues of the adjacent second molars by disrupting the periodontal tissue attachment (the mechanism that anchors the teeth in their surrounding bone) — leading to their loss by predisposing them to bacterial, plaque-induced, periodontal disease. They can also damage to adjacent tooth roots due to caries and formation of pocket.

Painless: One interesting fact is that in most cases, impacted teeth can exist quite asymptomatically; in other words, you wouldn't even know they are there, let alone causing problems. However, impacted, submerged, third molar teeth interrupt vital structures: in the lower jaw, like the nerves that supplies sensation or in the upper jaw, impacting or entering into the sinus. Conclusively, these teeth are located where they're not supposed to be, yet are causing no pain.

Painful: On other occasions, they will really let you know they are there with a painful pericoronitis (“peri” – around; “corona” – crown; “itis” – inflammation). This is an acute inflammation and infection of the surrounding gum tissues that typically occurs with a partially erupted, lower wisdom tooth. It is temporarily treated with medications.  Since this condition is likely to be recurrent, it is important to have the affected tooth or teeth evaluated for removal.

Impacted teeth results in pain also can result in other unpleasant side effects, including:

• Infection
• Swelling
• Bleeding of the tissue around the tooth
• Bad breath

Impacted teeth cannot grow in properly, and so dentists will recommend their removal in most cases.

Pregnancy and dental treatment .....always recommended

Pregnancy causes profound and remarkable changes in all organ system. The dental team should be aware of the altered physiologic status of the pregnant patient to avoid inappropriate interpretation of normal changes as pathologic. With pregnancy most important change takes place in the cardiovascular and hematological system as a result of the altered hormonal activity. Due to increase in mineralcorticoids, there is the retention of sodium, which in turn leads to water retention, thus total body water and plasma volume increases by 30-40% leading to hemodilution (dilution of blood) there by producing a state of “physiologic anemia of pregnancy”. During the second and third trimester, a decrease in the blood pressure and cardiac output can occur when patient is in supine position due to the compression of inferior venecave by gravid uterus, causing reduction of cardiac output. 

This condition is called supine hypotensive syndrome and is manifested as light headedness, hypotension and syncope. If it occurs, emergency care for situation consists of rolling the patient into her left side to lift the uterus off the venecave and administering 100% oxygen. Pregnant patient may be positioned semi-reclining. The ideal position of the pregnant women in dental chair is left lateral decubitus position with right buttock and hip elevated 15 degrees

Pregnancy and dental work questions are common for expecting moms. There is a general concept that pregnant moms should completely avoid dental treatment rather depend on medications for removal of dental symptoms. This concept is false.

Preventive dental cleanings and annual exams during pregnancy are not only safe, but are recommended. The rise in hormone levels during pregnancy causes the gums to swell, bleed, and trap food causing increased irritation to your gums. Preventive dental work while pregnant is essential to avoid oral infections such as gum disease, which has been linked to preterm birth. During pregnancy, dental treatment may be modified but need not be withheld, provided that the risk assessment is made properly for both patient and the fetus.

First trimester – only emergency procedure if utmost necessary should be done. Avoid X-rays as much as possible because baby is in the organogenesis (organ forming stage)

Second trimester – the most safe and comfortable period for the mother to accept dental treatment. Don’t skip your dental check up appointment simply because you are pregnant. It is recommended to atleast get cleaning done once if not done in past 6 month.

Third trimester 

it is very difficult for the pregnant lady to lie on her back for extended period of time. If at all she has to take dental treatment the treatment span should be short , while getting upfrom dental chair, if chair is reclined, it should be straightened slowly.

Coping With Morning Sickness 

If morning sickness is keeping you from brushing your teeth, change to a bland tasting toothpaste during pregnancy. Ask your dentist or hygienist to recommend brands.

Rinse your mouth out with water or a mouth rinse if you suffer from morning sickness and have bouts of frequent vomiting.

Art of restoring a badly decayed/fractured teeth

A post and core is a prosthetic device that is recommended when there is inadequate tooth structure remaining to support a traditional restoration or an artificial crown.

Post and core procedure is painless and does not even require local anesthesia as the tooth has long been dead after the root canal treatment. A post and core can only be made for a tooth that has had root canal treatment.

Some posts are ready made, whereas others are made in the laboratory especially to fit the tooth.

Why are post and cores needed ?

A great deal of dental crown stability depends on the amount of tooth structure that extends into its interior. If very little tooth structure occupies this space, the crown will be easily dislodged, especially by forces directed at its side.

Basically, the core is rebuilding the tooth so it is closer to its original dimensions. Hence, the crown's stability will greatly increase, and therefore its long-term chances for success are maximized.

                                              

Is a post always needed ?

A dental post is generally recognized as just an aid in helping to anchor a dental core to a tooth.

As a rule of thumb, if more than half of a tooth's original crown portion has been lost, a post is needed to assist in anchoring the core to the tooth. If more than half still remains, a core by itself (which basically means a direct build up with composite materials) will probably suffice.

Factors to be considered in making the decision to use a post

Many have stated that the main reason for placing a post is to strengthen the connection between the coronal build-up material and remaining tooth structure to the root portion of the tooth. In my opinion, that is only partially true. Additionally, the following potentially negative or positive factors should be considered in the decision to use a post. All of these factors should be observed before making the decision:

• Quantity of remaining tooth structure

• Quality of remaining tooth structure

• Remaining adjacent teeth

• Occlusion

• Planned restoration to be placed on the tooth

When is a post and core not indicated ?

There are certain conditions that make the use of a post and core device inadvisable :

·         Intense pain, gingival bleeding, suppuration, advance infections, tooth abscesses etc. These situations will be evaluated on a case-by-case basis and the post and core should be placed with the greatest caution.

·         Tooth shows advance mobility. Mobility is an indicator of bone loss around the tooth and it should be evaluated on a dental X-ray as well.

·         When the tooth crown is severely damaged (especially when the tooth is fractured bellow the gumline) and the remaining part of the tooth is not strong enough to support the post.

                                              

Structure

A post and core consists of two parts :

·         The post

The post is a small rod, usually metal/carbon fiber, which is inserted into the root space of the tooth and protrudes from the root a couple of millimetres. The post is then used to hold the core, or a filling in place.

Because the post is inserted into the root canal, a post and core can only be made for a tooth that has had root canal treatment.

·         The core

The core replaces missing tooth structure in preparation for making a new dental crown. Normally, a dental core can be directly built up from composite materials without a post to hold it in place.

However, a dental post can be used to help to anchor the core to the tooth. In this case, the core is generally made off metal alloys and the device is called post and core.

The core is then utilized to hold a dental crown in place. The crown can be a single unit crown or a retainer crown for a dental bridge.

Success rates

The procedure is successful in over 90% of cases.

Potential risks

·         Tooth fracture

·         Root fracture

·         Root canal failure (it is difficult to repeat root canal treatment once the post is in place)

·         Post coming out

·         Post protruding through the side of the root (this is a particular risk if the root is curved)

After Dental Post And Core

Post procedure care                                                       

Patients should avoid eating on the crown, following a post and core procedure. Certain foods, such as hard or chewy sweets, should be avoided as the crown could become loose.

Possible discomfort

Some minor discomfort to be expected after this procedure, but this can be easily controlled with normal painkillers.

Tooth Sensitivity ....commonest dental problem

Dentinal hypersensitivity, or tooth sensitivity, is a common dental problem. It is experienced as a painful sensation in the teeth, often occurring after eating or drinking something hot, cold, sweet or acidic. Most sufferers are between 20 and 50 years old. Tooth sensitivity can start to happen when the softer, inner part of the tooth called ‘dentine’ becomes exposed. Dentine lies under the enamel and the gums. 

Thousands of microscopic channels run through the dentine towards the centre of the tooth that link to the nerves on the inside of the tooth. When dentine is exposed, these nerves are easily stimulated by external triggers (such as a cold drink), resulting in the characteristic short, sharp sensation of tooth sensitivity.

Common causes of tooth sensitivity include:

Aggressive brushing  

Toothbrush and/or toothpaste damage may be the most frequent cause of sensitive teeth. By brushing too hard and/or using abrasive toothpaste, you may be removing tooth structure at the necks of your teeth resulting in pain, especially to cold drinks, food, and air, but also to physical pressure, hot, sweet and sour.

Lack of a Twice-Daily Routine

Taking a laid-back approach to brushing, flossing and rinsing can let tarter build up along the gum line leading to advanced gum disease there by exposing root surface and a potential cause of tooth sensitivity.   

Cracked tooth

A crack or chip in your tooth may expose the underlying dentin or may fill with bacteria from plaque, causing the nerve to inflame.

Teeth grinding

over time, grinding or clenching your teeth can erode enamel and expose dentin.

Gum disease 

You may have noticed that your gums are starting to pull away from your teeth. This means your gums are receding, exposing sensitive nerve branches living in the tooth’s root. Inflamed or sore gums may cause sensitivity due to the loss of supporting ligaments, which exposes the root surface leading directly to the tooth. Harsh brushing can be culprits.

 Or if you have advanced gingivitis, that is periodontal disease, the gums are moving away from the tooth, exposing the roots.

Tooth decay

Gum disease or other local factors can cause lodgment of food thus resulting in decay which is also a potential cause of tooth sensitivity. Since you see no decay on top of the tooth, you might not be aware a cavity exists, but it can create tiny holes near the gum in front or the back of the tooth.

Tooth whitening 

Using products with peroxide or baking soda can seriously aggravate exposed roots or dentin.

Acidic Diet

If you frequently eat sharp-tasting and/or sour food and drinks, this could be stripping away tooth enamel. Check your regular diet for highly acidic foods like citrus fruits, tomatoes, yogurt, sour cream, aged cheeses and acidic drinks such as orange juice, sports drinks, wine and carbonated drinks including soda, and aim to limit your intake.

5. Sugary Diet

Loading up on sugary treats such as cookies and cake can prompt bacteria to grow, leading to eroding gums that expose sensitive areas of the teeth.

OR

It is possible to experience tooth sensitivity after routine dental procedures such as the placement of a filling or crown, tooth restoration, or even teeth cleaning. Such sensitivity is temporary

Measures in handling sensitivity

Toothpastes for sensitive teeth

Desensitizing agents (there’s loads of different ones on the market now) work by blocking off the dentinal tubules, so that the nerves don’t get stimulated.

They work a lot better by gently massaging the paste or gel into the sore spot with a finger. Do not rinse it off with water or mouthwash. It may take several weeks before the desired effect is achieved.

High-fluoride mouthwashes

You may want to try a non-alcohol mouthwash with a high fluoride content instead. Some of them are specifically designed to reduce sensitivity. They should be used twice a day after brushing – one of those times should be just before you go to bed, so the mouthwash doesn’t get rinsed away when you drink or eat something.

Swish the mouthwash back and forth between the teeth for at least 30 seconds, and do not rinse with water afterwards.

Recaldent

Now there are also available tooth remineralizing agent which have also proved to be beneficial (these are quite expensive though).

Professional Intervention

What can dentists do about sensitive teeth?

Only a dentist can confirm you have dentinal hypersensitivity. If you are experiencing any dental problems, always consult your dentist for advice. If you have dentinal hypersensitivity, you can help to minimize further exposure of the dentine, care for your sensitive teeth and relieve the  symptoms by making some simple changes to your daily oral care routine and dietary habits.

• Depending on the cause of the sensitivity, your dentist may be able to paint special fluoride gels, rinses or varnishes onto the affected teeth
• If this doesn’t help and you can’t put up with the sensitivity, your dentist can seal or put bonding around the neck of the tooth, to cover exposed dentine. You should try the other options first though.
• If you grind your teeth, ask your dentist about the possibility of having a mouthguard made to wear at night.
• If there is a hidden caries probably it needs to filled.

 

Rules for Sensitive Teeth

Continue to follow a good brushing and flossing routine to maintain the good health of your teeth. Use a soft bristle brush and brush gently. Try desensitizing toothpaste. There are several different brands for sensitive teeth. With regular use, you should notice a difference in the degree of sensitivity.