Expert Witness Journal Dec 24 - Journal - Page 46
Wisdom Tooth Surgery
Trigeminal Nerve Complications
Dr R Kumar BDS LDS RCS MSc ImpDent MAGDS RCSEd PGCert Orthodontics PGCert
Facial Aesthetics Expert Witness CUBS Bond Solon
Terminology
M3M terminal mandibular molar
LN Lingual nerve
IAN Inferior Alveolar nerve
IAC Inferior Alveolar canal
Lingual to the tongue side
Buccal to the cheek side
Distal to the back of the mouth
Prophylactic removal
Prophylactic removal of 8s is uncommon but can
occur in patients that are planned to undergo:
• Bisphosphonates, antiangiogenic's, chemotherapy
• radiotherapy of the head and neck
• immunosuppressive therapy
• reduction of mandibular fractures
• orthognathic surgery around the angle of the
mandible
• resection of benign and malignant lesions
• military personnel about to be deployed (Pepper)
Introduction
Wisdom teeth are also known as terminal molars, 3rd
molars or 8s. They usually erupt between the ages of
17 and 24 years of age but in about 25% of worldwide
cases the teeth become impacted against the second
molars or the 7s (WHO).
Primary dental treatment
On initial presentation with soft tissue inflammation,
the patient may complain of pain, swelling, reduced
opening, halitosis and or food impaction.
Impacted mandibular molars (M3M) tend to suffer
future problems such as decay, soft tissue infection and
inflammation and commonly cause secondary decay
against the 7s.
The general term for wisdom tooth soft tissue
infection/inflammation is pericoronitis.
The dentist may try to clean the periodontal soft tissue
area around the 8 and advise either a saltwater rinse
or antibiotics are prescribed.
The instance of decay on the 7s can range from 24 to
80% depending on the age of the patient (Fisher),
which can lead to gross destruction of the 7s, the need
for root canal treatment or even the removal of the
tooth.
Third molar surgery
Due to the impaction, the wisdom tooth generally
flares up on a regular basis at least once or twice a year
and eventually the soft tissue infection is so severe that
the patient requests the removal of the impacted
tooth.
Wisdom tooth impaction occurs as the wisdom tooth
is developing (and the roots are growing) but the angulation prevents a full and functioning eruption.
Impaction generally means that the wisdom tooth is
stuck either horizontally, vertically or at an angle
against the 7 or the body of the mandible behind the
wisdom tooth.
A study carried out had reported follow up data on
Finnish students confirming that by the age of 38
years most impacted mandibular molars required removal (Venta).
However, there is increasing evidence that mandibular 8s should be removed before permanent symptoms or additional damage to the 7s occurs (Huang)
3rd molar surgery is one of the most common surgical procedures performed in secondary care in the
National Health Service (McCardle).
M3M surgery is usually carried out in a surgical setting
such as a dental practice or an Oral Surgery Hospital
setting.
The surgeon is usually a dentist with experience in
oral surgery tooth extractions or an Oral Surgeon.
M3M general post-surgery risks
During the surgical removal of the 8, a surgical flap is
usually raised, cortical bone is removed and the tooth
is then elevated completely.
The flap is then closed and sutured and the patient is
usually given analgesics and on occasion antibiotics.
Winter’s classification of impaction (Iwanaga)
EXPERT WITNESS JOURNAL
44
DECEMBER 2024
