Exodontia.Info
Wisdom Teeth Treatment Options
Improved & Targeted Oral Hygiene

A wisdom tooth that is only partially through the gum or
has prone to decay, gum disease or inflammation-infection
of the tissues surrounding the tooth’s crown.

If the
wisdom tooth does not need to be removed (see the
NICE Guidance on the Extraction of Wisdom Teeth), then it
can be kept but will need targeted oral hygiene.

This involves very scrupulous cleaning around the tooth
operculum) possibly using such adjuncts as antiseptic
mouthwashes or gels (
Corsodyl is very good for this).

Problems with the procedure:

Future flare-ups with the wisdom teeth can still occur
especially if stressed, moving house, sitting exams etc.

May be regarded just as a stop-gap measure, delaying the
day that the tooth may need to be removed.

The
NICE Guidelines emphasise the link between the
presence of plaque and
peri-coronitis (inflammation /
infection around the crown of the wisdom tooth,
NICE
Guidance on the Extraction of Wisdom Teeth, 1.4).


Operculectomy ± Opposing Tooth Removal

If the flap of gum overlying the wisdom tooth (the
operculum) is causing the problem, then this can be
removed by a number of means (‘cold steel’,
glacial acetic
acid, laser or cautery).

Problems with the procedure:

It possible that this may grow back and the
operculectomy
may need to be repeated.

In the area where the
operculum is removed, runs the
Lingual Nerve that supplies sensation to the tongue
(and if this is effected by the
operculectomy, a numb
tongue may result as well as loss of taste on that side of
the tongue; the numbness can last up several months) and
sometimes aberrant blood vessels (that can be surprisingly
vigorous in bleeding).

Coupled with this, it can be quite sore afterwards and
there may be limitation of mouth opening.

If the
wisdom teeth flare-ups have been quite episodic,
then it may be hard to know if the
operculectomy has in
itself, been successful.

An
operculectomy is sometimes considered if the upper,
opposing
wisdom tooth is traumatising the operculum.  
SIGN suggests pain associated with the lower wisdom
tooth
is commonly exacerbated by the upper wisdom tooth
biting on the gum flap (
operculum), causing pain and
discomfort.

Alternatively, if the upper
wisdom tooth is easy to remove
and is non-functional, then immediate removal of that tooth
will often dramatically relieve the pain from the area.  This
is particularly useful where there is likely to be delay in the
removal of the lower
wisdom tooth and can be regarded
as an interim measure (after referral but prior to surgery).
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Last Updated 17th January 2016
Exodontia / Tooth Extraction

Wisdom teeth are removed only if the reason for removal is mentioned in the NICE
guidelines.

Wisdom teeth cannot be prophylactically / preventively removed.

Just because
wisdom teeth are present, it does not mean they have to be removed.

The guidelines boil down to waiting for some pathology to develop – decay, gum
disease,
infection around the  tooth crown, cyst development etc.  This is regarded
by some as
supervised neglect.

Problems with the procedure:


Patients should not be exposed to these risks of a surgical procedure unnecessarily.


Coronectomy

If the roots of the wisdom tooth seem to be in very close proximity to the nerve that
supplies sensation to the lip and chin (the
Inferior Dental Nerve) or if the tooth itself
is deep within the lower jaw so that total removal of the tooth may be impractical /
‘tricky’ / damage the nerves / lead to a possible
broken jaw, then only the crown of
the tooth may be removed (
coronectomy / intentional partial odontectomy).

Problems with the procedure:

If, when the tooth is being decoronated, the roots are found to be mobile, then the
roots have to be removed as well (hence, the original problems of nerve damage
etc are not circumvented).

The roots left behind often migrate away from the nerve so that if they give any
more problems, the roots can be removed with reduced risk to the nerve.