Surgical extraction of impacted wisdom teeth is still one of the most frequently performed procedures by oral surgeons both in the hospital environment and in office practice. At the beginning of the 20th century, when antibiotics had not yet been discovered, the side effects of the operation were investigated at length and surgery was planned only if it would cause great distress to the patient. After the use of antibiotics in dentistry became widespread after the second half of the 20th century, extraction of wisdom teeth that caused problems or may cause problems in the future became easier, no longer being a feared operation.
Deciding on the extraction of impacted wisdom teeth can sometimes be challenging for the physician. Based on the research conducted in the past 30 years, we can summarize this issue under two headings: the American school and the British school. In the American school, impacted wisdom teeth are extracted for prophylactic (protective) purposes, regardless of their degree of impaction and whether they will cause trouble. This view makes sense in the following ways: If an impacted wisdom tooth causes distress to the patient, the extraction process will become more difficult and the use of medication during and after the extraction will increase. This is important today, when the effects of excessive drug use on the patient's physical condition are widely discussed. It is clear that the recovery period after the operation will be prolonged, which is directly proportional to the loss of workforce. Health policies of developed countries work towards preventing the disease before it occurs. In the English school, impacted wisdom teeth that do not cause any symptoms are left in the mouth until they cause trouble.
In the light of this information, if we would like to briefly summarize when impacted wisdom teeth should be removed; This decision is a decision that the oral and maxillofacial surgeon and the patient will discuss and make together. If wisdom teeth did not take their place in the series at the beginning of adolescence, they either remained impacted or did not form at all. Although the reasons for impacted teeth vary widely, the most common and common reason is the shrinkage of the jaw structure of human beings as they evolve and get used to a soft diet. Diagnosis is made with a simple panoramic radiograph. During the intraoral examination, infection, swelling and pain in that area are evaluated. In panoramic radiographs, the position of the impacted tooth, its relationship with the tooth in front of it, and whether there is any pathology around it are examined. In the light of this information, it is time to remove the impacted tooth in cases where the patient has swelling and infection that requires the use of antibiotics, and in cases of dull pain that spreads to the ear, face and throat, requiring the use of painkillers. If any cystic lesion or osteoporosis around the tooth is detected on the x-ray, the tooth should be removed without allowing the situation to worsen, even if it does not cause any discomfort.
In case of disorders caused by crowded teeth, impacted teeth may need to be removed before, during or after orthodontic treatment. This decision is a decision to be made jointly by the patient's orthodontist and oral surgeon.
In transplant patients where infection may threaten the patient's life, in patients who will undergo or have had open heart surgery, in diabetic patients who have high blood sugar and cannot be adjusted with medications, impacted teeth are diagnosed by the patient's physician.
In female patients who are considering pregnancy, it is appropriate to have impacted wisdom teeth removed before pregnancy, as intraoral interventions during pregnancy are limited. It should not be forgotten that hormonal changes during pregnancy can exacerbate many pathologies that do not cause any problems in the mouth.
Systemic conditions that may arise in later ages may make it difficult to perform impacted tooth surgery. Considering that wound and bone healing may be delayed and the healing potential may decrease in patients over the age of 35, it would be appropriate to perform this procedure before the age of 35.
Empacted twenty-year-old surgery is a surgery performed in a clinical setting under local anesthesia. There are many factors that will determine the difficulty of the operation. The degree of impaction of the tooth, the technique used, the quality of the surgical equipment and, most importantly, the experience of the physician performing the procedure determine the duration of the operation, and these factors also directly affect the situations that will occur after the operation. Correct anesthesia was applied during the operation Otherwise, the patient does not feel pain, only pressure. After the tooth is removed, the wound is closed with stitches. In cases where time is limited or the patient does not want to come to appointments frequently, both upper and lower impacted wisdom teeth can be removed at the same time. This may reduce the number of appointments and ensure that the medications given after the operation are used less frequently. Since the upper and lower teeth will heal at the same time, the total healing period is reduced by half.
If the medications prescribed after the operation are used regularly and the doctor's recommendations in the post-operative period are followed, healing will occur without any problems. Edema, which is maximum at the 48th hour after the operation, returns to normal within 5 days. Stitches are removed after 1 week. Soft tissue healing, which is further accelerated by removing the stitches, is completed in 15 days, and the filling of the tooth extraction socket with bone is completed in the 3rd month.
In patients with serious systemic problems (uncontrolled diabetes, heart diseases, cancer treatment, bleeding and clotting disorders, bisphosphonate drug use) should be taken into consideration. The procedure is performed according to the treatment protocol to be determined in consultation with the patient's doctor, or is postponed until after the situation is resolved. In case of pregnancy, the procedure is performed in the 2nd trimester or postponed until after birth. If a tumor formation in the mouth is suspected in the twenty-year-old area, extraction is not performed.
In cases of severe impaction or in cases where the lower jaw nerve and the tooth are in close relationship, the degree of the problem and the problems that may occur afterwards are determined with the help of further imaging examinations. is evaluated, and a decision is made to extract the tooth within the framework of patient-physician cooperation.
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