European International Journal of Pedagogics
37
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TYPE
Original Research
PAGE NO.
37-43
DOI
OPEN ACCESS
SUBMITED
25 October 2024
ACCEPTED
27 December 2024
PUBLISHED
17 January 2025
VOLUME
Vol.05 Issue01 2025
COPYRIGHT
© 2025 Original content from this work may be used under the terms
of the creative commons attributes 4.0 License.
Wisdom tooth extraction:
features of the procedure
Abdurashidov Oybekjon Abdurashid Ugli
Assistant, Samarkand State Medical University, Samarkand, Uzbekistan
Abstract:
The third molar (molar) is more often called
the wisdom tooth or the "figure of eight" (the third
molar is the 8th from the middle of the dentition). It is
not preceded by a baby tooth, and the laying does not
occur in the prenatal period, but at the age of 3-5 years.
The "eight" erupts later than others, when the jaw
bones have completely or partially stopped growing
between the ages of 14 and 30, sometimes even later.
Growth and eruption are completely dependent on the
hereditary characteristics of the organism.
Keywords:
Jaw bones, prenatal period.
Introduction:
Wisdom teeth and their eruption
features
The third molar (molar) is more often called the wisdom
tooth or the "figure of eight" (the third molar is the 8th
from the middle of the dentition). It is not preceded by
a baby tooth, and the laying does not occur in the
prenatal period, but at the age of 3-5 years. The "eight"
erupts later than others, when the jaw bones have
completely or partially stopped growing between the
ages of 14 and 30, sometimes even later. Growth and
eruption are completely dependent on the hereditary
characteristics of the organism.
The crown of the third molar looks no different from the
adjacent crowns. The main features are in the structure
of the roots and root canals. As a rule, there are several
channels. They are meandering, narrow, and not always
located in a separate root. 2-3 roots are considered the
norm, but sometimes there are more, fewer, or just one
root, and several channels can be seen in it. This makes
it very difficult to treat caries.
By the time the third molar erupts, the bones of the jaw
have in most cases already finished their growth, so it
often does not have enough space in the dentition,
which means that the eruption is wrong. This condition
is called dystopia. Normally, the "eight" should erupt
vertically and correspond in height to the rest of the
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crowns, but the dystopic tooth, trying to erupt,
changes its position and can be positioned:
• vertically, but significantly lower (sometimes higher)
than the rest of the teeth in the row.;
• horizontally –
if the growth goes towards the
neighboring tooth, its root suffers; when growing
forward or backward, soft tissues are injured;
• diagonally (slanted, at an angle) –
both the root and
the crown of the adjacent tooth may be affected.;
• turning around its axis
- a tortoposition;
• Transposition is performed in place of the other
tooth.
Sometimes the "eight" does not erupt at all. If at the
same time a person has no complaints and the X-ray
does not show its rudiments, then this is a variant of
the norm. But when the "eight" does not completely
erupt or does not erupt at all, which is accompanied by
swelling and pain, this is no longer the norm. A
retained tooth is:
• completely uncut, covered on top with bone tissue of
the jaw or gum;
• partially cut through, but covered with a hood,
through which you can see part of the crown.
• The thir
d molars are often both dystopian and
retinated.
When to remove wisdom teeth
The third molar, which has erupted normally and
performs all its functions, does not need to be
removed. Even caries of the figure eight can be cured
quite successfully. In the future, it can become a
support for a non-removable prosthesis. If a wisdom
tooth hurts, it is removed only according to indications
and after an examination. Indications for removal are,
first of all, pain and discomfort that occur in the patient
during eruption. With these symptoms, he goes to the
dentist, and he already decides what exactly needs to
be done after the examination and X-ray. The "Eight" is
removed if available:
1. deep caries, which cannot be treated for some
reason, mainly due to the inaccessibility or obstruction
of root canals (they are often narrow, tortuous);
2. pericoronitis (pericoronitis)- inflammation of the
gum (hood) covering the erupting molar on top;
3. retention
–
the "eight" cannot break through the
bone tissue, which leads to the development of
infectious and inflammatory processes in the soft
tissues and bone tissue of the jaw;
4. dystopia
–
growth is directed not vertically, but to
the side, which leads to injury to the surrounding
tissues, malocclusion and growth of the remaining
teeth in the dentition due to the lack of space necessary
for this (the second molar may be particularly affected);
5. the need to install braces in case of improper growth
or crowding of teeth in the dentition
–
the third molars
can disrupt this process.;
6. pinching of the trigeminal nerve branches,
accompanied by bouts of severe pain or discomfort
(paresthesia).
Sometimes the abnormal growth of the third molar is
detected even before the patient complains. In such
cases, the dentist also recommends its removal.
Infectious and inflammatory processes during teething
The growth and eruption of the third molar is often
accompanied by infectious and inflammatory processes
of the surrounding soft tissues. This is due to the fact
that the "eight" often begins to erupt under the hood,
which covers its gums. Infection penetrates under the
hood and an inflammatory process develops. The course
can be acute or chronic, and the inflammation can be
catarrhal, purulent, or ulcerative. Symptoms of
pericoronitis:
• u
npleasant sensations in the teething area
–
discomfort, itching, pain;
• putrid breath;
• swelling of tissues, pain when chewing, sometimes
convulsive jaw spasm (trismus);
• increased div temperature (not always);
• enlargement and soreness of the submand
ibular and
cervical lymph nodes.
If you suspect improper eruption and inflammation of
the gums, it is better to consult a dentist immediately,
without waiting for serious complications. Depending
on the existing pathology, the dentist may prescribe
therapeutic treatment, remove the hood or tooth.
When you need to see a doctor urgently
Some patients hope to the last that "this will happen"
and do not turn to a specialist in a timely manner. The
consequences of this tactic can be serious: the infection
will spread like a fire to the surrounding tissues. As an
emergency, you should consult a doctor if the following
symptoms appear:
• increased pain and pus discharge;
• the appearance of fever;
• significant swelling of the mucous membrane in the
oral cavity, spreading to the surrounding tissues
–
the
cheek swells, which is noticeable from the outside;
• destruction of the "eight" by caries –
painful reactions
to cold, hot, sour, sweet food;
painful enlargement of the submandibular lymph
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nodes.
The appearance of such symptoms indicates that a
complication is beginning and specialist intervention is
required.
Wisdom tooth extraction procedure
The third molar is removed strictly according to the
indications. An experienced doctor will perform the
operation absolutely painlessly. If it's a simple removal,
it will only take a few minutes. If the operation is
complicated, it will take longer (depending on the
problem), but it will also be painless. Professionalism is
required from the doctor in this situation, and a
positive attitude and calmness are required from the
patient.
Preliminary examination
Before removing the third molar, the doctor carefully
examines the patient, prescribes an additional
examination (X-ray of the jaw) and only then decides
on further treatment tactics. At the same time, the
issue of anesthesia is being resolved.
Preparation for surgery
Before removing the "eight", the doctor must treat
acute purulent-inflammatory processes. After that, he
sets the date of the operation and explains to the
patient what is necessary immediately before the
operation.:
• eating –
dentists do not recommend surgery on an
empty stomach;
• brush y
our teeth using a toothbrush and floss; rinse
your mouth with antiseptic;
to calm down, if necessary, take a sedative of natural
origin: a tablet of valerian extract, Novo Passit,
motherwort infusion or something else;
• tell your doctor if you are allerg
ic to any medications,
as well as what you suffer from and what medications
you take all the time (you cannot perform surgery after
taking some medications).
Must not:
• use alcohol, drugs, and pills with psychoactive effects
(tranquilizers, antipsychotics);
• Smoking leads to vasoconstriction and slower healing
after surgery.;
• steaming in a steam bath or sauna –
vasodilation is
fraught with postoperative bleeding;
• engage in sports or hard physical work.
To perform the operation, you will need:
• a syr
inge for anesthesia;
• scalpel –
for cutting gums (not always required);
• elevator –
a tool that pricks the dental root and
removes it from the cell;
• forceps –
grab the dental crown and remove it along
with the root in a simple operation;
• A drill is n
ecessary for complex removal of a molar; it
is cut and removed piece by piece.
Simple Wisdom Tooth Extraction
This operation is possible if:
• the presence of one or more smooth roots in the third
molar;
• the crown is not destroyed;
• absence of dystopia
and retention.
The doctor performs local anesthesia (infiltration or
conduction). After 5 minutes, when the patient feels
numbness of the tissues, the gum is pushed back in the
neck of the third molar, the root is lifted with an
elevator, and if necessary, forceps are used to capture
and extract the dislocated tooth. Sometimes only
forceps are used for removal. After removing the
wisdom tooth, the hole is treated with an antiseptic and
the bleeding is stopped. If necessary, if the hole is large,
1-2 stitches are applied.
Features of wisdom tooth extraction on the upper and
lower jaws
The upper jaw has relatively thin and porous bone
tissue, while the lower jaw has much more dense bone
tissue. Therefore, to remove the upper "eights", it is
enough to inject an anesthetic into the gum near the
affected tooth (infiltration anesthesia). When removing
a lower wisdom tooth, conduction anesthesia is usually
used
–
an injection is made at the exit point of the nerve
innervating this area.
It is easier to remove the third molars from above than
from below, but if the root breaks off, it is more difficult
to remove it in the upper jaw due to limited access to
the surgical site.
Recommendations for oral care after wisdom tooth
extraction
The dentist-surgeon always tells the patient what to do
after wisdom tooth extraction. Following the doctor's
recommendations after wisdom tooth extraction will
promote rapid wound healing and maximize the risk of
complications. Wound healing depends on the degree
of tissue injury and the patient's general health.
What painkillers can I take?
In the first hours and days after wisdom tooth
extraction, the patient will be disturbed by gradually
subsiding pain and discomfort. The degree of their
severity depends on how traumatic the removal was.
During this period of pain relief, medications from the
group of nonsteroidal anti
–
inflammatory drugs
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(NSAIDs) that relieve inflammation, swelling and pain
are prescribed - Diclofenac, Naiz, Ketorol, Ketonal, etc.
You should not use Aspirin instead
–
this drug has
significant blood-thinning properties and can increase
bleeding. An overdose of NSAIDs can also cause
bleeding.
The pain can be maintained by swelling of the tissues.
To reduce it, you can apply cold to your cheek and take
an antihistamine (Claritin, Zodak, etc.).
How to brush your teeth
On the first day after the removal of the third molar, it
is better not to brush your teeth, it is enough to make
baths with an antiseptic solution three times a day (for
example, with 0.05% Chlorhexidine solution). On 2-3
days, if there is no bleeding, you can brush your teeth
with a soft brush without paste, without touching the
wound. If the gum is not inflamed after wisdom tooth
extraction, there is no bleeding and pain, you can brush
your teeth as usual for 4-5 days.
Suture and hole care after wisdom tooth extraction
On the first day, it's just baths with Chlorhexidine. You
can not rinse your mouth, so as not to remove the
blood clot in the wound. You just need to keep the
solution in your mouth for 2-3 minutes. No special care
is required for the sutures, but in case of complex
removal, the doctor may prescribe a course of
antibacterial therapy for 5-7 days.
Is it possible to eat and drink
You can drink immediately after wisdom tooth
extraction, but you need to do it carefully so as not to
remove the blood clot covering the wound. You can eat
no earlier than after 2 hours, preferably soft or semi-
liquid food. Do not chew it on the injured side. This rule
must be followed until the hole heals completely.
Possible complications after wisdom tooth extraction
With the right approach to treatment and the patient
following the doctor's recommendations, the risk of
complications after tooth extraction is minimal. Most
often, complications after wisdom tooth extraction are
associated with abnormalities in the development of
the third molars and impaired oral hygiene. Much less
often, complications are associated with medical
errors.
Bleeding from the hole
Normally
–
minor bleeding may persist for 2-3 hours
from the beginning of the postoperative period. This
complication is more often associated with decreased
coagulability of the patient's blood. Sometimes the
cause may be injury to a sufficiently large vessel.
Suturing the wound prevents bleeding even after
simple removal. If bleeding is detected, apply a sterile
bandage swab to the hole and immediately consult a
dentist. It is not difficult to eliminate such a
complication.
Dry hole syndrome
Normally, after wisdom tooth extraction, a blood clot
forms in the hole, blocking the bleeding and infection
entering the wound. It is very important not to
accidentally remove this clot by sticking your tongue out
or rinsing your mouth. Sometimes a clot does not form
against the background of significant bleeding.
If a blood clot in the hole is removed or does not form
after wisdom tooth extraction for some reason, the
wound gapes and bone can be seen at its bottom. Food
enters the wound cavity, which is a nutrient medium for
bacteria living in the oral cavity. In this case, they talk
about dry hole syndrome and a high risk of developing
alveolitis, an inflammation of the soft tissues of the hole.
To avoid the infectious and inflammatory process in the
well, baths with antiseptic solutions, gels with anti-
inflammatory and antibacterial properties (Metrogil
Denta, etc.) are used.
Inflammation, swelling and pain
The infectious and inflammatory process in the well
(alveolitis) often develops after the removal of the third
molar. This is due to the peculiarities of the structure,
growth of the third molar, and its location in the
dentition. This process begins on 2-3 days after wisdom
tooth extraction, manifested by swelling and pain. If the
cheek is swollen, the gum swells, the patient cannot
fully open his mouth, chew and swallow food, and
speaks with difficulty. A convulsive contraction of the
jaws (trismus) is characteristic. Sometimes alveolitis is
accompanied by a slight increase in div temperature
and general weakness.
The infection can spread like wildfire to the surrounding
soft tissues, cheek, tongue, causing purulent-
inflammatory processes (abscesses, phlegmons) and
jaw bones (osteomyelitis). A sign of such a complication
is a sharp rise in temperature to high numbers, chills,
headache, throbbing, bursting pain in the jaw. The
patient cannot cope with such a complication on his
own, he will need the help of a doctor, and sometimes
even hospitalization.
Pain after wisdom tooth extraction
After wisdom tooth extraction, the jaw almost always
hurts. These are post-traumatic pains, they last for
several days and are accompanied by a decrease in the
intensity of pain. Read more about the pain after tooth
extraction and how to relieve it. The duration of pain
after wisdom tooth extraction depends on how
traumatic the operation was. If there is no swelling and
the pain decreases, then there is nothing to worry
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about.
But the pain after wisdom teeth extraction can become
increasing and accompanied by edema, which
indicates the onset of inflammation. It can also become
burning in the form of electric shocks
–
one of the signs
of the inclusion of branches of the trigeminal nerve in
the process. In all these cases, you should immediately
consult a doctor.
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