Impacted teeth are teeth that can only partially erupt or cannot erupt at all due to obstruction by adjacent teeth, bones or soft tissues. Common impacted teeth include mandibular third molars, maxillary third molars, maxillary canines and some supernumerary teeth. Among them, mandibular third molars, also known as wisdom teeth, are the teeth most susceptible to impaction. Impacted tooth extraction refers to a surgery that extracts the impacted teeth in the mouth from the alveolar socket. The impacted teeth that usually need to be extracted are wisdom teeth. Generally speaking, the effect of treatment can last for more than 10 years. The surgical method of impacted tooth extraction is related to the position of the teeth and the degree of impaction. People who need to extract impacted teeth are recommended to go to a regular medical institution for treatment to avoid adverse consequences.
Applicable people
Impacted tooth extraction is suitable for people with impacted teeth.
Taboo groups
1. Patients with uncontrolled acute pericoronitis.
2. Teeth on which the malignant tumor is located or teeth adjacent to the tumor.
3. Patients undergoing radiotherapy.
4. Tooth extraction should be stopped or postponed when the heart disease patient is in the following conditions: recent myocardial infarction, recent frequent attacks of angina pectoris, congestive heart failure, severe arrhythmia, heart disease combined with hypertension.
5. Patients with blood system diseases should be cautious when having teeth extracted, mainly including anemia, leukemia, thrombocytopenic purpura, hemophilia, etc., which can easily cause continuous bleeding after tooth extraction, slow healing of tooth extraction wounds, and low anti-infection ability.
6. Patients with diabetes, hyperthyroidism, kidney disease, liver disease and other diseases.
7. It is best not to undergo this treatment for women who are pregnant or menstruating.
8. People with mental abnormalities or psychological disorders.
Technical/surgical risks
1. Gingival damage during surgery: Gingival damage is mostly caused by incomplete gum separation, improper placement of forceps, or accidental clamping of the gums by the forceps beak.
2. Intraoperative damage to adjacent soft tissues: This often occurs when the dental elevator is improperly used or lacks proper protection, leading to slippage. Common injuries occur in the soft tissues adjacent to the gums, tongue, floor of mouth, or palate. Avoid involving adjacent soft tissues when using the dental drill.
3. Intraoperative periosteum injury: During flap surgery, tearing of the mucoperiosteal flap is a common complication, which is mostly caused by unreasonable flap design or improper operation.
4. Tooth fracture: Tooth fracture is a common complication during surgery. There are many reasons for fracture, such as excessive tooth decay, dead pulp, curved root end, hypertrophy, excessive root bifurcation, adhesion of the tooth root to the surrounding bone tissue, or improper force.
5. Damage to adjacent teeth or opposing teeth: mostly caused by improper operation by the surgeon.
6. Teeth displaced deeply: Generally, displaced teeth or broken roots should be removed at the same time; small, non-infected broken roots that enter the mandibular canal do not need to be removed. If numbness of the lower lip persists, delayed extraction of the broken roots can be performed after 3 months.
7. Alveolar fracture: Alveolar fracture is often caused by improper placement of dental forceps or dental elevators, the use of force, or failure to completely eliminate bone resistance.
8. Mandibular Fracture: Mandibular fractures are rare and often occur during the extraction of low-positioned impacted wisdom teeth. Excessive force during tooth extraction, such as splitting, bone removal, and the use of dental elevators, can easily fracture the inherently weak mandibular angle. Furthermore, mandibular fractures can also occur during tooth extraction in the elderly with osteoporosis, mandibular cysts, tumors, hyperparathyroidism, or after radiation therapy.
9. Nerve damage: Dexamethasone, vitamin B1, B6, B12 and other medications should be given , supplemented by physical therapy to reduce nerve edema and promote nerve recovery.
10. Bleeding: The cause may be systemic factors, such as blood diseases, hypertension, etc.; it may also be caused by damage to large blood vessels or tearing of gums and periosteum during the operation.
11. Temporomandibular joint dislocation: If the patient opens his mouth too wide or for too long during surgery, or if there is severe external force when splitting teeth and removing bones, the temporomandibular joint may be dislocated. Patients with habitual dislocation are more likely to suffer from this condition.
12. Instrument breakage: Doctors should avoid using violence during operation.
13. Tooth swallowed or inhaled accidentally after dislocation: When the tooth becomes loose, use dental forceps to clamp and pull it out, and avoid using a dental elevator to directly push it out; swallowed teeth do not require special treatment, but if they are accidentally inhaled into the trachea, you must immediately consult an ENT doctor to remove them to avoid accidents.
14. Syncope during surgery: Stop tooth extraction immediately and wait for the doctor to identify the cause and then provide symptomatic treatment.
15. Postoperative bleeding: Most postoperative bleeding is caused by local and systemic factors, which are post-tooth extraction bleeding.
16. Postoperative infection: It is mainly caused by improper treatment of tooth extraction wound, foreign objects such as tooth fragments, bone fragments, dental plaque left in the alveolar socket, or incomplete removal of inflammatory granulation tissue.
17. Postoperative pain and swelling: After tooth extraction, pain and swelling are usually mild or non-existent, and generally require no treatment. However, some patients may experience excessive pain and swelling, which can cause significant pain, affect wound healing, and increase the chance of infection.
18. Limited mouth opening after surgery: This may be caused by damage to the mandibular joint, damage to the masticatory muscles, or inflammatory stimulation, excessive swelling, pain during infection, etc.
19. Subcutaneous emphysema: It usually appears on the day of surgery and is located in the cheek, submandibular or submental areas. Clinically, there is swelling but no tenderness, but palpable crepitus.
20. Dry socket: Trauma, infection, and a large extraction socket are currently considered the main causes. Symptoms include severe pain 2-3 days after extraction, radiating to the auricular and temporal areas, submandibular region, or top of the head, which is not relieved by standard analgesics.
Postoperative care
After the removal of impacted teeth, attention should be paid to local care, medication management, diet adjustment and follow-up examinations.
1. Local care: Do not brush your teeth or rinse your mouth within 24 hours after the operation, and do not lick or suck the wound; afterwards, pay attention to maintaining oral hygiene. You should clean your mouth by brushing your teeth in the morning and evening, rinsing your mouth after meals, and using dental floss to avoid food impaction.
2. Medication management: Patients with gingivitis can use antibiotics under the guidance of a doctor to eliminate local inflammation.
3. Dietary adjustment: In your daily diet, you should reduce the intake of foods that are too hard, sticky, too cold or too hot.
4. Follow-up examination: Follow the doctor’s instructions for follow-up examination after surgery to understand the condition of the oral cavity and teeth in a timely manner.
Preoperative precautions
1. Complete routine blood tests, four infection tests, coagulation function tests, and electrocardiograms before surgery. Patients with a history of hypertension, heart disease, diabetes, or drug allergies should inform their doctor promptly before surgery to rule out contraindications.
2. Before surgery, cooperate with the doctor to complete the oral examination to understand the eruption of the third molar and its position in relation to the surrounding tissues, and to confirm whether there are any local lesions. If there are any, appropriate treatment should be given before tooth extraction.
3. Take X-ray examination, dental film or mandibular panoramic (curved section) film.
4. Do not take aspirin or other anticoagulant drugs 2 weeks before surgery.
5. Women should avoid use during menstruation, pregnancy and lactation.
Surgical procedure
The surgical method for removing impacted teeth is related to the position and degree of impaction of the teeth. Taking the extraction of wisdom teeth as an example, for fully grown wisdom teeth, they can be extracted after separating the gum tissue and loosening the tooth roots; for impacted teeth, the gums need to be cut and the teeth split before they can be removed; some wisdom teeth are blocked by bone tissue, so after cutting the gums, part of the bone covering the tooth surface needs to be removed before the teeth can be exposed and extracted. Here, we take impacted teeth without bone tissue obstruction as an example. The surgical process mainly includes anesthesia, making incisions, splitting teeth, removing fragments, cleaning wounds, suturing and other steps.