Trial Molars: Characteristics, Functions, Symptoms, Treatment, Complications and Alternatives

They are the four third molars that are located in the dental arch of the permanent dentition.

In the dental arch usually four chordal wisdom teeth are formed, one for each buccal quadrant, they are placed in the last position of the denture line, at the bottom of the mouth.

The wisdom teeth develop in the back of the mouth and usually when they grow up it is at the end of adolescence.

It is at this time when the 28 teeth of an adult are generally already in place and the space in the mouth for the wisdom teeth to grow properly is not enough.

That is why they usually grow crooked, sideways or misaligned and as they emerge they push the other teeth out of alignment and causing problems of agglomeration.

Although most people have wisdom teeth, it is likely that some of the third molars never develop or become visible.

All this because they did not burst through the gums or also emerge at an angle or emerge partially.

When the wisdom teeth grow in this way, it is called “impacted.”

There is also the possibility that a person has more wisdom teeth than the usual four.

Wisdom teeth usually appear between 17 and 21 years old.

When young, the roots are not completely formed and the bone is softer, so there is less chance of damaging nearby nerves when they are removed.

With the passage of time, the roots will continue to grow, making it more painful and more vulnerable to complications at the time of the wisdom teeth surgery.

Characteristics of wisdom teeth

  • Its anatomy is very variable, can present between one to four roots and one to six conduits in the form of C.
  • It may be inclined in a distal or vestibular direction, which is an even greater disadvantage for its access compared to the second molar.
  • They can be blocked by other teeth or by the bone and placed in a position under the gum that blocks them and does not allow their exit.
  • The teeth that are located next to the wisdom teeth are the most affected and prone to presenting gum and decay problems.
  • Those wisdom teeth that can not erupt in their entirety, cause that part of the tooth is covered by pieces of the gum, being reservoirs of food and bacteria that can lead to infections or inflammations. This usually happens with the wisdom teeth located in the lower jaw.

Wisdom teeth functions

The wisdom teeth are considered relics of human evolution, anthropologists argue that these were useful for the first men by the type of diet they had (roots, nuts, canes, meats) as they are foods that require a lot of chewing to to be able to form the food bolus.

When the teeth weathered or fell off, the wisdom teeth were the replacements.

Currently with modern advances in oral hygiene and seeing that our current diets are based on softer and soft food, no teeth need these handsets.

So evolutionary biologists classify the wisdom teeth as dysfunctional because of human evolution.

Basically space dental arch may contain 28 teeth, but when the wisdom teeth emerge, are 32 teeth in competition for space.

Adverse reactions usually occur due to overcrowding, these usually cause discomfort.

Symptoms of the wisdom teeth growth

Pain appears in the back of the gums, behind the last molars.

The pain gradually increases when the wisdom teeth continue to emerge in the small space where they are growing, compressing the nerves, the jaw bones and the surrounding teeth.

It is possible for wisdom teeth to emerge through the surface of the gums and it is relatively easy for bacteria to enter through this opening of the gum around the tooth.

This causes the introduction of bacteria in this open tissue.

Food and bacteria are trapped causing an accumulation of plaque, which can lead to:

  • Dental caries : Developed by the corrosive action of the plaque on the surface of the tooth, which advances and affects the adjacent teeth.
  • Diseases in the gums (gingivitis or periodontal diseases) : This occurs when the toxins released by the plaques cause irritation of the gums and redness and swelling appear, causing pain. This disease in the gums also affects the nearby teeth and the bone that is around the wisdom teeth.
  • Pericoronitis : When there is an infection, caused by the plaque, in the soft tissue that surrounds the tooth.
  • Cellulitis or abscesses : It is a bacterial infection that occurs in the soft tissues of the cheek, tongue or throat, with accumulation of pus in the wisdom teeth or in the surrounding tissue. If immediate relief for these conditions is not sought, it is very likely that these oral infections pass into the bloodstream affecting the entire organism.

Wisdom teeth may be affected when the jaw bone and nearby teeth, due to lack of space, block the eruption of these teeth.

Being trapped without being able to emerge, but their roots continue to be extended by the time they remain impacted.

If not treated in time, impacted wisdom teeth can give rise to cysts and in some cases even tumors.

Cysts and benign tumors are a rare condition where the gum develops a swelling due to the presence of fluid or a tumor mass.

The presence of cysts or tumors can damage adjacent teeth and tissues, including bone, complicating extraction of wisdom teeth.

The symptoms of this impaction can include severe pain in the back of the gums, presence of infections and other complications.

The longer you wait to remove the wisdom teeth, it is very likely that procedures are required for surgical removal that are more invasive, or that these molars cause permanent damage to the surrounding tissues.

Occasionally, these infections can cause inflammation not only of the gum tissue, but also of the cheeks or other area adjacent to the affected side of the jaw.

The swelling causes pressure on the adjacent structures and radiates to the ear causing intense pain.

In some cases, an infection in the ear or a sinus problem can cause a pain that radiates to the teeth, so it is considered important to establish the differential diagnosis.

Treatment of wisdom teeth

The most recommended treatment for the symptoms that cause the appearance of wisdom teeth is definitely the extraction of those teeth.

The extraction of the wisdom teeth is done by an oral surgeon and under local or general anesthesia.

The options and any type of complication that may occur, will be discussed before starting the extraction procedure with the patient.

If the wisdom teeth have already begun to erupt through the surface of the gums, they can be removed with relative ease, as is done with any other tooth.

When the wisdom teeth are impacted it is a little harder to eliminate.

Extraction of the wisdom tooth is a common practice and is surely the best option to alleviate the symptoms that wisdom teeth generate.

Currently, specialists recommend the preventive extraction of wisdom teeth , before the discomfort occurs and are a problem for the oral health of the individual.

If swelling, infections, swallowing difficulties, fever or a lot of pain occur, antibiotics should be prescribed to prevent the infection from increasing or spreading to other parts of the body.

You can also prescribe the use of rinsing with warm salt water or with antibacterial mouthwash.

These actions are short-term to reduce inflammation and reduce tooth pain until definitive treatment can be performed.

Process

This procedure can be as simple as the extraction of any other dental piece, or so complicated that it requires a more complicated surgical intervention.

As with any dental problem, it is important that the specialist in your regular dental checkup review the state of the wisdom teeth and recommend the ideal time to perform the extraction.

First, when it is necessary to remove the wisdom teeth, a panoramic radiograph of the mouth should be performed.

This gives the dentist a clear view of the position of the teeth and allows the diagnosis, to program the way in which extraction of the wisdom teeth is performed.

To perform the procedure, a local anesthetic is administered to numb the area around the tooth.

It is necessary to make an incision in the gum, and it may be necessary before extracting the tooth sectioned into small pieces.

The time it takes to extract the tooth varies, in some cases the procedure only takes a few minutes, but it is possible that in other cases it may take more than 30 minutes.

Post operatorio

After the removal of the wisdom teeth, you may experience swelling, pain and discomfort, inside or outside the mouth, these symptoms are more intense during the first three days.

The medical guidelines must be followed without modifications.

The specialist prescribes analgesics, anti-inflammatories and a treatment for infections and other recommendations such as:

  • Do not rinse until 24 hours after surgery.
  • You can not brush your teeth. When the brushing is done on the area of ​​the surgery, it should be done after 48 hours, gently and with great care.
  • At 48 hours after the surgery, you should rinse your mouth at least 5 to 6 times a day, especially after eating, with a mixture of warm water with salt or mouthwashes containing chlorhexidine for 15 days.
  • If the clot forms and normal bleeding has stopped, it is recommended to gently bite sterilized gauze with cold water in cold water for 45 minutes. This helps accelerate the clotting process.
  • If the side of the face where the extraction was made is immediately inflamed after surgery, a bag with ice should be placed for 30 minutes every 3 hours. This will help the inflammation to reduce rapidly.
  • Do not smoke or drink, as nicotine irritates mouth sores and alcohol inhibits the effects of antibiotics.
  • Points should be removed about a week after the surgery.
  • Day-to-day activities should be restricted on the day of surgery and efforts and strong physical activity should be avoided after surgery.
Possible complications

Like all surgery, there are risks that are associated with the extraction of wisdom teeth.

These risks include infections or delays in healing, which are more likely when the patient smokes during recovery or if they have diabetes.

Another complication is the so-called ” dry alveolus “, which occurs when the coagulum normally formed after extraction is lost in the dental alveolus.

So the bone and nerves are exposed to the air, causing pain and delaying recovery.

This manifests as a painful sensation in the gum or jaw and in some cases the presence of a bad smell or taste that comes from the empty tooth socket.

There may also be a risk of damage to the nerves, which cause pain or numbness of the lower lip, chin, teeth, tongue, gums and a slight tingling sensation.

Other options

The removal of all wisdom teeth is not absolutely necessary.

When the wisdom tooth erupts cleanly through the gum tissue without compromising the adjacent tooth, the wisdom tooth can remain in the dental arch without any problem.

In these cases, dental hygiene is stricter, good brushing should be done, flossing is recommended.

It is imperative that the wisdom teeth be inspected regularly by a dentist to determine what is the proper diagnosis and the course that these teeth follow over time.

The situation of the wisdom teeth varies greatly in the ages between 16 and 23 years

Eventually, the wisdom teeth can cause pain, produced by a small flap of gum tissue that has been displaced by the exit of the wisdom tooth, which has swollen and barely covers the back of the tooth.

If there is enough space for the accommodation of the tooth, the excess tissue of the gum can be removed to solve this problem and extraction of the wisdom tooth is not necessary.

It is necessary to modify the brushing angle and increase the frequency of flossing.

It can help protect gum tissues by keeping them healthy and prevent the appearance of conditions such as painful gingivitis or infections that occur around the wisdom teeth.

In situations when the third molar has started its eruption through the gum tissue, but there is no occlusion or contact with other teeth, which interferes with its exit, the extraction should be considered.

When reviewing the position of erupting wisdom teeth, these teeth are often difficult to keep in good cleaning condition.

When these teeth acquire cavities, it is usually recommended to remove them instead of removing cavities or repair wisdom teeth with the use of fillings, root canals or crowns, which are indicated for the rest of the teeth successfully.