Wisdom Teeth... not so wise.

A wisdom tooth, in humans, is any of the usually four third molars, including mandibular third molar and maxillary third molar. Wisdom teeth usually appear between the ages of 17 and 25.  Most adults have four wisdom teeth, but it is possible to have more, in which case they are called supernumerary teeth. Wisdom teeth commonly affect other teeth as they develop, becoming impacted or "coming in sideways". They are often extracted when this occurs. Wisdom teeth are the last teeth to erupt in the mouth. Technically molars, because they erupt behind the 2nd molars in the mouth. We have 4 wisdom teeth, two in the upper arch and two in the lower. The wisdom teeth are the ones least needed for good oral health. They may not erupt or emerge from your gums until your late teens or early twenties - if they erupt at all. Most often they are impacted or trapped in the jaw-bone and gums, usually because there is not enough room for them in your mouth. Our jaws are smaller than those of early humans, who needed large jaws and more teeth for their tougher diet. We don't need that extra chewing power any more. In fact, wisdom teeth often do more harm than good, and in-case of any problems related to them, your dentist would suggest removing them. 

There are a few possible ways in which wisdom teeth may cause problems: 

Gum disease: Most people are aware of the pain experienced during the eruption of these teeth. This generally happens because these partly erupted teeth are difficult to keep clean, and the accumulated food particles cause the gums around the tooth to get infected. Such an infection is felt as swelling and pain around the area. Sometimes the tooth is trying to erupt, but has not yet broken through the gums. When the upper tooth bites down onto this gum, pain can be caused. 

Impacted: It sometimes happens that there is not enough space in the mouth for these teeth to erupt. In such cases they may try to erupt in an abnormal direction, or may get locked into the jaw. This locking is known as impaction. 

Decay: A wisdom tooth may decay unnoticed, as they are the most difficult teeth to keep clean, being so far back into the mouth. Positions of Impaction: Due to unavailability of space in the jaws, the impacted wisdom teeth grow in many different directions, commonly at an angle. The complexity of surgery depends on the type of impaction, as explained below. 

A wisdom wisdom tooth may grow at an angle towards your other teeth. This type of impaction is called as a Mesio-angular impaction. • A  wisdom tooth which erupts at an angle away from your other teeth is said to be Disto-angularly impacted. • A  wisdom tooth facing your other teeth horizontally is said to be Horizontally impacted. • A  tooth which is in normal direction but still unable to erupt due to lack of space is said to be Vertically impacted. 

Floss and brush daily to ward off tooth decay and gum disease, and make sure you get regular dental checkups. Extraction Wisdom teeth are extracted for two general reasons: either the wisdom teeth have already become impacted, or the wisdom teeth could potentially become problematic if not extracted. Potential problems caused by the presence of properly grown-in wisdom teeth include infections caused by food particles easily trapped in the jaw area behind the wisdom teeth where regular brushing and flossing is difficult and ineffective. Such infections may be frequent, and cause considerable pain and medical danger. Other reasons wisdom teeth are removed include misalignment which rubs up against the tongue or cheek causing pain, potential crowding or malocclusion of the remaining teeth (a result of there being not enough room on the jaw or in the mouth), as well as orthodontics wisdom tooth care precautions 

1). Avoid excessive rinsing or gargling of mouth. 

2). Avoid excessive spitting of excess saliva and blood in mouth. Try to swallow your saliva as per normal. 

3). Take cool liquid to soft diet as tolerated. 

4). Avoid driving or operating heavy machineries if you are taking any sedatives or medications that makes you drowsy or interferes with your motor reflexes. 

5). Do not tug at or pull at the sutures or stitches at the operative site.

An ode to gums

The term periodontal diseases means diseases related to the periodontal ligament or periodontium.which means diseases occurring near or around a tooth. A branch of dentistry dealing with the study and treatment of disease of the periodontium is called as periodontics.The tissues investing and supporting the teeth including the cmentum,periodontal ligament, alveolar bone, and gingival is termed as periodontium.In general gum diseases, gingivitis can be assigned in a group termed as periodontitis,an inflammatory reaction of the periodontium.It can also be a degenerative disorder of periodontal structures marked by tissue destruction. 

The gums are the soft tissues which develop the alveolar processes of the upper and lower jaws and surround the neck of the teeth. These are composed of dense fibrous tissues covered by stratified squamous epithelium. Alveolar nerve, greater palatine,nasopalatine nerve along with lingual nerve play the role of nervous connections to gums. Healthy gums are bright pink in colour. But due to nutritional deficiencies, improper oral hygiene may cause various gum diseases. The earliest sign of pyorrhea alveolaris is a deep redline along the free edge of gum. One of the inflammatory conditions of the gingivae is Vincent’s stomatities in which ulceration of gingival margin and formation of a pseudo membrane. In this condition very bad smell will occur inside mouth. Another condition in which painful purple red indurate papule found on the alveolar margin in the region of molar or premolar the along with foul smell is termed as Cancrum oris.In dental abscess, swollen gum is sometimes a feature. People who are working in led polluted areas, blue lines may be seen along the alveolar margin. 

As age advances the gums recede and teeth appear longer. The gums may bleed on palpation which becomes swollen, spongy and tender in a condition called scurvy .here defective formation of collagen impairs healing of wounds and causes capillary hemorrhage, and reduced platelet adhesiveness. Dietary deficiency include not consuming fruits and vegetables for more than two months and feeding infants exclusively on boiled milk, this can precipitate vitamin-C deficiency. Trauma, surgery, burns, infection, smoking, drugs such as corticosteroid intake, aspirin consumption can also lead to increase in requirement of vitC

 In pyorrhea, the initial symptoms are enlargement and inflammation of the soft tissue and bleeding of the gums. Without treatment, the soft tissue deteriorate and the alveolar bone may be reabsorbed causing loosening of the teeth and recession of the gums. In general, periodontal diseases often caused by poor oral hygiene by local irritants such as bacteria,imparted food,cigarette smoke or by a poor bite. In order to maintain a healthy gum, proper cleaning of gums along with teeth is essential. More or less cleaning with water after chewing more starch, glucose content food is a must. Keep in mind that gums are the foundation for strong and healthy teeth.

Emercency Dental Tips (Part 2)

In this second of a two part series we complete our list of emergeny tips. Dr Hamill is available to answer emergency question after hour and should be consulted before starting treatment.

Bitten tongue, cheek, lips, etc: Gently rinse area with cool water or wipe with damp gauze or cloth. Swelling is controlled with a cold pack or crushed ice in a ziplock. If bleeding continues, apply pressure with cool wet gauze or teabag. Take appropriate pain medication.

Gum Boil: Keep the area clean by gentle toothbrushing and rinsing with salt water. If pain and swelling increases in the area then cool compresses and pain medications will help. Do not try to pop the boil. You may need to be put on antibiotics. See us as soon as possible.

Knocked out Tooth: Save the tooth or tooth pieces in a balanced saline solution, contact lens solution, milk or water. If bleeding continues, apply pressure with cool wet gauze or teabag. Take appropriate pain medication. Do not clean the area as the tissue fragments will help the healing process if the tooth can be reinserted. Be gentle with the developing clot, no spitting, smoking or use of a straw. You must get to a dentist within 60 minutes to have any real chance of saving the tooth.

Loose Baby Tooth: If the child can wiggle the tooth out...great! Encourage the child to move the tooth in all directions, but do not use large forces. Slow and steady usually wins out. If both the adult tooth and baby tooth are visible then see us for an assessment.

Toothache: Avoid the area as much as possible: no biting, or food items in the area, avoid hot and cold drinks. If pain increases and swelling occurs, then a cold compress in the area will help. Pain medications as needed. See us as soon as possible, you will likely have to take antibiotics.

Teething Pains: Freeze or chill some baby carrots and apply them to the area. Ice chips in a ziplock or cloth is also good. Some mild pain relievers and teeth gel (follow the instructions closely, do not overuse) can help.

Wisdom Tooth: Brush your teeth and rinse with warm salt water. If the area begins to swell and pain increases, a cool compress and pain medications will help the situation. You may need to take antibiotics and the tooth/teeth will likely need to come out. Give us a call immediately

* In general, Advil (Motrin/Ibuprofen) 200mg every 4-6 hours should help pain and reduce inflammation. Tylenol (Acetaminophen) 325mg every 4-6 hours is a good alternative. Different pain medications can be described once your situation is evaluated.

Emergency Dental Tips (Part1)

Our office philosophy is to offer emergency dental care as swiftly as possible to our patients. However it is important to be proactive in your own dental care. Dr Hamill is available to answer emergency question after hour and should be consulted before starting treatment.

Dr Hamill has put together a list of suggestion on “What to do” when problems occur.

Fractured or Broken Tooth Punctures Skin: Rinse your mouth with salt water if you have it. Regular water will work if salt is not available to help prevent infection. If there is bleeding apply pressure to the affected tissue and cover with a wet gauze or clean piece of cloth. Monitor the amount of blood loss to determine if blood is clotting. Do not remove fractured or broken pieces of your tooth that are embedded deeply into your skin or oral cavity. If you are able to take pain medication,* do so and contact our office right away. 

Gums Start Bleeding: Typically this is gum disease also referred to as periodontal disease. A daily dose of brushing your teeth after meals (or at least twice a day) and flossing daily should help reduce blood loss. However if bleeding persists contact us right away.

Canker Sores: Gently brushing and rinsing with salt water to help keep the area clean. After about two weeks you should notice a significant reduction in size. Applying pain medication to the affected area is not recommended, tablet /pill form should suffice.* Also make sure to avoid consuming acidic food.

In general, Advil (Motrin/Ibuprofen) 200mg every 4-6 hours should help pain and reduce inflammation. Tylenol (Acetaminophen) 325mg every 4-6 hours is a good alternative. Different pain medications can be described once your situation is evaluated.

The Importance of Medical History

Your dentist will be able to care for you much better if you let him know your medical history. After all, he can find out about other diseases too when he is examining your mouth.

As an example, if you are pregnant, teeth whitening treatment may not be for you, but the dentist will not know this unless you tell him. The chemicals used for whitening can prove to be harmful in pregnancy. Similarly, let him know if you are recently diagnosed with diabetes, so that you will be treated accordingly.

It is imperative that you be upfront with your dentist. Most dental offices want a completed medical history form, this form is typically available on the dentist website and should be completed prior to your first visit and when any changes occur to your medical history.