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Wisdom teeth - A major problem in young generation, study on the basis of types
and associated complications
G. Biswari1, P. Gupta2, D. Das1
1 Lecturer, 2Medical Officer, Department of Dental Surgery, College of Medical Sciences, Bharatpur, Chitwan, Nepal
Abstract
The aim of this study was to describe the characteristics and types of the impacted mandibular third molar at
the highest risk for pain and pericoronitis using clinical and radiographic analysis. A total of 239 volunteers,
including 147 (61.5 %) male and 92 (38.5%) female patients presenting with acute pericoronitis, participated in
the study. The mean age of the participants was 28 years (range 16–40 years). The analysis of type, angulations
and eruption level of the mandibular third molar were achieved by using I.O.P.A. X-ray and in few cases, lateral
oblique of mandible. While mesioangular impaction was the most frequent angulation (44.4%), horizontal impaction
was quite less (11%). Vertical impaction (27.6%) was slightly higher than distoangular impaction (15.9%) and
aberrant (0.8 %).
Key words: Impacted third molar, pericoronitis, types of impaction
Correspondences: Dr. G. Biswari
E-mail: dr_arian3@rediffmail.com
Introduction
Impaction occurs where there is prevention of
complete eruption into a normal functional position of
one tooth by another, due to lack of space (in the dental
arch), obstruction by another tooth or development in
an abnormal position.1,2 An impacted tooth may be:
Completely impacted: when entirely covered by soft
tissue and partially or completely covered by bone
within the bony alveolus.
Partially erupted: when it has failed to erupt into a
normal functional position
Review of the literature
‘Our ancestors had larger jaws so there was room
in the human mouth for 32 permanent teeth, including
third molars—wisdom teeth. But now our jaws are
smaller. The result: There’s no longer room in most of
our mouths to house 32 teeth. So the last teeth we
develop—our wisdom teeth,often become impacted
or blocked from erupting.’3
A major conclusion of evolution is that the human
jaw has shrunk from its much larger ape size to the
smaller modern human size as humans evolved. In
short, evolution has produced ‘an increase in brain size
at the expense of jaw size.’4 In the process, the jaw
has became too small for the last teeth to erupt which
are normally the third molars.
Research now indicates that the reasons for most
third molar problems today are not the evolutionary
changes but something else. These reasons include a
change from a coarse abrasive diet to a soft western
diet, lack of proper dental care, and genetic factors,
possibly including mutations.
Original Article
Journal of College of Medical Sciences-Nepal,2010,Vol-6,No-3, 24-28
24
The "wisdom teeth" or last molars, are in man,
approaching a vestigial condition since they generally
do not appear until relatively late, between the ages of
twenty and thirty years, and in many persons are never
cut at all. In a large percentage of individuals, they are
useless, and they often become impacted and have to
be removed surgically.5
The loss of an organ in evolution purely as a result
of disuse, also called Lamarckian Evolution, has now
been thoroughly disproved. The belief that wisdom
teeth are vestigial organs that lack a function in the
body (as was previously believed for the appendix), is
less common today but still evident. It is also commonly
assumed by the general public.
Another problem cited for their removal is the
possibility of cysts and tumors developing in the sac
surrounding an impacted wisdom tooth. This
abnormality is relatively rare—usually around one
percent of all impacted third molars are surrounded
by cysts, although one study found the rate was 11%.6, 7
One reason they were believed to cause problems
was that the wisdom teeth normally erupt last, between
18 and 25 years of age. Consequently it was assumed
that if not enough room did not exist in the jaw, teeth
crowding would result. Since they erupt at about the
time when the youth goes off into the world to become
‘wise’ the name ‘wisdom teeth’ was used to describe
them.8 In 13–15% of patients they never develop and
only from 9 to 24% of all cases become impacted,
usually because they are pointed in the wrong direction
when they break through the gum, causing them to push
against the second molar.9
Although third molars have the greatest incidence
of impaction of all teeth, the impaction risk is much
smaller than the proponents of prophylactic
odontectomy (the routine removal of asymptomatic
unerupted teeth) claim.10
Materials and methods
This study was conducted at the Dental Dept. of
the College of Medical Sciences & Teaching Hospital,
Bharatpur, Nepal. Total Two hundred thirty nine
patients were selected for this study with complain of
pain and swelling over back teeth of the lower jaw.
Intra oral Periapical Radiographs and when
necessary, lateral oblique radiographs of the mandible
of patients with impacted third molar were taken.
Differentiation of the type was done on the basis
of depth and angulation of impacted teeth with occlusal
plan. Depth of impaction was measured in millimetres
with a pair of callipers and ruler. For the measurement,
a perpendicular from the alveolar margin to the amelo-
cemental junction of the impacted teeth was measured
with the callipers and read from the ruler.
All extractions were done under local anaesthesia,
the bur technique with preservation of the lingual plate
was used, while in 23 cases bur or lingual bone split
technique was used. Personal details including age, sex,
diagnosis, X-ray type, type of impaction, associated
pathology, antibiotics used were recorded. Forty-four
percent of the patients were in the age of 16-25 years.
Results
There were 239 patients consisting of 147 males
and 92 females. Two hundred and thirty-nine impacted
mandibular third molar teeth were extracted. Details
of the age of patients and the types of impaction are
presented on Table 1. One hundred forty-four (60.3
%) extractions were from patients aged 25 years and
below while, ninety-five (39,7%) were extracted from
elder patients. Mesioangular impaction was the most
G. Biswari et al ,Wisdom teeth - A major problem in young generation, ...................
25
frequent angulation (44.4%) which was easy to extract
compared to horizontal impaction which was quite less
(11%) but most difficult to extract. Vertical impaction
(27.6%) was slightly higher than distoangular impaction
(15.9%) and aberrant (0.8 %).
Table- 1: Age distribution and type of impaction
Types 16-25 yr 26-35 yr 35 yr > Total (%)
Mesio-angular 63 36 07 106 (44.4%)
Vertical 40 23 03 66 (27.6%)
Disto-angular 22 15 01 38 (15.9%)
Horizontal 18 08 01 27 (11.3%)
Aberrant 01 00 02 02 (00.8%)
Total 144 82 13 239 (100%)
(%) 60.3% 34.3% 5.4%
Discussion
For generations, many dentists recommended
extraction of impacted wisdom teeth because the
procedure in the young was ‘much easier than in later
years, when the bone became more dense. Also, the
younger the patient, the better the procedure will be
tolerated.11 This advice has now been replaced with
the conclusion that ‘extracting only those third molars
that remain impacted and become pathologically
involved is associated with less expected costs and
disability than prophylactic removal of wisdom teeth.10
Although a competent surgeon can reduce serious
problems later in life by appropriate removal of third
molars, routine prophylactic removal is now regarded
by many researchers as ill advised.9 A review of 12
studies on prophylactic removal found ‘there is little
justification for the removal of pathology free impacted
third molars.’12 According to Samsudin and Mason13,
pain was once the major reason asymptomatic wisdom
teeth were removed (73.7% of all cases). Surgeons
usually set a removal decision threshold based on
several criteria and if a tooth has characteristics which
exceed the threshold, it is removed14. This requires
training, experience and knowledge.
Teeth extraction can cause postoperative pain,
swelling, and tempromandibular joint dysfunction.15 The
most common complications include infection and dry
socket, trauma to the neurovascular bundle and
Journal of College of Medical Sciences-Nepal,2010,Vol-6,No-3
26
temporary or permanent paresthesia or anesthesia of
the lip, trauma to the lingual nerve, tongue numbness
(temporary or permanent), root segments left in the
socket and risk of damage to adjacent teeth.16 One
Michigan study found that about ten percent of all such
operations resulted in complications, mostly minor, but
included some serious problems such as infection,
persistent bleeding, severe tooth socket inflammation,
permanent numbness of the lip and tongue and
occasionally, catastrophic haemorrhage which could
be lethal.17,18
The impacted mandibular third molar tooth is
common among adults. It has been estimated that 1
out of every 11 mandibular third molar teeth, aged 15
to 35 years was impacted. In older adults, 1 in every
46 mandibular third molar teeth was reported to be
impacted. This study agrees with the trend that
impacted third molar teeth are common in young adults
and it is important to know type of impaction before
planning of management.
Conclusion
Several factors have been found to be important
in causing third molar problems and malocclusion. The
most important factor is probably diet, but the influence
of other factors including mutations, need to be
examined more fully to understand why wisdom teeth
are more often a problem today.
Impaction of mandibular 3rd molar is a common
problem in adult and it causes pain, pericoronitis and
some times more serious problems like cellulitis,
submandibular space infections in delayed condition,
that is why the conclusion of this study is better to
extract impacted 3rd molar in initial stage after
confirming the type and eruption pattern of particular
teeth by radiograph to avoid delayed problem
associated with impaction like post operative pain and
infection.
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