The basic principle of dentistry is to keep the teeth in the mouth by treating and rehabilitating them and stay away from surgical methods as much as possible. Today, owing to the contributions of scientific and technological developments, this goal is nearing more than ever.

But, in some cases, extraction might be the only consultation method for conserving the patient’s health and making a sound treatment plan.

These cases can be summarized as:

- Teeth that can’t be rescued due to advanced caries and loss of tooth substance,
- Teeth which are cracked due to a stroke and which can’t be treated,
- Some abscessed teeth which couldn’t be cured with a root canal treatment,
- Loose teeth due to advanced gingival inflammation,
- Deciduous teeth which do not fall out on time,
- Teeth which create a problem due to advanced location changes (twisted, tilted etc.)
- Teeth within a cyst or tumor
- Teeth which couldn’t erupt or which cause a problem,
- Teeth which cause crowding in order to support the orthodontic treatment.

Among all teeth due to their special status, the most frequently extracted ones are the wisdom teeth.

Wisdom teeth are the third molars located at the right and left end of the upper and lower jaws. As they are the last teeth to erupt between at 16-20, they are named as the wisdom teeth.

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Since they are the last permanent teeth to erupt, there might not be sufficient place for them in the mouth. Therefore the wisdom teeth are located either under the gingival tissue or the bone, in some cases they are seen impacted beside another tooth.

Usually the wisdom teeth of the lower jaw aren’t located at the same plane with the other teeth, they tend to erupt at an angle to the adjacent teeth. As this situation proceeds, the wisdom teeth lean on the neighboring teeth causing pressure and crowding.

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On the other hand, the wisdom teeth of the upper jaw tend to erupt at an angle into the cheek causing cheek biting.

Sometimes, the wisdom teeth of the lower jaw tend to erupt from within the jaw bone, but they can’t penetrate the soft tissue placed on the bone and only a part of them may be visible in the mouth.

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The neighboring tissues of such teeth tend to get easily inflamed and result in great discomforts with severe pain. The patient has difficulties in opening his/her mouth due to the pressure of the inflammation on the surrounding masticatory muscles. Moreover, difficulty in swallowing and swelling of the lymph glands under the jaw are also observed.

In this case, the first thing to do is to prescribe an anitibiotic so that the acute inflammation changes to a chronic phase. Afterwards this tooth has to be extracted by a surgical procedure.

Partially erupted or crooked wisdom teeth also cause pain, crowding and inflammation. As they are located at the very back it is hard to brush them and they tend to decay very easily. The caries located at the enamel and dentin layers can be treated with a filling. But for wisdom teeth with a pulpal infection, the treatment of preference is usually extraction because the root canal treatment of wisdom teeth do not present optimum results as the working conditions of the area are not ideal and as it is hard to keep them free of saliva.

The extraction method of wisdom teeth differ according to the erupted amount. Their extraction can be performed just like other routine extractions or depending on the degree of eruption, a surgical intervention may be preferred.

Before the extraction, a radiograph should be taken because their roots are usually curved like a hook or a rod.

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Wisdom teeth with twisted roots

These teeth with such roots have to extracted with a minor surgery. Because in such cases fracture of the roots is inevitable.

How to recover after wisdom tooth extraction?

- The gauze placed on the surgical site should be kept there for half an hour.
- Once the gauze has been taken off, an extra one shouldn’t be placed if not needed. Care should be taken not to interfere with the clotting process.
- The mouth shouldn't be rinsed with water.
- Nothing should be eaten for 2 hours following the extraction, and afterwards hot or cold foods should be avoided.
- Smoking is strictly forbiden for 72 hours. Smoking causes the clot to break down resulting in inflammation. This condition named as dry clot leads to pain.
- Alcohol is strictly forbidden for 72 hours.
- The extraction area shouldn’t be disturbed, it shouldn’t be attempted to spit out. The extraction area should be kept out of use for 72 hours.
- In case of pain, painkiller pills (not aspirin) should be taken after consulting the dentist.
- The extraction area should be kept clean and free from any kind of food rests. After 24 hours it may be brushed with a soft tooth brush.
- A light bleeding of 6-24 hours is considered normal. But in case there is extreme bleeding and this time span has been exceeded, a dentist should be consulted.
- Similarly, in cases of lasting pain and swelling, a dentist should be consulted.
- After operative wisdom teeth extractions, a facial swelling and pain is considered normal. This swelling can be avoided by painkillers and antibiotics. Applying cold compress (not ice) on the area right after the extraction will help the swelling to decrease.
- The stitches will be removed after approximately one week. Until this time, the patient should take soft foods, brush the teeth with a soft tooth brush and shouldn’t use alcohol or tobacco as these will inhibit the clotting process.

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The information contained in the site is to inform about dentistry and treatment methods.
This information is definitely not a substitute for the physician to examine the patient for medical purposes or to make a diagnosis.