Surgical-Dentistry.Info
Wisdom Teeth Treatment Options

A wisdom tooth that is only partially through the gum or has
a flap of skin overlying it (an operculum), can be prone to
surrounding the tooth’s crown.

If the wisdom tooth does not need to be removed (see the
NICE Guidance on the Extraction of Wisdom Teeth), then
it can be kept but will need targeted oral hygiene.

This involves very scrupulous cleaning around the tooth
(+/- operculum) possibly using such adjuncts as antiseptic
mouthwashes or gels (Corsodyl is very good for this).

Problems with the procedure:

  • Future flare-ups with the wisdom teeth can still occur
    especially if stressed, moving house, sitting exams etc.

  • May be regarded just as a stop-gap measure,
    delaying the day that the tooth may need to be
    removed.

The NICE guidelines emphasise the link between the
presence of plaque and peri-coronitis (inflammation /
infection around the crown of the wisdom tooth, NICE
Guidance on the Extraction of Wisdom Teeth, 1.4)


Operculectomy

If the flap of gum overlying the wisdom tooth (the
operculum) is causing the problem, then this can be
removed by a number of means (‘cold steel’, glacial acetic
acid, laser or diathermy).

Problems with the procedure:

It possible that this may grow back and the operculectomy
may need to be repeated.


  • Coupled with this, it can be quite sore afterwards and
    there may be limitation of mouth opening.

  • If the wisdom teeth flare-ups have been quite episodic,
    then it may be hard to know if the operculectomy has
    in itself, been successful.


An operculectomy is sometimes considered if the upper,
opposing wisdom tooth is traumatising the operculum.  
SIGN suggests pain associated with the lower wisdom
tooth is commonly exacerbated by the upper wisdom tooth
biting on the gum flap (operculum), causing pain and
discomfort.

Alternatively, if the upper wisdom tooth is easy to remove
and is non-functional, then immediate removal of that tooth
will often dramatically relieve the pain from the area.  This
is particularly useful where there is likely to be delay in the
removal of the lower wisdom tooth and can be regarded
as an interim measure (after referral but prior to surgery).


Exodontia / Tooth Extraction

Wisdom teeth are removed only if the reason for removal
is mentioned in the NICE guidelines.

Wisdom teeth cannot be prophylactically / preventively
removed.

Just because wisdom teeth are present, it does not mean
they have to be removed.

The guidelines boil down to waiting for some pathology
to develop – decay, gum disease, infection around the
tooth crown, cyst development etc.  This is regarded by
some as supervised neglect.

Problems with the procedure:





  • pain

  • restricted mouth opening


Patients should not be exposed to these risks of a surgical
procedure unnecessarily.


Coronectomy

If the roots of the wisdom tooth seem to be in very close
proximity to the nerve that supplies sensation to the lip and
chin (the Inferior Dental Nerve) or if the tooth itself is deep
within the lower jaw so that total removal of the tooth may
be impractical / ‘tricky’ / damage the nerves / lead to a
possible broken jaw, then only the crown of the tooth may
be removed (coronectomy / intentional partial
odontectomy).

Problems with the procedure:

  • If, when the tooth is being decoronated, the roots are
    found to be mobile, then the roots have to be removed
    as well (hence, the original problems of nerve damage
    etc are not circumvented).

  • The roots left behind often migrate away from the
    nerve so that if they give any more problems, the roots
    can be removed with reduced risk to the nerve.


Articles on coronectomy / intentional partial
odontectomy of 3rd molars:

Coronectomy (intentional partial odontectomy of lower
third molars).

Coronectomy: A Technique to Protect the Inferior Alveolar
Nerve.

Coronectomy - An Alternative Therapy for the symptomatic
impacted 3rd molar - Report of 9 cases