Wisdom Teeth Infection

Introduction

Definition of wisdom teeth infection 

Wisdom teeth are the last set of teeth coming into the mouth from the bone underlying. Because of evolutionary changes, there is not much space left for the molars to come up to the mouth, making them impacted. When they get infected, it results in a wisdom tooth infection.

Wisdom teeth are a total of four in number and erupt between the ages of 18 and 25 for both males and females. Since their eruption time is at the time of maturity, unlike the rest of the teeth, they are named wisdom teeth. Two teeth in the upper jaw and two in the lower jaw share the left and right sides of the jaw.

Lower wisdom teeth are  near many important structures and are more prone to get an infection because of their dependent position. Upper wisdom teeth are close to the temporomandibular joint responsible for opening and closing of the mouth.  All the muscles that enable mouth movements–chewing, opening, closing, talking, and eating are associated closely with upper wisdom teeth.

So infection of these wisdom teeth can result in affecting the anatomical structure situated beside these impacted teeth. Therefore, one has to take proper care of these wisdom teeth.¹

Importance of treating a wisdom teeth infection

Infected wisdom teeth have to be treated, if not, can lead to some of the following consequences:  

• Inability to open the mouth
• Swelling in the palate
• Swelling in the floor of the mouth
• Lymph Nodes swelling
• Jaw Pain
• Fever¹

Types of impaction based on the covering

1. Hard tissue impaction- when the impacted teeth are covered by bone, making it unable to erupt or come out of the bone
2. Soft tissue impaction- when a tooth has come out of the bone, but is just covered by gums and cannot be seen in the mouth²

Types of impaction based on the position of the impacted tooth. 

1. Horizontal impaction- when the impact teeth are positioned completely horizontal to the adjacent erupted molar and covered with bone on the top
2. Vertical impaction- When the impacted tooth is placed parallel to the adjacent erupted tooth but covered with bone on the top
3. Mesioangular impaction- When the impacted tooth is somewhat angulated horizontally with the adjacent erupted tooth, but not lying completely forming an angle
4. Distoangular impaction-When the impacted tooth is positioned away from the teeth, and directed towards the bony structure of jaws, it’s called distoangular impaction²

Causes 

As teeth are placed adjacent to each other and they all share a common basal bone called the alveolar bone, in which they develop and erupt, the infection can also spread from one tooth to the next. The following are major reasons for wisdom teeth infections. 

1. Overcrowding of teeth in the mouth– crowding of the teeth in the front and back jaw regions–can cause food accumulation and results in tooth decay that can be transported to wisdom teeth
2. Poor oral hygiene habits- When one is unable to maintain good hygiene in the mouth, the incidence of tooth decay increases
3. Trauma–Any sudden impact to the teeth can cause shock and the tooth can lose vitality. When this trauma occurs during tooth development, it can prevent the outcoming of wisdom teeth and infection later on
4. Injury to the gums– When gums get injured or damaged or infected. The harmful bacteria persisting in the mouth enter the bone and may result in infection
5. Small Jaws– With continued evolution, the human jaw has been degrading in size, which also results in the impaction of wisdom teeth
6. More intake of sugars– Intake of foods that contain high sugar content, can attract more bacteria, and bacteria may lodge at the impacted teeth site and cause infection³

Symptoms

Whenever there is an infection in impacted wisdom teeth, the structures adjacent to those teeth are affected. This occurs due to the accumulated  pus in response to the infection whichcauses pressure on the anatomical structures. It causes the following: 

• Pain and swelling in the gums– Accumulation of pus in the last part of the oral cavity results in pain and swelling in the gums and area in which the tooth is situated
• Difficulty opening the mouth– Due to the accumulation of pus, the muscles that help in opening  the mouth cannot function, resulting in difficulty  opening the mouth
• Unpleasant taste or odour in the mouth: Due to difficulty in opening, the person cannot properly brush his teeth, leading to food accumulation in the mouth and a bad odour. Due to the availability of logged food, bacteria develop more rapidly and may alter the salivary constitution. All these changes result in the alteration of taste perception by the patient sometimes³

Diagnosis

Diagnosis of impacted teeth can be done by: 

1. Clinical examination– with the absence of teeth in that region
2. Evidence of swelling or pus discharge in the missing tooth region
3. With the help of radiographs like

 periapical radiograph(IOPA)- It is a small radiograph that can cover 2-3 teeth at a time, which helps in identifying the infection of wisdom tooth 

OPG-Orthopantomogram(OPG)- that depicts all the teeth in both upper and lower jaws. It helps in accessing the position of all four wisdom teeth and planning the treatment accordingly.⁴ ⁵

Treatment

1. Antibiotics to eliminate the infection—Antibiotics constrain the further production of bacteria and pus, which can result in temporary relief of pain. But proper treatment has to be administered to avoid long-term consequences
2. Pain relief medication to manage discomfort- Pain relieving medication like Non-steroidal anti-inflammatory drugs or opioids can be suggested. Similar to antibiotics , they provide temporary relief
3. Saltwater rinses can help alleviate symptoms. Salt has the property to absorb water from the microbes, thereby making them inactive. That's why salt mixed in lukewarm water and gargling daily can reduce the development of harmful bacteria in the mouth. Saltwater gargling reduces the infection and can cause temporary relief
4. Cutting the soft tissue covering the impacted tooth in cases of soft tissue impaction can prevent further exposure to food, and infection can be cleared with time
5. Extraction of the infected tooth in severe cases- When the infection is more, with pus deposition in the gums and bone adjoining, it's best to remove the impacted tooth⁴ ⁵

Prevention

1. Proper oral hygiene practices, including brushing and flossing regularly- Proper maintenance of teeth with brushing and flossing can reduce wisdom teeth infections
2. Regular visits to the dentist for cleanings and check-ups- Regular visits to the dentist can help you to identify the problem at the earlier stages and helps in preventing future consequences
3. Reduce intake of sugars- reduce the incidence of infection
4. Opting for braces treatment when there is crowding of the teeth
5. Maintaining a proper diet and healthy lifestyle to maintain overall health¹^,²

Risks and Complications of Surgery. 

Though the removal of impacted teeth is a minor surgical procedure, there were minor risks associated with surgery: 

1. Infection– Infection secondary to surgery, can be treated with antibiotics
2. Damage to nearby structures– minor errors may lead to damage to structures nearby and can cause temporary or permanent damage
3. Unhealed socket (dry socket)- On removing the tooth, a blood clot will be formed. If the blood clot is removed by mistake, further healing. This condition can be avoided by preventing drinking with a straw immediately after the removal of the tooth of
4. Damage to local nerves can cause temporary or permanent facial palsy. Hence, the surgeon has to be careful while operating closer to nerves²

Recovery time after the surgery

The removal of an impacted tooth is a minor surgery that requires cutting the bone that is in the way of the impacted tooth. Therefore, most of the time, it may result in swelling. But by taking proper care, one can reduce swelling in one to two weeks.²

Summary

The third molar is so natural to our ancestors. But coming to us, jaws reduced in size leading to impaction. As one can not determine the growth of the jaws, one can take care to reduce the incidence of infection by taking proper care of the mouth and health. As it is a common issue nowadays, faced by almost everybody, it’s better that everyone should have minimum awareness of the impacted teeth, causes of infection, ways to prevent the infection etc.