Treatment of blocked teeth Recently, many patients have asked about wisdom teeth and extraction of blocked teeth, and we can appreciate the pain and confusion caused by blocked teeth disorders. In fact, there are many related knowledge, articles and books available online or for purchase. Because of the different perspectives of the authors and the differences in knowledge base, similar articles are of different quality and it is difficult for patients to identify and truly understand. The development and formation of blocked teeth: Blocked teeth are generally referred to as specific teeth in permanent teeth, i.e. permanent teeth during or after the replacement of our milk teeth, if there is no special account. It is the same as other teeth through three processes: 1, embryogenesis and differentiation (like the formation of seeds); 2, the formation of dental tissue (differentiation of tooth components), which includes the formation of enamel, dentin, pulp and root; 3, tooth eruption and replacement. These are not the focus of this article and will not be elaborated. So what exactly is an interrupted tooth, and how is it so special that it confuses us so much?1.1 Evolution and formation of interrupted teeth There is evidence that the teeth of humans and other higher vertebrates originated from the J-scales of ancient fish ancestors, as evidenced by the extant sharks. In fact, the teeth of sharks are specialized J-scales. The important watershed between mammals and their reptilian ancestors is not fecundity or milk secretion, but the differentiation of teeth and the emergence of the second emergence of teeth, the so-called “second emergence of teeth” is the animal’s life only two sets of teeth, which we usually call milk teeth and permanent teeth. Reptiles, on the other hand, can keep changing their teeth throughout their lives. The teeth of mammals are divided into incisors, canines, premolars and molars. Primates, including humans, have a total of 32 teeth. However, human teeth differ from those of other primates, most notably in that human canines are not as long and sharp as those of other primates. Although human canines are significantly degraded compared to other primates, human canines are still the strongest compared to other human teeth. The roots of the canine are longer and stronger than those of all other teeth, and are deeply embedded in the jawbone (as will be mentioned later, it is also a common obstructive tooth, which is why it tends to be an obstructive tooth). In addition, the upper and lower jaws of humans have shrunk so that many people’s wisdom teeth, the last of the back molars, do not erupt. Many people have only 28 teeth in their lifetime. More people often have partial or incomplete degeneration, i.e., between 28 and 32 teeth, and the extra teeth often do not erupt properly due to the short jaw, forming an obstructive tooth. So are the extra teeth necessarily obstructive teeth? 1.2 Definition of an obstructive tooth A tooth that does not erupt or never erupts to a normal occlusal position due to soft tissue or bone resistance is called an obstructive tooth. The most common obstructive teeth are the mandibular third molars, followed by the maxillary third molars and maxillary cuspids. According to statistics, at least 20% of adults have interrupted teeth. 2, the classification of obstructive teeth and harm: 2.1 Classification of obstructive teeth There are two common methods of classification in clinical practice: one is based on the relationship between wisdom teeth and the long axis of adjacent teeth, i.e., commonly vertical, anteriorly inclined, horizontal, lingually oriented, etc. (shown in the figure above); one is based on the relationship between wisdom teeth and the high and low position of adjacent teeth (not elaborated). For those who can cause clinical symptoms, wisdom teeth that can erupt normally by clinical means are not obstructed teeth and are not included in this classification. 2.2 Hazards of interrupted teeth This type of interrupted tooth is manifested as a completely ambiguous interruption into the jawbone or a partial interruption in contact with soft tissue, partly in the bone and partly in the soft tissue, partly in the bone and partly outside the soft tissue. Not every obstructed tooth can cause harm. For teeth that are completely within the hard and soft tissues, they often do not cause damage and can remain undetected and untreated for life. For the majority of teeth that are blocked, they can cause some damage. Between the gums covering it, it is easy to hide stains and bacteria, causing dental crowding, food inclusions, bad breath, and molar decay. When the body resistance decreases, inflammation and pain often occur, in serious cases, the cheeks can be swollen, difficult to open the mouth, and even general fever, swelling of the frontal lymph (pregnant women pay special attention, easy to cause unpredictable harm due to inflammation), osteomyelitis, and even the formation of cysts under certain conditions, because the direction of the blocked teeth is not correct, repeated stimulation of the local tissue to form ulcers and cancer. 3 prevention and treatment of blocked teeth: For the teeth that can cause the above symptoms mostly need to be treated. More important than the treatment of the disease is the prevention. 3.1 Prevention: The function of teeth is to cut, mash, and grind food (especially the chewing function). People often ask how few doctors were sought before, teeth could erupt normally for the replacement of milk and permanent teeth, and they seldom heard the words wisdom teeth, obstructed teeth, and extracted teeth. What is going on now and why do so many children need to have their milk teeth replaced by tooth extraction, and wisdom teeth and blocked teeth disorders relieved by tooth extraction? In fact, in order to have a set of healthy teeth, you must pay attention to dental care and eat more calcium-rich foods. Especially in infancy and early childhood, attention should be paid to the choice of diet. Parents should give their children more vegetables that promote chewing, such as celery, cabbage, spinach, leeks, kelp, etc., and other need to chew more fava beans, bones, pancakes, corn, sorghum, beef, dog tough and rough food, and some nuts, such as acorns, melon seeds, walnuts, hazelnuts, etc.. Coarse grains are good for promoting the development of the jaw, developed and neat teeth. Only when the jaw bone is sufficiently stimulated to have healthy teeth and muscular jaw bone, the teeth will have enough space to erupt, and will not be unable to erupt normally due to insufficient space and resistance of soft and hard tissues. 3.2 Treatment of obstructed teeth Wisdom teeth and obstructed teeth that are already in clinical condition generally need to be extracted. However, not all teeth require this treatment, such as those mentioned above that are completely buried in the bone and do not cause symptoms, or those that can erupt normally by traction, and wisdom teeth that are completely buried in the bone and obstructed, which generally do not require treatment. For example, wisdom teeth that are swollen and painful and can erupt normally require gingival removal to aid eruption or pericoronal rinsing to await normal eruption. Extraction of obstructive teeth: There are many reasons for the formation of obstructive teeth, but the main reason is the relative lack of bone volume in the jaw and the lack of sufficient space to accommodate all permanent teeth. Obstructed teeth and wisdom teeth often cause inflammation of the soft tissues surrounding the crown, known as “pericoronitis”. These teeth are not only non-functional but harmful and must be extracted as soon as possible. What are the benefits of wisdom teeth extraction in the lower jaw? 1. Prevention of periodontal and alveolar bone destruction of the second molar: the presence of mandibular obstructive wisdom teeth, especially in the proximal middle obstruction, causes the loss of bone in the distal middle of the mandibular second molar, and makes the functional mandibular second molar loose prematurely. 2. Prevention of caries: The wisdom teeth themselves and the distal mesial surfaces of the adjacent second molars are prone to caries. Preventing pericoronitis: When partially erupted, the tooth surface of the blocked wisdom tooth is often covered by soft tissue, forming a blind pocket, which becomes a good place for bacteria to breed and cause pericoronitis. If the blocked tooth is not removed, pericoronitis can recur and may gradually worsen and cause infection in the adjacent space. 4. Prevention of root resorption of adjacent teeth: Sometimes the pressure of the blocked wisdom tooth can cause root resorption of the second molar, early detection and early treatment can help to preserve the adjacent teeth. 5. Prevention of odontogenic cysts and tumors: If an obstructed wisdom tooth is present, the follicular sac is also present. Although in most cases they do not change, there is a possibility of cystic transformation into odontogenic cysts and odontogenic tumors. 6. Prevention of pain: Complete osseous blockage can sometimes cause unexplained pain. 7. Prevention of dental crowding: some scholars believe that wisdom teeth have crowding effect on the front teeth, causing and aggravating the crowding of the front teeth. 8. Prevention and treatment of some crowded teeth or orthodontic treatment needs, uncommon mouth opening restriction and cancer generation. Extraction of obstructive teeth is a more complex treatment technique in dentistry extraction. Since extraction can cause local tissue damage, bleeding, swelling, pain and other reactions, as well as fluctuations in blood pressure, body temperature and pulse rate, it must be treated with caution. Particular attention should be paid to patients with cardiovascular and hematologic diseases, otherwise it may have serious consequences. Missing teeth can cause atrophy of alveolar bone, displacement or elongation of neighboring and opposing teeth, resulting in chewing disorders. Missing front teeth directly affect pronunciation and appearance. Therefore, the indications for tooth extraction must be strictly controlled, and extraction should be considered only when the tooth has adverse health effects and cannot be preserved by effective treatment. The following are the indications for extraction of blocked teeth: 1. recurrent pericoronitis caused by mandibular blocked wisdom teeth; 2. decay of mandibular blocked wisdom teeth themselves or decay and pain caused by a molar (second molar) in front of them; 3. food embedment between wisdom teeth and a molar (second molar) in front of them; 4. odontogenic cyst or tumor caused; 5. for the need of orthodontic treatment; 6. causing temporomandibular joint disorder and other pain The wisdom teeth can not be diagnosed to remove the obstructed wisdom teeth. 7. For women with pre-pregnancy checkups for the presence of blocked teeth, it is recommended that prophylactic extraction side cause unpredictable complications during pregnancy. The following are contraindications for extraction of blocked teeth: (1) Severe cardiovascular disease and high blood pressure above 180/100 mmHg. Patients with general heart disease can have their teeth extracted as long as they do not show signs of cardiac insufficiency (e.g., shortness of breath with mild activity or lying down). Anti-infection prophylaxis should be given before and after tooth extraction because heart disease patients have reduced resistance and are more prone to co-infection than normal people. (2) Bleeding diseases: Patients who are prone to bleeding such as hemophilia, primary thrombocytopenic purpura, leukemia, etc. have a tendency to bleed because the coagulation process in their bodies is impaired. The bleeding is difficult to stop after tooth extraction, which can cause hemorrhage and life-threatening. (3) Menstruation, pregnancy and lactation: Women should avoid tooth extraction during menstruation in principle. (4) Severe liver and kidney function impairment and active liver disease. (5) Malignant tumors and psychiatric attacks should be avoided. (6) Before the symptoms of diabetes mellitus are controlled. (7) Extraction should not be performed after strenuous exercise or labor, or after drinking alcohol. (8) Those who have a history of allergy to procaine anesthesia (some can be changed to acupressure or needle anesthesia). The gauze or cotton ball on the wound after tooth extraction should be bitten down for about half an hour to 45 minutes before spitting out. A small amount of blood in the saliva within 24 hours is normal. There is no need to be alarmed if the saliva is slightly bloody, but if the blood does not stop appearing, please contact the physician. 2. Rest in a semi-recumbent position after tooth extraction, do not lie flat and do not take a hot bath immediately to avoid bleeding from the incision. 3. Do not eat or drink until 2 hours after tooth extraction. You can eat liquid or semi-liquid food, and do not eat hard or hot food. 4. On the day of tooth extraction, you should not do strenuous exercise or heavy physical labor, drink alcohol, play musical instruments, suck on the wound or rinse your mouth. After the anesthesia wears off, the extraction wound is slightly painful, but generally no medication is needed; if there is fever, severe pain, swelling or heavy bleeding, prompt consultation should be made. 6. Except for the third molar and multifocal teeth, adults generally need to be fitted with dentures after tooth extraction, which can be done at the hospital or dental clinic about 2 months after extraction. 7. Patients with sutures in the extraction wound should come to the hospital 5-7 days after surgery to remove the sutures, not too short and not too long. If the time is too short, the wound is not completely healed and the sutures are removed at this time, the wound will be easily split; if the time is too long, the wound will be easily infected and the healed wound may be split again. Due to the malposition of the blocked teeth, they are blocked by the neighboring teeth, and some of them may be completely buried by the bone tissue. Therefore, the extraction of blocked teeth is more difficult than other teeth. The gums should be cut if they are covered by gums, the bone should be removed if they are buried by bone, and the crown should be split if they are blocked by neighboring teeth. Extraction is done in pieces. Therefore, extraction of obstructed teeth takes longer time and there are more complications that may occur during and after the operation, such as; bleeding, broken root, adjacent teeth damage, postoperative lower lip numbness, dry socket, etc. Supplementary note: There are experts at home and abroad who have published books on the extraction of blocked teeth, which is a complicated process, so the technical aspects of the extraction of blocked teeth will not be discussed here. Some of the information and pictures in this article are from the Internet, and I apologize for the many common sense repetitions and applications found.