Obstructed teeth, the little devil in the toothbed In late adolescence, the human jawbone is almost fully developed. However, in some people, the jawbone is not large enough for the wisdom teeth to erupt. In this case, the wisdom teeth are blocked in the jawbone or grow in other directions. This type of tooth is called an obstructed tooth. These wisdom teeth that have difficulty growing may have only part of the crown exposed to the gums or may be completely buried in the jawbone. Due to the lack of space, the obstructed wisdom tooth grows in various directions, usually at various angles to the adjacent teeth: toward the adjacent teeth (proximal mesial obstruction), away from the adjacent teeth (distal mesial obstruction), or toward the labial or lingual (palatal) side (horizontal or vertical obstruction). In some cases, the roots may be deformed or grow toward the maxillary sinus or the site where the mandibular nerve is located. The obstructed tooth grows in a distorted position in the dental bed, not only preventing it from erupting normally, but also usually crowding the adjacent teeth, causing problems with extreme crowding. The gums around the crown of an obstructed tooth often become inflamed and painful, causing pericoronitis of the wisdom tooth, which requires anti-inflammatory treatment and improved local oral hygiene. In severe cases, this can lead to multiple facial infections, resulting in swelling of the cheeks, difficulty in opening the mouth, and even generalized fever and swollen submandibular lymph nodes. The obstructed tooth often also causes decay and loosening of adjacent teeth and alveolar bone resorption. To extract or not to extract the wisdom teeth that should be extracted: Decay: If the wisdom teeth are decayed, except for the simple occlusal surface decay that is not deep enough to be filled, we suggest to extract the wisdom teeth that are decayed on the adjoining surface, and those that have deep damage and even need root canal treatment, in order to eliminate the future problems. Invasion of adjacent teeth is usually not known by the patient, but by the dentist’s X-ray diagnosis. Usually, the wisdom tooth does not have enough space to erupt and will fall on the second molar, making the tooth difficult to clean and even causing partial resorption of the tooth, resulting in discomfort or toothache. As mentioned earlier, not everyone’s four wisdom teeth will grow together. Therefore, if there is no opposing wisdom tooth on the opposite side of a wisdom tooth to bite, over-eruption of the wisdom tooth may sometimes occur, which may affect the bite. Obstructed teeth: Obstructed teeth are usually buried in the alveolar bone and need to be extracted if they repeatedly cause pericoronitis or are diagnosed as a lesion. Wisdom teeth that do not need to be extracted: If the wisdom tooth is in a positive position, expected to erupt normally, and the upper and lower bite relationship is normal, it does not need to be extracted; if there is no history of inflammation and pain in the soft tissue around the crown of the wisdom tooth, and if the wisdom tooth is not decayed, it does not need to be extracted; if the wisdom tooth has a pair of bite teeth, it will not erupt excessively, and it also has chewing function, so it does not need to be extracted. It is not easy to grow, but even more difficult to extract. Because of 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, it is more difficult to extract an obstructed tooth than other teeth, because the gum has to be cut open if it is covered by the gum, the bone has to be removed if it is covered by the bone, and the crown has to be split and removed in pieces if it is blocked by the neighboring teeth. Therefore, extraction of obstructed teeth is time-consuming, and there are more possible complications during and after surgery, such as bleeding, broken roots, damage to neighboring teeth, postoperative lower lip numbness, and dry socket. Hammering and chiseling are the hallmarks of the traditional way of tooth extraction, and are also the commonly used methods in clinical practice at present. However, its disadvantage is that the vibration is relatively high, especially when facing low bone ambiguous obstructed teeth, the extraction performed by this method will be very difficult, the procedure will be long and the chance of related risks will increase exponentially. In addition to the traditional extraction method, there is also the turbine minimally invasive extraction method, which is less invasive and less shocking, using a turbine to cut and disintegrate the tooth to eliminate resistance and then extract it. The advantage is more obvious in the face of low bone ambiguous obstructive teeth, but it requires a high level of skill for the physician and requires some training. Tips: Precautions after tooth extraction The cotton used to compress the hemostasis after tooth extraction should be bitten for 40-60 minutes and spit out immediately, so as to prevent the clot from falling off and forming dry socket after biting the hemostasis cotton for too long. Two hours after tooth extraction, it is advisable to eat thin rice, soft drink or liquid food, which should not be too hot. Do not rinse your mouth and brush your teeth within 24 hours of tooth extraction to avoid bleeding. Do not use anything (e.g. finger, toothpick, etc.) to pick the wound at the extraction site to avoid causing wound inflammation. It is normal for a small amount of blood to seep from the wound after tooth extraction, so please spit sparingly. If spitting contains a small amount of blood, there is no need to be alarmed; if the bleeding is excessive, come to the hospital for treatment to stop the bleeding.