What is dry socket?

The typical scenario for dry socket is the occurrence of throbbing pain about two to four days after the tooth is extracted. Dry socket pain is often accompanied by bad breath and a foul taste in the mouth. With this onset of pain, it is obvious that proper healing has been interrupted.

Dry socket is a condition in which there is inflammation of the jawbone (or alveolar bone) after a tooth extraction. It is also referred to as "alveolar osteitis" and is one of the many complications that can occur from a tooth extraction. The occurrence of dry socket is relatively rare, occurring in about 2% of tooth extractions. However, the percentage rises to at least 20% when it involves the removal of mandibular impacted third molars (lower wisdom teeth).

what is the relation between dry socket and tooth extraction ?

A dry socket is a condition that may result after a tooth extraction if the blood clot that normally fills the socket is lost. The dry socket leaves underlying nerves exposed, which is very painful. The condition is treated by a dentist who cleans the wound and places a special dressing into the socket. Over-the-counter anti-inflammatory medications like ibuprofen may be used to treat pain and decrease swelling.

What causes dry socket ?

A dry socket is caused by the partial or total loss of a blood clot in the tooth socket after a tooth extraction. Normally, after a tooth is extracted, a blood clot will form as the first step in healing to cover and protect the underlying jawbone. If the blood clot is lost or does not form, the bone is exposed and healing is delayed

In general, a dry socket is a result of bacterial, chemical, mechanical, and physiologic factors.

• Bacterial: Preexisting infection that is present in the mouth prior to a dental extraction such as periodontal disease (or periodontitis) can prevent proper formation of a blood clot. Certain oral bacteria can cause the breakdown of the clot.
• Chemical: Nicotine used by smokers causes a decrease in the blood supply in the mouth. As a result, the blood clot may fail to form at the site of a recent tooth extraction.
• Mechanical: Sucking through a straw, aggressive rinsing, spitting, or dragging on a cigarette causes dislodgement and loss of the blood clot
• Physiologic: Hormones, dense jawbone, or poor blood supply are factors that prevent blood clot formation.

What are risk factors for getting dry socket ?

Prior to a tooth extraction, risk factors for developing a dry socket include smoking, presence of impacted wisdom tooth, being female, and being above the age of 30.

Smoking is a risk factor for developing a dry socket due to the nicotine found in cigarettes. Exposure to nicotine reduces the blood supply available to the healing socket and can prevent the proper formation of a blood clot at the extraction site.

Extraction of impacted third molars (wisdom teeth) can be traumatic as some surrounding gum tissue and jawbone may need to be removed or may be adversely affected during surgery. Although the extraction is necessary, the resulting trauma can increase the chances of dry socket.

Previous infections such as periodontal disease or pericoronitis at the site of the extraction can predispose an individual to dry socket.

Women have been found to develop a dry socket more so than men. This may be related to hormonal factors such as use of oral contraceptives or normal hormonal changes during a woman's cycle.

Patients older than 30 years of age with impacted third molars have an increased risk of dry socket. With age, the jawbone becomes more dense and has less blood supply available. A dense jawbone increases the risk of a traumatic extraction and less blood supply decreases the chances of blood clot formation and timely healing.

What are dry socket symptoms and signs ?

A tell-tale sign is a socket that has a partial or total loss of a blood clot. The jawbone may be visible in the socket and the surrounding tissue may appear gray due to poor healing.

Symptoms of dry socket

Symptoms of a dry socket include a throbbing steady pain that presents a few days after a tooth extraction. The pain may radiate to other parts of the head such as the ears and eyes on the same side of the face. Bad breath and a bad taste may also be present due to the accumulation of food debris and bacteria in the socket.

How is dry socket diagnosed ?

Diagnosis of a dry socket is based on history of dental treatment, clinical examination, and the individual's symptoms. Timing of beginning of symptoms begin may be an indicator for a dry socket. During normal healing, the discomfort of an extraction should lessen over time. However, if the pain increases this is an indication that healing is delayed and could possibly be due to a dry socket. Typically, symptoms for a dry socket develop two to four days after a tooth extraction. Most dry sockets happen within the first week after tooth extraction.

What is the treatment for dry socket ?

Treatment usually involves symptomatic support while the socket heals. Initially, the dentist will gently irrigate to clear the socket of food debris. Next, an analgesic medicated dressing or packing is placed within the socket to cover the exposed bone. This usually provides immediate relief. This dressing may need to be replaced every few days during the healing process. The dressing is often coated with "dry socket paste," which is made up of ingredients with pain-relieving properties, including eugenol (clove oil).

Additionally, medications can be prescribed to manage the pain. Nonsteroidal anti-inflammatory drugs (such as Advi or Aleve) or narcotics (such as hydrocodone/acetaminophen) are often used to relieve pain.

Are there home remedies for dry socket ?

Home treatment for a dry socket usually involves temporary management of pain until a dental professional can be seen for treatment. Methods to provide some relief include use of over-the-counter pain medications for pain management, cold compress, or insulated ice pack on the affected side of face (15 minutes on and 15 minutes off), rinsing with saltwater to remove food debris and use of clove oil (place a one to two drops of clove oil on a clean cotton swab and gently apply to the affected area). Again, these methods are only for temporary relief of pain. Delaying a follow-up visit with the dentist or surgeon could prolong the pain as well as the recovery time.

What is the average healing time for dry socket ?

Average healing time is seven to 10 days, as this is the amount of time it takes for new tissue to grow to cover the exposed socket.

What is the prognosis for dry socket ?

Prognosis is good as there usually are no longterm consequences. Once the tissue is able to cover the bone, the healing will progress normally.

Is it possible to prevent dry socket ?

The prevention of developing a dry socket may be influenced by the methods used by the dentist or surgeon performing the tooth extraction. Such preventive methods include (1) placement of a packing at surgery with or without antibiotic, (2) placement of sutures to protect the blood clot. These details can be discussed with the dentist or surgeon prior to the procedure to determine if these preventive methods would be recommended.

After extraction, there are a few day-to-day activities that should be avoided smoking, drinking with a straw, and vigorous spitting or rinsing. Diet should be a soft food diet. The area should be kept as clean as possible with gentle rinsing with an antibacterial solution such as chlorhexidine rinse. This oral rinse can be prescribed by your surgeon. It is important to follow any special instructions given by the dentist or surgeon in caring for the extraction site at home.

Lastly, recent studies have shown that the incidence of dry socket with women is significantly decreased when tooth extractions are performed during their menstrual period (menses). When teeth extractions can be electively planned, the recommendation is to perform this procedure during the menstrual period. In this way, the risk of dry socket due to cycle-related hormonal changes can be eliminated.

What is jaw pain ?

Jaw pain in defined as pain involving either the upper or lower jaws or both due to known and unknown reasons. Most commonly pain is seen in lower jaw.

What are the types of jaw pain?

• Typical jaw pain where the patient can localise the area of pain.
• Atypical jaw pain where the patient complains of a generalised pain and cannot localise nor specify the nature of pain.

What are the causes of jaw pain ?

• Pain related to a decayed tooth radiating to other areas of the jaw.
• Pain due to abnormality in the jaw joint architecture and function (temporomandibular joint dysfunction – abnormalities in the TMJ disk ) – usually associated with reduced mouth opening and clicking sounds near the jaw joint while opening and closing the mouth.
• Pain related to infected cysts or tumours.
• Pain due to poor periodontal condition.
• Certain pathological conditions like trigeminal neuralgia or other neuralgias – characterised by sharp stabbing type severe pain
• Pain due to pathologies involving the mandible condyle bone – usually also associated with a deviated chin or jaw.

Atypical jaw pain implies pain which cannot be assigned to any specific cause or region.

What are the causes of jaw joint related disorders ?

Jaw joint related disorders are usually caused by

• Improper teeth fillings or crowns causing abnormal loading of jaw joint on both sides.
• Improper occlusion- abnormal relationships between upper and lower teeth , faulty dentures.
• Hypermobility or excessive opening of mouth.
• Abnormal habitual closed mouth position of teeth.
• Hereditary causes.
• Trauma or blow to the chin causing indirect impact on the jaw joints.
• Some drugs – some antipsychotics.
• Excessive stress causing habitual clenching of teeth forcefully (bruxism).
• Excessive wearing of teeth resulting in abnormal jaw relationships.

Pain in the jaw joint region is usually associated with pain in the adjacent ear and headache and sometimes neck pain.

A lot of factors have to be taken into consideration while dealing with jaw pain. The cause is usually multifactorial.

What are the treatment options for jaw pain ?

Treatment modalities include removal of the causative factors ( removal of faulty dentures or cyst or tumours) as well as symptomatic management.

Pain related to carious tooth – treated with restorations/root canal treatment. Consultation with endodontist is recommended.

Pain related to infected cysts or tumours- treated by removal of cyst or tumor.

Pain due to poor periodontal condition- oral prophylaxis /periodontal flap surgery- consultation with periodontist is recommended.

Trigeminal neuralgia or other neuralgias- alcohol injections, local anaesthetic nerve block, nerve surgery.

Pain related joint related disorders: conservative management options like hot fomentation, LASER therapy, jaw repositioning splints, discontinuing faulty dentures.

Surgical management In case of failure to have adequate relief following medical treatment, surgical options (like disc repositioning surgery, temperomandibular joint replacement) should be thought about. Consultation with an Oral and maxillofacial surgeon is recommended for comprehensive evaluation and management.

A medication is used to make your tissues numb.

Various formulation in which lignocaine is available ?

It usually comes in two forms, one with adrenaline (also called- epinephrine, a blood vessel constricting agent, usually in minute quantities -1:2,00,000 units) which helps in increasing the duration of numbness, and to decrease bleeding and another being without adrenaline.

Will i be unconscious during lignocaine injection ?

No, it only makes tissues numb without making unconscious.

How long the effect of lignocaine remain ?

The numbness usually starts within few minutes (3-5 mis)and lasts for 90-120 minutes in most patients (time can vary from half an hour to 3 hours) . 

Method of application of lignocaine ?

Gels, spray forms etc can be applied directly to skin or mucosa (surface anesthesia), whereas injectables are injected into tissues (Infiltration) or injected near a nerve (nerve block).

How does lignocaine work ?

It works by temporarily blocking the pathway of pain signals along nerves. Pain is caused by stimulation of pain receptors at the ends of nerves. This stimulation causes sodium to enter the nerve ending, causing electric build up that is perceived in brain as pain. Lignocaine works by stopping the entry of sodium from outer surface into nerve endings. Thus causing numbness and relieving pain.

Will lignocaine always work ?

When lignocaine is applied near nerve endings or nerves, it always works, except when there is pus build up around the tissues. Reason for insensitivity may be due to unexpected position of nerves.

What are the side effects expected ?

Adverse effects are rare when lignocaine is used as local anesthesia and used correctly, as it has low systemic toxicity. When lignocaine is injected into blood, it causes nervousness, anxiety, muscle tingling, twitching, headache, drowsiness,  confusion, vomiting and higher quantities may cause low blood pressure, low or irregular heart rate.  Dentist usually takes great care to not to inject into blood vessels.

What if you swallow lignocaine ?

At doses given in dental chair, other than metallic taste, nausea, vomiting, no adversities are expected and is expelled from urine.

When does doctor uses lignocaine with caution ?

When patient is suspected of liver impairement.

What is impacted wisdom tooth ?

Wisdom tooth is the third molar tooth that is last tooth to enter in mouth, located at most backward in upper and lower arch. They are 4 in number. Some people do not have all third molar.

Third molars are usually completely developed between the ages of 15 and 18, a time traditionally associated with the onset of maturity and the attainment of "wisdom."

When they are unable to fully enter the mouth, they are said to be "impacted". This is usually due to a lack of space. Our jaws are evolving, and due to our refined food, they are developing shorter in size. Therefore, the wisdom teeth become impacted. These teeth are erupted in instalment.

This occurs when a person’s jaw simply does not have enough room to accommodate these final four teeth. This can cause the wisdom teeth to become strapped below the surface of your gums or grow in at an odd angle.

When the teeth do not have enough room to emerge normally, they are considered impacted, they can become twisted, tilted or displaced as they are trying to emerge.

There are several ways that your teeth can be considered impacted, based on where their placement is in your jaw. A soft impaction is when the crown of the tooth has come through the bone, but the gum tissue is still covering part of the tooth.  Partial bony impaction occurs when the tooth is partially through, but another part remains in the jawbone. Lastly, complete bony impaction is when the entire tooth remains encased in the jawbone.

It is important to note that not all impacted wisdom teeth show symptoms. You could have impacted wisdom teeth and not even realize it. The best way to determine if you have impacted wisdom teeth, is by contacting your dental provider.

Why do my wisdom teeth need to be removed if they are not causing problems ?

Just because your wisdom teeth don’t hurt does not mean that they are healthy.  Wisdom teeth are prone to disease and often do not become symptomatic until they are a major problem.  Wisdom teeth should be evaluate and removed in the following instances:

• Infections and/or periodontal disease.
• Pericoronitis (inflamed tissue around wisdom teeth).
• Cavities that cannot be restored.
• Pathology such as cysts and tumors(Cyst around an impacted wisdom tooth. Cysts can cause severe destruction of the jaw bone if left untreated).
• Damage to neighboring teeth(Impacted wisdom teeth can cause decay in the tooth in front of them. Often, this results in the loss of both teeth. Timely removal of the wisdom teeth can prevent this unnecessary tooth loss.
• For crocked teeth correction( orthodontic treatment).
• Cryopreservation has also been suggested as these are a source of stem cells which can be used for treatment of various bone marrow related disorders.
• Cryopreservation has also been suggested as these are a source of stem cells which can be used for treatment of various bone marrow related disorders.
• If a decision is taken that removal is indicated, due to current or anticipated symptoms and problems, this is better done early. This is because it is generally easier to remove an impacted wisdom tooth in the younger patient as the bone is more flexible, and the area will heal up faster.

Wisdom tooth surgery: is it wise ?

American Public Health Association  recommended removing wisdom teeth only based on evidence of diagnosed pathology or demonstrable need, and opposes prophylactic removal, which "subjects individuals and society to unnecessary costs, avoidable morbidity and the risks of permanent injury."

Similarly, a 1980 report by the National Institutes of Health  recommended removing wisdom teeth because of infection, cavities, cysts, tumors and damage to adjacent teeth and bone. It does not recommend removing asymptomatic, fully impacted teeth.

Patient presentation when wisdom tooth is culprit ?

• Pain,
• Swelling,
• Fever,
• Leukocytosis,
• Malodor due to pericoronitis(gum infection) or infection from this tooth.

Gum pain, bleeding or tenderness is one of the first warning signs of an impacted wisdom tooth. Gums can also appear red and swollen, and you might even have swelling around the jaw, headaches, or difficulty chewing due to the pain or swelling.

As well as mouth pain in the rear molar region, signs of impacted wisdom teeth can include a bad taste in the mouth or bad breath. These symptoms can indicate that the impacted wisdom tooth has become infected, which means that you need urgent treatment.

An impacted wisdom tooth is hard to clean due to its location in your mouth. Once a tooth is partly covered and has a problem with eruption, it can be in danger of debris accumulating and causing a greater risk of infection.

More serious symptoms can develop:

•  Swollen glands under the chin (‘lymph nodes’).
• Swelling of the face and jaw, may indicate cellulitis.
• Muscle spasms in the jaw.
•  Fever and general malaise.

Such symptoms may indicate a severe, spreading infection which can be very serious if left untreated. Immediate advice should be sought from your oral surgeon.

Prevention of Symptoms

The cleaner the area and your mouth in general is kept, the less likely that pericoronitis and other problems will occur.

Therefore  general oral hygiene measures  should be adhered to, including flossing in the area of the wisdom tooth and regular use of mouthwashes

Pre surgery evaluation

• Inspection by doctor.
• Proper record of patient medical condition and medical clearance for surgical extraction of teeth.
• X-ray of tooth and jaw.( Orthopantomogram or CBCT can be considered to know about location, morphology and relation to adjacent tooth, bone or vital structures like nerve, maxillary sinus. Difficulty of extraction can be judged by how much of the crown portion is in bone or how much angulated is it)
• Patient routine blood investigation, chest x-ray and ECG (If surgery planned for general anesthesia.)
• Pre anesthetic clearance.
• Written and informed consent.( With every extraction of a lower wisdom tooth there is potential risk of injury to the nerve. This injury may be as mild as ‘bruising’ of the nerve resulting in some altered sensation than might last from a few hours to a few months or the nerve can be severed or crushed resulting in permanent numbness of the lower lip on that side. Fortunately, such misfortunes are extremely rare.
• Not all impacted wisdom teeth have to be removed, especially those which have not penetrated out of the bone at all.)
• Premedication.
• Lignocaine pictures.

Impacted tooth  procedure.

Some wisdom teeth can be safely removed in the dental chair under local anaesthetic. The more severely impacted teeth and teeth that appear to be very close to the nerve in the bone are usually referred to a maxillo-facial oral surgeon for extraction, often under general anaesthetic.

local anesthesia which only affects the impacted area, mild sedation anesthesia administered through an IV which will completely suppress your awareness during the procedure, or general anesthesia inhaled through your nose which also will render the patient unconscious.

Patients are asked to refrain from eating or drinking for 6 hours prior to their procedure if they are to have IV anesthesia.

Once asleep, local anesthesia (numbing) is administered, The procedure itself consists of making an incision in your gum, removing any bone blocking easy access to the tooth, possibly dividing the tooth into sections if necessary, then removing the tooth and carefully cleaning the affected site before stitching it closed to prevent infection.

The wisdom teeth are removed, and the areas are closed with dissolving/non dissolving stiches stitches. 

The numbness will last 6 – 8 hours and the stitches will be removed after one week if stiches are non-dissolving.

Once the procedure is complete, you will spend a brief time in the recovery room and then are allowed to go home.

Length of procedure

Your dentist will usually  refer you to a specialist (oral surgeon) for the extraction of any wisdom teeth that appear to be deeply impacted. For some, the treatment involves a straightforward extraction under local anesthetic, done in a few minutes. For others, the procedure can take over an hour, with a general anesthetic being needed.

Most wisdom tooth removals fall somewhere between these two extremes. But what will affect the difficulty of your treatment?…

The length and difficulty of the procedure will depend on:

• The size and shape of the roots.
• The degree of impaction, i.e. the amount they are buried under the gum.
• The angle the tooth lies at.
• Your age and general health.
• The degree of access the surgeon has to the area, determined largely by how wide you can open your mouth.
• How close the roots lie to the nerve canal that runs through the jaw bone.

Based on the above factors the surgeon will advise you whether or not any sedation is advisable. The more difficult extractions may be made easier for the patient by the use of sedation. This may be via IV or inhaled (nitrous oxide). The most difficult removals may require a general anesthetic and are carried out in a hospital. If necessary, all four wisdom teeth may be removed at the same visit, especially if general anesthetia is being used.

If sedation is required, you will need to fast from food for six hours beforehand.  You will also need collected after the procedure by an adult.

Post procedure

you keep your head elevated and use ice packs on and off for about 48 hours.  You should start with clear liquids, then non-chew food and then begin taking your prescriptions.  Swelling peaks at 48 – 72 hours.  By the 3rd or 4th day, the swelling should typically be resolved.

Supportive care like antibiotics can be considered after the extraction especially in medically compromised patients.

After wisdom teeth surgery, it’s advisable to quit smoking for a few days as smoking can highly affect your healing process

Most patients, according to a quality of life questionare, return to normal lifestyle by postoperative day 4 and return to regular diet by postoperative day 7.

Tips For Fast Recovery

1.Pain relief is important as part of extraction care. But always stick to the recommended dose.

Pain Relief

Take whatever pain relief your dentist recommends during wisdom teeth removal recovery and stick to the recommended dose.  Non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen are often the ideal choice although your dentist may prescribe something stronger.  Take the first dose before the numbness has worn off after the extraction. Do not take aspirin for pain relief after wisdom tooth removal, as it may make your wound bleed.

2. What you do in the first 24 hours is crucial in terms of total recovery time

In the First 24 Hours After Extraction:

• You can expect some oozing from the socket for about the first 24 hours during wisdom teeth removal recovery.  Even a minor amount of bleeding may appear worse than it is, as it will be mixed with a larger amount of saliva.  If there is any further bleeding place some gauze (which the dentist should provide you with) on the socket and again bite on it for 20 minutes.
• Avoid hot drinks, and take small sips when drinking fluids.  Do not use a straw.
• Diet advice – Eat soft food and eat in small mouthfuls. A liquid diet is not necessary unless advised by your dentist.
• Avoid smoking and drinking alcohol.
• ​Do not rinse your mouth and avoid spitting.
• Take it easy. In particular avoid strenuous exercise.
• It may help to prop your head up with an extra pillow when lying down.

Swelling may occur after wisdom tooth extraction. Ice packs, placed on the face for 15 minutes at a time, with a 15 minute break between times, can reduce any swelling during recovery.

3. From 24 Hours After Surgery:

•  Continue with soft foods while necessary.
• Use a salt-water (one-half teaspoon of salt in a cup of luke-warm water) mouthwash or proprietary oral rinse a few times a day to help keep the area clean, thus preventing wound infection.
• ‘Chlorhexidine’ gel applied to the extraction site can also aid healing time by killing bacteria at the site.
• If stitches are placed, they may be the type that will dissolve away over a week or two. Alternatively, you may need to return to have the stitches removed. Your dentist will advise you on this.

Pain and minor symptoms that last for a few days and even up to a week is normal, so long these are getting better each day.  If you experience a worsening pain after about two days, this may indicate a ‘dry socket’ (a painful condition where the socket does not heal properly after extraction).

4.  Regular rinsing is vital after 24 hours

Healing After Wisdom Teeth Removal

The initial healing phase, which closes up the socket, usually takes 2-3 weeks. The surrounding bone can take 3- 6 months to completely settle into place. However, pain should be lessening by the second day.

As the gum tightens up faster than the bone heals, you may feel the sharp edge of the socket with your tongue.  Sometimes little pieces of bone may make their way out from the wound.  This is a normal part of the healing process.

Once wisdom teeth removal recovery is complete and the area has healed and settled, the original problems caused by the impacted tooth will have gone. Your mouth will feel more comfortable and less crowded where the original problem was.

Following Complication may occurs after surgical removal of impacted wisdom teeth:

• Pain,
• Swelling,
• Trismus (limited mouth opening),
• Infection,
• Damage to the nearby teeth or fillings.
• Fracture of the root of the wisdom teeth. This piece of root is either removed or if it is small it can be left in place.
• Dry socket(a very painful condition that develops when a blood clot does not form properly at the extraction site, or when the clot is lost too early.)

Prevention – To reduce the chances of getting this problem when recovering from surgery, be sure to follow the post-operative instructions you get from your dentist. These tips will include:

• Brush your teeth use and a mouthwash before the extraction.
• Avoid smoking for at least 24 hours afterwards.
• Do not rinse out your mouth for 24 hours – this allows a good clot to form.

Paresthesia, Tmj pain, sensitivity or loss of vitality or pocket formation with respect to adjacent tooth forms the rare complications.

Mandible fracture and displacement of tooth in adjacent spaces are the rarest of the complications.

Conclusion

Getting your wisdom teeth removed can be quite an invasive minor surgical procedure. As with any surgery, there are possible complications. These include common complications such as wisdom teeth dry socket, bruising and tenderness as well as rarer complications such as nerve damage.

Your oral surgeon will advise you of these possibilities in general and point out any complications you are particularly at risk of.

There are many doctors who are not oral surgeons that remove wisdom teeth.  They take weekend courses where “practice management consultants” convince them to remove wisdom teeth in order to, "increase their bottom line."  They are not properly trained to treat the possible complications that can arise from the removal of wisdom teeth.

"If a doctor cannot treat all of the possible complications of a procedure, they have no business performing the procedure at all." Oral and Maxillofacial Surgeons (OMFS)are well versed in the prevention of and treatment of complications of wisdom tooth removal and tooth extractions. Furthermore, only OMFSs are adequately trained in general anesthesia.

American Public Health Association recommended removing wisdom teeth only based on evidence of diagnosed pathology or demonstrable need, and opposes prophylactic removal, which "subjects individuals and society to unnecessary costs, avoidable morbidity and the risks of permanent injury."

Similarly, a 1980 report by the National Institutes of Health recommended removing wisdom teeth because of infection, cavities, cysts, tumors and damage to adjacent teeth and bone. It does not recommend removing asymptomatic, fully impacted teeth.

Just because your wisdom teeth don’t hurt does not mean that they are healthy.  Wisdom teeth are prone to disease and often do not become symptomatic until they are a major problem.  Wisdom teeth should be evaluate and removed in the following instances:

• Infections and/or periodontal disease.
• Pericoronitis (inflamed tissue around wisdom teeth).
• Cavities that cannot be restored.
• Pathology such as cysts and tumors (Cyst around an impacted wisdom tooth. Cysts can cause severe destruction of the jaw bone if left untreated).
• Damage to neighboring teeth(Impacted wisdom teeth can cause decay in the tooth in front of them. Often, this results in the loss of both teeth. Timely removal of the wisdom teeth can prevent this unnecessary tooth loss.
• For crooked teeth correction( orthodontic treatment).
• Cryopreservation has also been suggested as these are a source of stem cells which can be used for treatment of various bone marrow related disorders.
• If a decision is taken that removal is indicated, due to current or anticipated symptoms and problems, this is better done early. This is because it is generally easier to remove an impacted wisdom tooth in the younger patient as the bone is more flexible, and the area will heal up faster.

Wisdom tooth is the third molar tooth that is last tooth to enter in mouth, located at most backwardly in upper and lower arch. They are 4 in number. Some people not have all third molar.

Third molars are usually completely developed between the ages of 15 and 18, a time traditionally associated with the onset of maturity and the attainment of “wisdom.”

When they are unable to fully enter the mouth, they are said to be “impacted.”  This is usually due to a lack of space . Our jaws are evolving, and due to our refined food, they are developing shorter in size.  Therefore, the wisdom teeth become impacted. These teeth are erupted in instalment.

This occurs when a person’s jaw simply does not have enough room to accommodate these final four teeth. This can cause the wisdom teeth to become strapped below the surface of your gums or grow in at an odd angle.

When the teeth do not have enough room to emerge normally, they are considered impacted, they can become twisted, tilted or displaced as they are trying to emerge.

There are several ways that your teeth can be considered impacted, based on where their placement is in your jaw. A soft impaction is when the crown of the tooth has come through the bone, but the gum tissue is still covering part of the tooth.  Partial bony impaction occurs when the tooth is partially through, but another part remains in the jawbone. Lastly, complete bony impaction is when the entire tooth remains encased in the jawbone.

It is important to note that not all impacted wisdom teeth show symptoms. You could have impacted wisdom teeth and not even realize it. The best way to determine if you have impacted wisdom teeth, is by contacting your dental provider and having an exam done, including x-rays, to determine where your wisdom teeth lie.

Most medicated syrups for children are made palatable by adding sugar in the form of sucrose. If left uncleaned, the deposits of syrups on teeth can lead to decay.

Milk teeth guide the eruption of permanent teeth and acts as natural space maintainers for the permanent set of teeth. Also, they are important for functional aspects like chewing and speaking. It is thus important to keep milk teeth healthy and get decayed milk teeth filled.

Advising them to delay tobacco use, divert the mind from the thought of tobacco, drink about 4-5 Its of water a day, do exercise and identify a quit date to completely forgo tobacco is something any person can do. In addition, referral to the nearest health facility for personalised counselling can help.