Judgment tooth

It often happens that a dente of judgement fails, thus remaining included (when the dental germ is completely covered by the gum) or seminclus (when it is partly visible). Failure to erupte (commonly called "growth") may be due to two factors:

• Given the conformation of jaw and jaw, it is possible that the tooth lacks place to erode (until).^[3]
• The tooth growth axis is not properly oriented. In the most complicated cases, it may be that the tooth grows horizontally, possibly by pressing on the second molar.

A dente of the judgement that has grown imperfectly is likely to cause pathologies such as cyst, pericoronite, caries and abscess.^[4]

The octaves, if they are properly eroded, can contribute to chewing and do not cause any disturbance as long as proper oral hygiene is applied. However, the fact that their growth is subject to variations and imperfections is also due to the evolutionary course of the human species: in the past man needed more molars to chew raw and ostic foods, which were abandoned during evolution while the dimensions of the jaw and jaw have clearly reduced, leaving little place available for normal development of the eighth tooth. The teeth of judgment are therefore a legacy of the past.^[5] It is only with the age that the jaw and jaw should reach sufficient size to allow its development. However, according to some anthropologists, the appearance of octaves in late age would have the task to counterbalance the excessive wear of other teeth. Prehistoric nutrition and dental care in fact caused early teeth loss. In this way, the third molar, having sufficient space to develop, carried out a reserve function, preserving proper chewing.

Extraction can be more or less complicated depending on the overall situation. For example, it is easier to extract from young people as the roots are not yet fully formed and the surrounding bone is softer; moreover, the tooth of higher judgment can be - at equal conditions - extracted more easily than the lower one. Depending on the case, it will be done with or without stitches, or with different types of anesthesia, in surgery or in clinic. The extraction of a completely outdated judgment tooth is the simplest case and usually does not require special attention apart from local anesthesia and the use of an appropriate analgesic. Even the extraction of a tooth of judgment included is often performed in local anesthesia.^[6]

In general, therefore, we can talk about three main conditions for an extraction intervention concerning the tooth of judgment. Each condition requires techniques and approaches that can be different:

• Simple extraction: the tooth is extruded, i.e. it is visible in arcata without having to resort to x-rays or computerized tomography with beam. It can be extracted with pliers or using levers via EWF (Extraction Without Forceps) technique. Ortopantomography is always required to determine, especially at the lower arch, the possible proximity of dental roots to the mandibular nerve.
• In semi-inclusion: the tooth of judgement is partially covered by gum and/or bone, but it is seen in arch. Oral surgery serves to free the dentarian element and then can easily extract it from the alveolar site. Working with sonic handles in cases such as this allows a technique that uses vibrations to cut hard tissues, such as bone and teeth, respecting soft fabrics.
• Total bone inclusion (complete): the tooth is completely hidden inside the jaw or jaw. In this case, the disodontisis of the tooth of judgment is inevitably faced with a surgical approach. It is necessary to access the tooth hidden in the bone by removing part of it and then exposing and then extracting the dentarian element, often after splitting it into smaller parts. Sonic surgery allows to protect soft tissues especially in cases of this kind.

The course after a routine intervention is generally quick. Inflators and blood loss are possible for several hours after surgery. If the loss is moderate, it is to be considered normal during the first day after extraction.^[7] In these cases the patient can bite on a gauze or on a fabric handkerchief. Paper tissues or ovats are to be considered as emergency solutions because they risk leaving traces that stick to the wound and which can cause its reopening when removed. It is also advantageous to slightly moisten the gauze or the handkerchief. In case of difficulty, to facilitate the healing of the wound we often recommend ice packs, while hot foods, cigarettes, coffee and alcohol are not recommended, as well as energetic rinses or too numerous or anti-aggregating drugs such as aspirin.^[8]

The extraction of a judgment tooth made for purely precautionary purposes (anywhere in the absence of symptoms) is a custom that varies from country to country, and whose need is not fully supported by scientific studies.^[9][10][11]

Although rare (0,005% of the total) the extraction of the third molar can involve, at a distance of two or three weeks, the fracture composed of the mandibular angle, due to the excessive and early load of the area operated during chewing.^[12]