The dentist outlined the rules to follow to keep your teeth healthy

There is still debate about whether it is better to keep wisdom teeth or have them extracted immediately. What should be done with teeth that have no roots? Can we leave an empty space after they are removed? By delaying the search for an answer or saving money for another visit to the dentist, we can cause irreparable damage to our teeth.

Dentist Rūta Zykutė says that it is very important to know the right answers yourself and to take action immediately. However, we should take care of our teeth not only when problems arise. It is much more important to look after them properly and prevent serious damage as early as possible.

We tend not to rush to the dentist until we feel pain or notice obvious changes in our teeth. Is this the right thing to do?

It is recommended that you see your dentist once a year, and children should see their dentist every six months.

Periodontal disease or tooth decay may be initially undetectable and cause no pain or discomfort. It is at this stage that teeth can be saved and will always last longer, and treatment will be less extensive.

Dentists keep repeating that people do not take proper care of their teeth. Is brushing your teeth in the morning and evening enough? What else can we do to keep them healthy?

Let me give you an example. Line up all the shoes in your home and take a shoe brush and scrub them all together. Will each shoe be clean after you do this? The same applies to teeth. Each tooth should be cleaned separately with a toothbrush, toothpaste and dental floss, and if your dental hygienist has recommended it, you should also use an interdental brush. There are many products available, so it is best to consult a dental hygienist, whom you should see at least once a year for professional teeth cleaning, to help you choose the right ones for you. Of course, a healthy, balanced diet and moderate consumption of acidic foods are also very important as well as a healthy lifestyle, avoiding alcohol, smoking and stress.

Sometimes it is necessary to treat a tooth by removing the nerve, which sounds painful and unpleasant. Is it true that after the nerve is removed, the tooth quickly starts to crumble and can break because it is dead?

Before root canal treatment, the patient is given a local anaesthetic, so the treatment is absolutely painless. During the treatment, all decayed tissue is removed, and bacteria-infected tissue is removed from the root canal using special instruments. The canals are then washed with disinfectant solutions and filled with a special sealing material. After the nerve is removed, the tooth certainly becomes weaker and more fragile as it is deprived of blood supply and innervation. The nerve is the main connection between the tooth and the brain, which can transmit information about the force of biting, the onset of tooth decay and other sensations to the brain. Therefore, if a nerve is lost, it is recommended to restore (replace) the tooth as soon as possible with special fillings or crowns. This will protect the tooth from breaking, which usually results in tooth extraction.

When it comes to molars and their loss, we often do not rush to treat the remaining empty space after extraction, reassuring ourselves with the saying “no tooth, no problem” as well as due to a lack of money and time. What do we lose along with a tooth and can we live without it?

The loss of teeth disrupts the natural alignment of the teeth. This leads to functional overload of individual groups of teeth. Due to the loss of a certain number of teeth, the remaining teeth have to work harder, so the pressure on the remaining teeth during chewing exceeds the normal pressure exerted by healthy teeth. In this situation, functional overload of the teeth develops. This can cause pain when chewing, and teeth that cannot withstand the overload begin to break. Over time, pathological tooth mobility develops, the jawbone begins to dissolve around the tooth, and the teeth begin to move towards the defect.

If a certain group of teeth falls out of the lower jaw, the teeth of the same group in the upper jaw no longer have support and, over time, become longer and may shift in one direction or another, causing deformities in the tooth row. The more time has passed since the tooth was removed, the greater the deformation.

Food is normally chewed on both sides of the jaw, which function alternately. If even one of the teeth used for chewing is lost, that side of the mouth is practically deprived of its chewing function, which can lead to changes in eating habits, impaired digestion of food in the mouth and stomach problems. However, I would like to emphasise that when a tooth is lost and not replaced for a long time, we lose not only the tooth but also the width and height of the former tooth to restore it. The remaining teeth are subjected to excessive stress, they wear out faster, and the muscles involved in chewing and the lower jaw joint are overloaded. Patients complain of an unusual position of the lower jaw, difficulty and prolonged chewing of food, fatigue of the chewing muscles, and pain in the joint. The joint may not always be painful due to compensatory mechanisms of the body, but special examinations reveal joint pathology in almost all cases of tooth loss.

The issue of wisdom tooth extraction has been discussed for a long time, but patients still cannot count on a unanimous opinion.

In what cases is it recommended to extract them, and when should they be retained?

Each patient is unique. They have their own individual anatomy, number and location of wisdom teeth, so it is impossible to say that wisdom teeth should always be extracted or, on the contrary, left in place. Only after a patient undergoes clinical and radiological examination can a dentist determine whether wisdom teeth need to be removed.

Wisdom teeth are the third molars, also known medically as the eighth teeth. These teeth are essentially no different from other molars, but they begin to erupt between the ages of 17 and 25, appear in both jaws and are usually four in number. However, there are cases when these teeth begin to erupt but never fully emerge, sometimes only some of them erupt, and in some patients, there are no signs of their development. According to research data, about 10% of people have no wisdom teeth at all. This situation is explained by the theory of evolution. Scientists believe that wisdom teeth are rudimentary in the modern human body and tend to atrophy.

Our ancestors ate unprocessed, hard, green food, as a result their jaws, which were activated by intense chewing, developed much larger, and there was enough space for the wisdom teeth to erupt because they were involved in the vital function of chewing. Over the course of evolution, dietary habits changed, and the load on the teeth decreased because more processed, easier-to-chew food was consumed. As a result, the jaw of modern humans has developed to be relatively small, making it difficult to accommodate wisdom teeth, which either do not erupt or erupt in an irregular position, causing a number of complications.

What are the most common complications of retaining wisdom teeth?

Inflammation of the surrounding soft tissues is the most common complication. When the tooth does not erupt completely, a pocket forms in the mucous membrane, also known as a “flap”, covering the remaining part of the tooth, which is constantly traumatised. Food residue accumulates under the flap and forms bacterial plaque. It is very difficult to remove it by regular hygiene methods which leads to the development of a purulent inflammation of the tissues called pericoronitis. If left untreated, this infection can spread to the throat or neck. The main symptoms of inflammation are swelling of the gums at the back of the teeth, bad breath and taste, intense pain on the side of the face where the tooth is erupting, extending to the ear and temple, difficulty opening the mouth or swallowing, fever, and headaches. Pericoronitis is treated by removing the pocket of mucous membrane that has formed and prescribing medication for inflammation and pain. If the mucous membrane grows back and the inflammation recurs, then it is recommended to remove the tooth.

Kada protinius dantis reikia šalinti?

I would highlight several cases:

• When wisdom teeth are non-functional, severely damaged by tooth decay, pulpitis or periodontitis.
• When the structure of the wisdom tooth roots or difficult access makes high-quality endodontic treatment impossible.
• When wisdom teeth that have not fully erupted cause recurrent inflammation of the soft tissues known as pericoronitis.
• When unerupted wisdom teeth can damage the roots of adjacent teeth or cause tooth crowding.
• When crooked wisdom teeth damage the cheek mucosa when chewing.
• When wisdom teeth erupt incompletely or are misaligned, bacterial plaque accumulates and damages the adjacent teeth.
• To reduce the likelihood of cysts forming around a retained tooth or to remove a tooth with a cyst, surgeons recommend extracting the tooth.
• To reduce the likelihood of infection and complications, surgeons recommend removing impacted or misaligned teeth at the end of adolescence, before the age of 20 when the roots are not yet fully formed. The longer you wait, the greater the risk of complications during extraction as there are cases where the roots of a retained tooth surround nerves or the roots of adjacent teeth.

How many wisdom teeth can be removed at one time? What method of anaesthesia is used during removal?

Only the individual situation determines whether wisdom tooth extraction will be a simple surgery requiring local anaesthesia, the same as for treating tooth decay or other dental treatment, or whether more serious surgical intervention will be required, which can also be performed under local or general anaesthesia. The complexity, number of teeth to be removed and duration of the surgery depend on the individual situation. For some people, the surgery may take only a short time, while for others it may take an hour or more. If all four wisdom teeth are to be removed or if the patient has cardiovascular disease, diabetes or other health conditions that pose a risk to their health, they will be hospitalised for scheduled surgery.