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By Jonathan Pedlar; John W Frame

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Extra info for Oral and Maxillofacial Surgery

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Answers on page 263. Fig. 33 44 See question 2. 5 ● ● ● ● ● Removal of unerupted teeth G. R. Ogden Although any tooth may become impacted or displaced, those most commonly affected are the lower third molars, maxillary canines, maxillary second premolars and supernumerary teeth. An impacted tooth, which may be unerupted or partially erupted, is one that fails to achieve a normal, functional position. This may be due to lack of space, obstruction by another tooth or bone or an abnormal path of eruption.

A suitable list of instruments is given in Appendix A. The gingival margin incision is made holding the scalpel in the long axis of the tooth, at the posterior extent of the flap and drawing the blade around the tooth in the gingival crevice. The sharp edge of the scalpel must be kept immediately against the tooth surface to prevent inadvertent laceration of the gingiva. Then the scalpel is turned so that the bow of the blade rests on the gingival margin just in front of the canine/premolar papilla and is drawn downwards and slightly forwards, curving into the sulcus, cutting full depth to bone.

Be aware that misdiagnosis can occur. The mouth smells and tastes foul (a smell of anaerobic bacterial activity or rotting meat). There may be a local lymphadenitis, but severe systemic response in the form of fever is rare. If no treatment were provided the condition would eventually resolve spontaneously, but it may take up to 4 weeks and during that time the pain would persist. Similar pain is experienced whenever an area of bone is left exposed in the mouth and usually settles when the exposed (and non-vital) bone is either eventually covered by granulation tissue or is separated from the underlying bone and sequestrated.

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