Impacted third molars, or wisdom teeth, can be very painful.
Credit: Carlos Caetano |Shutterstock

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Diagnosis

Wisdom teeth are the last to erupt and typically do so between the ages of 17 and 25. But according to the American Dental Association, they may grow sideways, emerge only partially or remain completely trapped under gum and bone, which either produces no symptoms or causes:

• Swollen, red, tender or bleeding gums
• Swelling around the jaw
• Bad breath
• An unpleasant taste in the mouth near the affected area
• Headache or jaw ache
• Occasional difficulty opening the mouth
• Occasional swollen lymph nodes in the neck

To diagnose impacted wisdom teeth, dentists look for swollen gums or signs of infection such as tenderness, redness and drainage, according to the National Institutes of Health (NIH). They also inquire about symptoms and regular oral cleaning habits. A diagnosis can only be confirmed with dental x-rays, which may also indicate damage to other teeth or the jawbone.

Surgical options

Some impacted wisdom teeth don’t require removal, but symptomatic cases usually need surgical extraction by a dentist or oral surgeon in an outpatient setting. Local or general anesthesia may be used, depending on the severity of the condition. First, an incision in the gums is made and any bone blocking the impacted tooth is removed before the tooth itself, according to the Mayo Clinic. Afterward, the incision is stitched shut and the empty tooth socket is packed with gauze.

Surgery may be delayed if a wisdom tooth is already infected, in which case a dentist would likely prescribe antibiotics and wait a week to 10 days before proceeding.

After Surgery

Patients are sent home with instructions for diet modifications and other measures to help manage the expected post-surgical pain and swelling. Complications are unusual, but may include:

• Infection of the tooth or gums due to bacteria or trapped food
• Sinus damage near upper wisdom teeth
• Dry tooth socket or bone exposure
• Weakened lower jawbone
• Nerve damage to the lower lip, chin or tongue

Patients who develop any post-surgical complications should contact their doctors immediately.

Risk on Non-Removal

Because bone is more flexible in people under 30, wisdom tooth removal may be simpler before then, according to the NIH. Some impacted wisdom teeth never need removal if they don’t cause dental problems, although AAOMS research indicates that even third molars that erupt in a normal, upright position may be as disease-prone as impacted ones.

Impacted teeth that are not removed may lead to serious complications, including:

• Cyst development around the tooth that may gouge the jawbone and damage adjacent teeth
• Infection of the tooth or gums
• Chronic mouth discomfort
• Misalignment of teeth
• Plaque caught between teeth and gums

A surgical implant to treat obstructive sleep apnea reduced major symptoms of the disorder by nearly 70%, according to a study published online Wednesday in the New England Journal of Medicine.

The new device stimulates a nerve at the base of the tongue, opening the airway. It is one of several new technologies being developed for sleep apnea, a disorder in which people stop breathing during sleep. Sleep apnea already has a very effective treatment, CPAP, or continuous positive airway pressure. But studies show that anywhere from 30% to more than one half of patients can’t or won’t use CPAP as directed by their doctors. Some patients complain that CPAP machines, which deliver pressurized air through a face mask, are uncomfortable and unwieldy. Sleep apnea, which is characterized by loud snoring and daytime sleepiness, is linked to a host of serious health problems, including an increased risk of heart disease, diabetes and stroke.

In the new study, 126 people with moderate to severe sleep apnea who had tried CPAP but couldn’t tolerate it had the new device surgically implanted and were followed for 12 months. The participants underwent overnight sleep studies before implantation and then again at two, six and 12 months. After treatment, the number of times they stopped breathing, either completely or partially during sleep, was reduced by 68%, to nine times per hour, down from 29.3 times per hour. Also, the number of times their blood-oxygen levels fell significantly, the so-called oxygen-saturation index, was reduced by 70% to 7.4 times per hour from 25.4 times per hour. Two patients had to have a repeat procedure because of pain at the implantation site. Other side effects included muscle soreness, temporary tongue weakness and tongue abrasions. The study was funded by the device’s manufacturer, Inspire Medical Systems Inc. of Maple Grove, Minn. Inspire’s device is approved in Europe; the company is applying for U.S. Food and Drug Administration approval.

“Some patients we encounter, despite our best efforts, we cannot get them comfortable with [CPAP] therapy,” said Patrick J. Strollo, professor of medicine and clinical and translational science at the University of Pittsburgh Medical Center and lead author of the study. The new implantable device “has the promise that we really have another option to treat patients.” About 18 million Americans have sleep apnea, according to the National Sleep Foundation, a nonprofit research and advocacy group.

The new device is placed under the skin of the chest. One electrical lead extends up the neck and encircles the hypoglossal nerve, which runs beneath the base of the tongue. The other lead extends to the middle of the chest, where a sensor detects breathing. The patient turns the device on with a remote control when ready for bed and turns it off upon waking. During sleep, the device electrically stimulates the hypoglossal nerve with each round of breath.