WISDOM TEETH.....

SHOULD THEY BE REMOVED?.....

Wisdom teeth, also known as third molars, are the teeth located furthest back in the jaws. They are the last ones to emerge (erupt) into the mouth and become visible. These teeth vary most in the timing of developement, crown and root structure, and position.

In some people, these teeth erupt completely and are functional. However, in most people wisdom teeth are either partially erupted or fully impacted within the jaw bones. In these situations, the teeth do not work properly and may need to be removed.

The position of wisdom teeth is affected by the size of the tooth in relation to the jaw, and how they develop within the jaws. A problem or lesion in the jaw can also determine the position of wisdom teeth.

EMERGING AND ERUPTED WISDOM TEETH.....

Erupted wisdom teeth are more likely to develop plaque and cavities. They are harder to brush and floss properly. The lower jaw can get in the way when cleaning wisdom teeth on the upper jaw. The cheek muscles can interfere when cleaning the lower wisdom teeth. Often, when these teeth erupt partially, a flap of unattached gum tissue remains. This acts as a trap where food debris and plaque can collect. Debris that builds under the soft tissue flap may inflame the gums. It can also infect the area, causing pain, trouble opening the mouth, bad taste and odour. Molars partly covered by soft tissue are 22 to 34 times more likely to develop disease than those at other stages of eruption.

In some cases, the position of the erupted wisdom teeth creates a tight contact area with the next molar. This prevents proper flossing and cleansing which leads to cavities. Restorative dental treatment on both molars will then be needed. The teeth may even be lost.

Sometimes wisdom teeth have been removed to prevent crowding of the front teeth (incisors), particularly in the lower jaw. However, most studies reviewing this risk found little or no effect. As a result, the decision to remove wisdom teeth should be based on other concerns.

TEETH THAT HAVE NOT EMERGED......

Wisdom teeth are the molars most often impacted (unerupted). This occurs more often in the upper jaw than the lower.

When wisdom teeth remain impacted in the jaw, they are at risk for other problems. Molars completely covered by soft tissue or bone tissue have about equal risk of developing disease as those that are partly covered. In particular, the follicle surrounding an unerupted tooth can sometimes grow, forming a cystic lesion. The most common type associated with unerupted wisdom teeth is known as a dentigerous cyst. It happens more often in the lower jaw. Other less common, but more aggressive lesions are also linked with impacted wisdom teeth. One type often requires surgery to avoid significant deformities and fractures.

Sometimes, impacted wisdom teeth must be removed because of specific medical conditions or to prevent the management of future eruption. In these cases, the risk of keeping the teeth outweighs the risk of possible complications from removal, even if teeth are not causing symptoms.

Other, less common reasons for removing unerupted wisdom teeth include:

* transplanting the molars into another site
* removing molars so they do not interfere with eruption of the second molars
* if the tooth is in the way of repairing a jaw fracture
* avoiding confusion with diagnosing jaw joint (TMJ) or muscle problems if there is unusual pain the the area.

RISKS OF SURGERY.....

As with any type of surgery, specific risks are associated with removing wisdom teeth. The risks often involve neighbouring nerves, vessels, sinuses, glands and muscles.

Nerve injury resulting in temporary or permanent loss of sensation is associated with two main lower jaw nerves. However, this happens in less than one per cent of surgeries. Other possible complications include:

* "dry socket" or loss of the blood clot that forms when the tooth is removed
* infection
* "secondary hemorrhage" or excessive bleeding.

After surgery, there may be pain, trouble opening the mouth, swelling and tiredness. About half of patients have these concerns during the first few days. Damage to the next tooth and tissues surrounding and supporting it, or developing a deep pocket next to the second molar, are rare. (Again, this generally involves less than one per cent of cases.) Fractures to the jaw occur, but very rarely. An oro-antral fistula, where an opening develops between the mouth and the maxillary sinus above, is also very rare.

Removing wisdom teeth that have extensive cavities, severe gum issues, disease or infection is generally a clear decision. The choice is less simple in the case of wisdom teeth that have no symptoms. Much literature suggests removing these teeth, while some says there is no need.

Your dental care provider should inform you of the pros and cons of keeping or removing wisdom teeth. Monitoring the situation and using x-rays will help ensure that un-erupted wisdom teeth are doing well in their growth and eruption process.

Inform yourself of the risks and possible complications of retaining or removing the wisdom teeth. Ask about the follow-up process in each scenario. The decsion to remove or retain wisdom teeth should be mutual; made by a well-informed patient and a skilled dental care provider.

CONQUER YOUR FEAR OF THE DENTIST...

The key to good oral health is prevention - stopping problems before they arise. Unfortunately, people who suffer from dental anxiety often fail to visit the dentist for routine care. When they finally do go, often a small preventable problem has turned into a problem which will require major intervention.

In our years of successfully treating dental phobics, we have used a number of techniques. Some even involve the use of mild sedatives but most techniques involve face to face communication, answering of the patient's questions, and a lot of listening.

It takes a true partnership between the patient and the dentist, a growing trust, and a growing relationship that cannot, nor should not, be pushed faster than the patient can accept.

Usually the first appointment is a "get to know you visit" where we take a complete medical and dental history and have a discussion with the patient. We have found that by clearly explaining any planned procedures (what they are and why we plan to do them) and by answering all of the patient's questions, much of the anxiety can be eliminated.

The first visit also includes a discussion on what is the most stressful thing about dentistry for the patient and ways we can reduce, if not eliminate the stress. We perform an examination, take digital x-rays and develop a treatment plan TOGETHER. The progress made in each visit is controlled by the patient and their readiness to continue.

During future visits, we follow through with the necessary procedures. A person can also reduce their anxiety by bringing a friend or loved one along with them for support.

We often advise people not to schedule appointments during stressful times. Don't for example, schedule an appointment before a major business meeting or in the middle of the day if you know you have several tasks to do after the appointment.

Also, during the procedure, the dentist will tell patients exactly what he is doing - when they are going to feel pressure and when they are going to feel coldness. He uses all the techniques available to minimize the pain. In the few cases where the patient will feel discomfort, he will tell them. Surprisingly, anxiety is reduced if a patient knows EXACTLY WHAT TO EXPECT.

MERCURY CHELATION...

Mercury is a toxic metal widely occurring in the biosphere which presents hazards associated with both ingestion and inhalation. Mercury has no essential function within the body.

Pesticides, large fish, and mercury dental fillings are the most potent sources of mercury. The amount of mercury found in fish is directly proportional to the size of the fish, with the largest and most long lived fish (eg sharks) accruing huge amounts of mercury by the end of their lives. Mercury tends to enter rivers, lakes and the oceans through industrial discharges and volcanoes. It settles in bacteria which are eaten by algae; algae are eaten by small fish; small fish are eaten by large fish, and so on up the chain. Each step concentrates the amount of mercury present in each animal.

Mercury has also been used as an antiseptic and pesticide. Many commercial preparations have contained the inorganic mercury salt calomel (mercurous chloride), including over the counter laxative preparations and some cosmetics. It has also been used to treat grain seed as a pesticide.

The largest source of mercury for most people in the Western World is from amalgam (silver) dental fillings. Amalgam fillings were developed by a British chemist in 1819 and were originally made from filing down silver coins and mixing the filings with mercury to make a paste of pliable mass. Modern amalgam is made from a mix of copper, tin, zinc, silver with 50% mercury. Mercury fillings have a life expectancy of 10 years, due to the highly corrosive conditions of the mouth. An electrical current tends to exist between the metals in the amalgam and saliva. This electrical current is actually a chemical reaction between the amalgam and saliva, and leads to a loss of mercury from the amalgam as a vapour, where it is inhaled. The normal chewing of food also causes the abrading of amalgam from the fillings, leading to the ingestion of small particles of mercury. Natural endogenous bacteria of the mouth and gut are able to convert inorganic mercury into organic mercury through methylation (adding a methyl group to the mercury element) and so forming methyl mercury.

The World Health Organization states that the largest estimated average daily intake and retention of mercury and mercury compounds in the general population is from dental amalgam fillings. The estimated daily intake of mercury from dental amalgams is 3.8-21 mcg per day.

Mercury can be found in a two main forms, inorganic and organic. Inorganic mercury is very toxic to humans, but not nearly as toxic as organic mercury such as methyl mercury. Methyl mercury is a form of mercury which has been bound to a simple organic carbon group. This makes it permeable to membranes and encourages its movement into brain tissue. About 10% of mercury ingested accumulates in the brain.

Mercury has an affinity for organic sulphur compounds called thiols, which are essential components of enzyme systems. Mercury will irreversibly bind to these thiol groups and inhibit their function in enzymatic reactions. Thiols are also involved in protein formation and help stabilize protein structure. Mercury is then able to cause the denatutrations of protein structures, particularly in the brain. It can also form a hapten with the protein it is bound to, causing the immune system to recognize that protein as foreign and destroying it at all opportunities. This leads to beginning of autoimmune disorders.

Mercury toxicity can be manifest in many forms. In acute organic mercury toxicity symptoms include loss of coordination, intellectual ability, vision and hearing. Organice mercury can produce redness, irritation and blistering of the skin. Chronic exposure to mercury can produce the following symptoms: fatique, loss of energy, weakness, oedema, pallor, inappropriate chilliness or excessive warmth, excessive perspiration without fever, fainting, blurred vision, headache, anxiety, irritability, hostility, agression, insomnia, restlessness, decreased concentration, grogginess, depression and thought of suicide.

In attempting to reverse the problem of mercury toxicity it is important to realize that the mercury contamination must be removed, whether this be the cessation of using cosmetics, eating fish, or having your dental amalgams removed. It is also important to supplement those nutrients most effected by mercury as this appears to one way of reducing the effects of chronic exposure.

As mercury will attach to sulphur amino acids in protein, it is important to supplement with nutrients to encourage mercury elimination.