What to do with an impacted wisdom tooth in the lower left jaw?

Management of Impacted Wisdom Tooth in the Lower Left Jaw

For an impacted wisdom tooth in the lower left jaw, surgical removal is recommended after proper diagnostic imaging to minimize risks of complications and prevent future pathology.

Diagnostic Assessment

Before making a treatment decision, proper imaging is essential:

1. Initial Imaging: Orthopantomography (panoramic X-ray) should be the first diagnostic examination for suspected dental impaction 1

2. Advanced Imaging: CBCT (Cone Beam Computed Tomography) is essential when assessing:

   • Relationship between lower third molars and the mandibular canal 1
   • Risk of nerve injury during extraction 1
   • Potential external root resorption 1

Decision-Making Factors

Several factors should guide the management decision:

Factors Favoring Removal:

• Potential for Pathology: Impacted wisdom teeth are associated with:

  • Pericoronitis (inflammation around the crown)
  • Root resorption of adjacent teeth
  • Periodontal disease
  • Dental caries
  • Development of cysts and tumors 2

• Age Considerations: Surgical complications increase with age, making earlier removal preferable 3

• Anatomical Relationships: Position relative to the mandibular canal and second molar 1

Factors Favoring Monitoring:

• Truly Asymptomatic: If the tooth is completely asymptomatic and shows no signs of disease 3

• High Surgical Risk: If extraction poses significant risks due to proximity to vital structures 1

Surgical Approach

If extraction is indicated:

1. Preoperative Planning:

   • Use CBCT to assess relationship with mandibular canal to prevent nerve injury 1
   • Plan surgical approach based on tooth angulation and depth of impaction 1

2. Risk Minimization:

   • Follow ALARA principle (As Low As Reasonably Achievable) for radiation exposure 1
   • Use careful flap design and bone removal techniques 1

Follow-up Protocol

If the decision is made to retain the impacted wisdom tooth:

• Regular clinical assessment at defined intervals 3
• Periodic radiographic monitoring to detect early signs of pathology
• Patient education about warning signs requiring immediate attention

Common Pitfalls to Avoid

1. Delayed Decision: Waiting until complications develop can lead to more difficult surgery and increased risk of complications 2

2. Inadequate Imaging: Relying solely on 2D imaging when 3D CBCT is needed to assess critical anatomical relationships 1

3. Ignoring Age Factor: Failing to consider that surgical complications increase with age 3

4. Overlooking Potential Pathology: Even asymptomatic impacted teeth can develop pathology over time 2

While some evidence suggests that watchful monitoring of asymptomatic disease-free impacted wisdom teeth may be appropriate 3, the potential for future complications and the increased risk of surgical complications with age often make early removal the preferred option for impacted lower wisdom teeth, particularly when there are signs of potential future problems.