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Wisdom tooth meets acute pulpitis, direct extraction or extraction after pulp opening?

Wisdom teeth are the remains of human evolution. Due to the degradation of the jaw, the eruption of wisdom teeth often causes ectopic eruption and impaction due to the lack of space. The abnormal eruption of and the difficulty of cleaning and prevention usually cause severe pain in the clinical manifestations of wisdom teeth pericoronitis, wisdom teeth or caries, periodontitis, pulpitis and other diseases near the teeth Therefore, surgeons generally recommend early prophylactic extraction of wisdom teeth with abnormal or asymmetric eruption rdquo; The main clinical characteristics of acute pulpitis…

Wisdom teeth are the remains of human evolution.

Due to the degradation of the jaw, the eruption of wisdom teeth often causes ectopic eruption and impaction due to the lack of space. The abnormal eruption of

and the difficulty of cleaning and prevention usually cause severe pain in the clinical manifestations of wisdom teeth pericoronitis, wisdom teeth or caries, periodontitis, pulpitis and other diseases near the teeth

Therefore, surgeons generally recommend early prophylactic extraction of wisdom teeth with abnormal or asymmetric eruption

rdquo;

The main clinical characteristics of acute pulpitis are severe pain. The general analgesic effect is not obvious. It is necessary to open the pulp cavity urgently to reduce the pressure in the pulp cavity and drain the inflammatory exudate in the pulp cavity before the pain can be relieved

The treatment principle of acute pulpitis is to preserve the vital pulp or the affected teeth as much as possible.

when wisdom teeth suffer from acute pulpitis, dentists and endodontics generally recommend that the wisdom teeth be extracted directly to relieve pain and avoid subsequent root canal treatment; However, in the absence of extraction conditions, endodontics choose to open pulp drainage to relieve the pain symptoms of patients, leaving wisdom teeth to be extracted after the pulpitis symptoms are relieved

However, there is no study to compare the postoperative pain between acute pulpitis wisdom teeth and normal wisdom teeth

In order to study the effect of acute pulpitis on the pain after wisdom tooth extraction, and to provide a reference for clinical practice, Zhang Wei, a doctor in the Department of Dentistry and endodontics of Wuhan University Stomatology Hospital, made a randomized controlled trial and objective evaluation on the postoperative pain of maxillary wisdom teeth with acute pulpitis. The results were published in the recent international dental journal Patients with acute pulpitis of maxillary wisdom teeth were randomly divided into group A (n = 30) and group B (n = 30)

In group A, 30 patients were directly extracted by surgeons. All 30 patients in group

B were treated with pulp opening and drainage by endodonists to ensure the drainage of inflammatory exudate in pulp cavity, so as to reduce the pressure of pulp cavity and relieve pain. After 24 hours of cavity development, the patients returned to the hospital and the wisdom teeth were extracted by surgeons

A total of 30 patients with maxillary wisdom tooth extraction without inflammation were selected as negative control group (Group C). After extraction of wisdom teeth, surgeons directly extracted wisdom teeth. The pain was quantified and recorded by visual analogue scale (VAS) The pain scores of group A were significantly higher than those of group B and group C on day 3, day 2 and day 3. However, there was no significant difference between group B and group C after wisdom tooth extraction. There was no significant difference in pain score between group A, group B and group C on day 4 and day 5 after wisdom tooth extraction

This study confirmed that the postoperative pain of wisdom teeth with acute pulpitis was significantly stronger than that of non inflammative wisdom teeth; pulpitis may be one of the causes of postoperative pain

The results have certain guiding significance for the clinical work of dental pulp doctors and oral surgeons: when wisdom teeth suffer from acute pulpitis, pulp should be opened first, and then the wisdom teeth can be extracted after the acute inflammation is relieved

It is suitable for further treatment of open pulp drainage

1

For the patients with acute pulpitis, the ipsilateral contralateral wisdom teeth also erupt in the ortho position, and the upper and lower wisdom teeth have good occlusion function, they can be considered to open the pulp and drainage first, and then complete the pulp treatment and restoration treatment before retaining;

2

For some special people, such as pregnant women, because they are not suitable for tooth extraction, when suffering from acute pulpitis of wisdom teeth, we should first open pulp drainage to relieve the pain, and then extract wisdom teeth after the end of pregnancy;

3

If the patients suffer from heart disease, hypertension and other systemic diseases and can not tolerate tooth extraction, they should first open the pulp and drainage, and then take further treatment after pain relief;

4

If the mesial inclination angle of the wisdom tooth with acute pulpitis does not exceed 45 DEG, the abutment teeth can be retained after pulp opening and drainage, and then complete pulp and restoration treatment can be carried out to preserve the wisdom teeth and avoid the loss of free end

When other molars can not be retained due to lesions, the wisdom teeth with acute pulpitis can be pulled out and transplanted to other molars In addition, if the second molar has been extracted, the wisdom teeth with acute pulpitis can be treated with complete endodontic treatment and restoration treatment, combined with orthodontic treatment, so that it can move forward to replace the second molar and establish the occlusion relationship with the opposite molars

direct removal is recommended:

1

The patients are in good health and can tolerate tooth extraction; the wisdom teeth with acute pulpitis have extensive caries, and the remaining tooth tissue has no retention value;

2

Other molars of the patients are in good condition. The position of the wisdom teeth with acute pulpitis is abnormal, and they are not occluded with the contralateral wisdom teeth. It is suggested that the upper and lower wisdom teeth should be extracted together;

3

However, if the root canal is seriously calcified and there is no condition for pulp treatment, direct extraction is recommended.

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