Partially erupted wisdom tooth, options?

[frostie]

Hi all,

Hoping some dentist on the forums here have some insight as to what my potential options are considering the circumstance.

Have a partially erupted(about 1/3) wisdom tooth on the jaw. Try to take care of cleaning as much as possible but can't seem to conquer an infection back there. Can smell it on the floss every time. I would like to tackle the issue but have concerns. If infection could be conquered with teeth in place would be wonderful. However, regular flossing, tooth brushing and water pic rinses with sea salt are not getting it to go away.

The obvious solution would be to simply pull the tooth. And that's the issue. The reason it hasn't already been done is i fear someone getting into the area and hacking up some nerves, don't want to be iv sedated for fear of not waking up, don't want to hear/feel the god awful noises/feelings of the extraction process, worry the area could easily get reinfected and create an emergent situation, among a bunch of other worries. Now ad on top the fact that i have not been to a dentist since childhood. due to horrible experiences, and that only compounds the conundrum i find myself in.

So, for the dentist. Here is an alternative idea i have to lay out. Would like you to review the logic and respond with your thoughts of my approach, or provide alternatives not currently opined here.
Starting from the wisdom tooth and working towards the front of the mouth/jaw there is a tooth molar that has a partially missing crown. Hearken back to horrible previous experiences, the top of this tooth was basically removed with a huge filling in the middle. The sides were left too thin and finally the tooth broke apart and the filling fell out. All that remains above the gum line is the "face" of the tooth. Not painful, but does collect lots of food in missing part so stay diligent on care. However, over the years the gum beneath the tooth is slightly discolored so i imagine the tooth is dead. Still firmly in place, but probably not worth the effort to try to do something with it cosmetically.
This brings me to my question. There is one molar between the wisdom tooth and the messed up one mentioned above. The molar abutting the wisdom tooth remains viable(for now). So my thought is why not remove the broken tooth and allow the wisdom tooth to push the adjacent molar down into the place of the removed molar? According to the latest x-ray the partially erupted molar's top edge rests under the crown of the adjacent molar

 

[frostie]

Sorry post went a little long. Just trying to be as descriptive as possible.

Continuation,


......and is sitting at 'about' a 45 degree angle. My logic/hope is if space is made for the wisdom tooth to push the adjacent molar into the position of the removed tooth i can avoid all the fears mentioned above. I don't mind if the process takes a while. Just don't know if that is too much to ask. Could the wisdom molar potentially migrate both teeth down into the proper position? Even if it wont go that far might this provide enough room for the wisdom molar to fully erupt and allow for the sealing off the gum line at rear of jaw?

If the dentists on here have other ideas to suggest, all ears. However, would be nice to understand the reasoning if you think the above mentioned solution is a bad one or less optimal.

 

[Gordon]

Could the wisdom molar potentially migrate both teeth down into the proper position?

Nice short answer. No.

You could enquire about orthodontic treatment to bring the 2nd molar forward into the extraction site and then guide the 3rd molar into place. Allowing an optimum of about 1mm tooth movement per month plus 6 months or so for retention afterwards, you'd be looking at wearing an orthodontic appliance for about a year and a half.

 

[frostie]

@Gordon

Let me know if i understand correctly.

On their own the teeth would not be able to move/migrate that far no matter how long a time frame. However, getting the teeth into the wanted position 'might' be possible with the assistance of orthodontic treatment(s), yes? The idea/logic is technically feasible, just needs help to accomplish?

If so, this question popped into my mind. With the wisdom tooth 2/3 still covered how would ortho be able to acces the tooth? Is the idea that once pressure is released along the jawline, by removal of near molar, that would allow the wisdom tooth to naturally fully erupt; or at least enough to provide a means to get something attached to tooth and assist in bringing it forward into new position?

edit: by "orthodontic appliance" are you referring to a retainer?

 

[Gordon]

On their own the teeth would not be able to move/migrate that far no matter how long a time frame. However, getting the teeth into the wanted position 'might' be possible with the assistance of orthodontic treatment(s), yes? The idea/logic is technically feasible, just needs help to accomplish?

Yep. The Second molar won't bodily move, it'll just tilt forward at best, which isn't great, as it'll create a nice plaque trap. It won't make any difference to the 3rd molar.
So moving the tooth bodily is the only possible course of action, which requires orthodontic treatment.

If so, this question popped into my mind. With the wisdom tooth 2/3 still covered how would ortho be able to acces the tooth? Is the idea that once pressure is released along the jawline, by removal of near molar, that would allow the wisdom tooth to naturally fully erupt; or at least enough to provide a means to get something attached to tooth and assist in bringing it forward into new position?

If a 3rd is available that's enough to bond an anchor onto and let the orthodontist start moving the tooth forward.
No nothing like a retainer, fixed brackets bonded onto all the teeth in the arch or thereabouts, with elastic bands attached to the teeth to pull them into position. Hang on...quick google search:

Like I said, not a trivial nor a quick task but possible in some cases.

When I was a student there was a trial of transplanting teeth, so in your case, you'd extract the first molar and the third molar carefully then shove the 3rd into the 1st molar socket, splint it for a while and Bob's your Uncle.
Unfortunately it was discovered that after 3-5 years the transplanted tooth would just self destruct and fall out... shame really it would have been great if it worked

 

[frostie]

@Gordon


Thanks. I know what braces are, just didn't see a place for an anchor to attach to the partially erupted tooth. Didn't initially realize ortho "treatment" and "appliance" were referencing the same thing. Knew you meant braces to get the teeth pulled into place, but was just thrown by the word appliance as to possibly mean something different(i.e. retainer).

So to make sure i understand correctly, we are talking about braces to pull the teeth into place. And the 'appliance' for about a year and a half is referencing that specifically. Not braces for a few months to get teeth into place then retainer to follow to make sure they remain in place. Once braces go on they stay until job completed and teeth root/settle in new position, yes?

If i got that correct, one more question. The wisdom tooth is sitting at an angle compared to adjacent molar. Once it is migrating forward will it naturally want to rotate into the upright position as it gets to a more level spot on jawbone, or will the braces/anchor be needed to coax/force it upright?

 

[Gordon]

So to make sure i understand correctly, we are talking about braces to pull the teeth into place. And the 'appliance' for about a year and a half is referencing that specifically. Not braces for a few months to get teeth into place then retainer to follow to make sure they remain in place. Once braces go on they stay until job completed and teeth root/settle in new position, yes?

Yes.

If i got that correct, one more question. The wisdom tooth is sitting at an angle compared to adjacent molar. Once it is migrating forward will it naturally want to rotate into the upright position as it gets to a more level spot on jawbone, or will the braces/anchor be needed to coax/force it upright?

The braces will probably be needed to upright the tooth. They tend to tip forward naturally, rather than go more vertical, annoyingly!

If you want to take this forward then you'd need to see a specialist orthodontist for an opinion, it's outside the scope of a regular dentist.

 

[frostie]

@Gordon


Gotcha, thanks for the assist. Just wanted to make sure my logic was not way off base.

Noticed you suggesting a specialist orthodontist. Is there a specific term i can use to search for them here in the states? Or would any competent orthodontist be knowledgeable enough to help suss this idea out?

 

[letsconnect]

I think by "specialist orthodontist", Gordon meant a dentist who specialises in orthodontics, i.e. an orthodontist (as opposed to a general dental practitioner).

 

[frostie]

@letsconnect



Thanks for helping translate. If this was in fact his meaning then all is clear now. Thanks again.