诊断

牙医或口腔外科医生可能评估您的牙齿和口腔,从而确定您是否有阻生智齿或者存在引发问题的其他疾病。这类评估通常包括:

  • 询问您的牙齿症状和一般健康状况。
  • 检查您的牙齿和牙龈状况。
  • 进行牙科 X 线检查,以揭示是否存在受影响的牙齿,以及牙齿或牙槽骨受损的迹象。

治疗

如果您的阻生智齿很难治疗,或者您存在可能增加手术风险的医疗状况,您的牙医就可能请您去看口腔外科医生,以讨论最佳治疗方案。

管理无症状智齿

如果阻生智齿没有引起症状或明显的牙齿问题,这类智齿就称为无症状。牙科界对于如何管理无症状阻生智齿存在一些分歧。针对这一课题的研究并没有确切表明一种策略优于另一种策略。

有些牙医和口腔外科医生建议拔掉无症状智齿,以预防未来可能出现的问题。他们认为:

  • 没有症状的智齿未必没有疾病。
  • 如果没有足够的空间让牙齿萌出,则通常很难接触到这些牙齿并进行正确地清洁。
  • 严重的智齿并发症在年轻人中比较少见。
  • 到年龄较大时手术难度更大,更容易引起并发症,尤其是在老年人中。

另一些牙医和口腔外科医生建议采取更保守的方法。他们指出:

  • 没有足够的证据表明在青年时期没有引发问题的阻生智齿会在日后引发问题。
  • 手术的费用和风险证明预期的益处并不合理。

如果采用保守的方法,牙医会监测龋齿、牙龈疾病和其他并发症。如果出现问题,牙医可能会建议拔掉牙齿。

手术拔除

引起疼痛或其他牙齿问题的阻生智齿通常采用手术拔除。如果出现以下情况,通常就需要拔除智齿:

  • 涉及智齿的感染或牙龈疾病(牙周病)
  • 部分萌出的智齿出现龋齿
  • 涉及到智齿的囊肿或肿瘤
  • 对邻近牙齿造成损害的智齿

拔除几乎都是门诊手术,所以您当天就能回家。手术过程包括:

  • 镇静或麻醉。可能对您采用使口腔麻木的局部麻醉;或者抑制意识的镇静麻醉;或者使您丧失意识的全身麻醉。
  • 牙齿拔除。在拔牙过程中,牙医或口腔外科医生会在牙龈上做一个切口,并移除所有阻碍接触到阻生牙牙根的骨头。拔除牙齿之后,牙医或口腔外科医生通常会用缝线缝合创伤,并用纱布塞住空腔(牙槽)。

智齿拔除术可能会引起一些疼痛和出血,还会导致相应部位或颚肿胀。有些人会由于颚肌肉肿胀而暂时难以张大嘴巴。您会得到一些关于护理创伤和管理疼痛和肿胀的指导,比如服用止痛药和用冷敷减轻肿胀。

极少数情况下,有些人可能会出现:

  • 由于术后的血凝块从牙槽中脱落而导致令人疼痛的干槽症或骨暴露
  • 由于细菌或陷入的食物碎渣导致的牙槽内感染
  • 邻近的牙齿、神经、颚骨或鼻窦受损

Managing wisdom teeth without symptoms

Dental specialists disagree about whether to remove impacted wisdom teeth that aren't causing symptoms. These are called asymptomatic wisdom teeth. Many dental specialists recommend removing asymptomatic wisdom teeth in the late teens to early twenties because the risk of complications is low and the procedure typically is safer and well tolerated by younger people.

Some dentists and oral surgeons recommend taking out wisdom teeth even if they aren't causing problems to prevent potential issues in the future. They say:

  • Symptom-free wisdom teeth may not be free of disease.
  • If there isn't enough space for the teeth to come in, it's often hard to get to them and clean them properly.
  • Serious problems with wisdom teeth happen less often in younger adults.
  • The procedure is harder with age and more likely to cause problems later.

Other dentists and oral surgeons recommend a more conservative approach. They note that:

  • There isn't enough evidence to suggest that impacted wisdom teeth that aren't causing problems in young adulthood will cause problems later.
  • The expense and risks of the procedure don't justify the expected benefit.

With a conservative approach, your dentist watches your teeth, looking for decay, gum disease or other problems. Your dentist may recommend taking out a tooth if problems arise.

Surgery to remove wisdom teeth

Impacted wisdom teeth that cause pain or other dental problems usually are taken out with surgery, also known as extraction. Extraction of a wisdom tooth usually is needed for:

  • Infection or gum disease, also known as periodontal disease, involving the wisdom teeth.
  • Tooth decay in partially erupted wisdom teeth.
  • Cysts or tumors involving the wisdom teeth.
  • Wisdom teeth that damage nearby teeth.
  • Stopping future problems.

Extraction is done mostly as an outpatient procedure, so you'll likely go home the same day. The process includes:

  • Sedation or anesthesia. You may have local anesthesia, which numbs your mouth. You also may have sedation anesthesia, which lowers your awareness. Or you may be under general anesthesia, which makes you go to sleep.
  • Tooth removal. During an extraction, your dentist or oral surgeon makes a cut in your gums and takes out any bone that blocks access to the impacted tooth root. After taking out the tooth, the dentist or oral surgeon typically closes the wound.

Wisdom tooth extractions may cause some pain and bleeding, as well as swelling of the site or jaw. Some people have trouble opening their mouths wide for a short time due to swelling of the jaw muscles. You'll receive instructions on how to care for wounds and manage pain and swelling, such as taking pain medicine and using cold compresses to reduce swelling.

Much less commonly, some people may have:

  • Painful dry socket, which is exposure of bone if a blood clot doesn't form or comes out of the socket after surgery.
  • Infection in the socket from bacteria or trapped food particles.
  • Damage to nearby teeth, nerves, jawbone or sinuses.

妥善处理与支持

拔牙的想法可能令人害怕,但推迟治疗则会导致严重和永久性的问题。与牙医谈谈您的担心很重要。焦虑很常见,没必要感到尴尬。寻求牙医关于如何应对焦虑和不适的建议。

许多牙医都会提供缓解焦虑的方法,比如听音乐或看视频。您可以带上一名支持您的家人或朋友。您也可以学习放松技巧,比如深呼吸和想象。如果您有严重的焦虑,向牙医或口腔医生咨询可能有所帮助的药物或镇静方法。

准备您的预约

如果您出现的症状或其他牙齿问题表明您有阻生智齿,请尽快看牙医。

牙医可能会询问这些问题:

  • 您出现了什么症状?
  • 您何时开始出现症状?
  • 是否有任何因素(例如偏向口腔后方的咀嚼)会加重症状?
  • 在您刷牙或用牙线剔牙时有没有发现出血?
  • 您有什么样的典型牙齿清洁习惯?