Wisdom Teeth (impacted)
How common is it in CdLS to have wisdom teeth impacted? My son’s dental surgeon wants to schedule surgery to have his wisdom teeth and other teeth removed. All of these teeth are impacted. Two of the front teeth have not come out of the gums. The surgeon stated that they may have to break my son’s jaw to remove the teeth. Is this common practice? Is there anything that you would recommend for the surgeon?
It is quite common to find the need for the removal of the permanent third molars in our patients with CdLS. One of the constant findings within this syndrome is a rather small mouth. The maxilla and mandible are extremely small and cause extensive crowding of the teeth and orthodontic problems. The third molars just do not have any room to erupt and often become impacted. Research tells us that if these teeth are left to sit within the jaw bone for a long time, there is a high chance that they will form cysts and destroy the bone around them. Therefore, oral surgeons recommend the removal at around 16 to 22 years of age.
If the front two central teeth are not erupted through the gums, but they are through the bone, then performing a gingivectomy, or the removal of the offending gums, will allow those teeth to be seen and become functional. At age 20, if they are still impacted within the bone, then they will probably need to be removed. Difficult to say what is the best solution without seeing the patient or x-rays, but this is exactly what oral surgeons are experts in and I am sure your surgeon understands the problems at hand and can explain their rationale rather easily.
The plan to break the jaw to remove the third molars (wisdom teeth) is probably due to a very restricted or limited jaw opening. I might think about whether that drastic a measure would be in the best interest of the patient. Having to recover from the removal of the wisdom teeth is difficult enough, but a broken jaw on top of that might be a lot. The oral surgeon might have meant that in the process of removing the wisdom teeth, the jaw may break. This is a common statement that is part of the informed consent when preparing patients for the surgery.
It rarely happens, but with the difficulties associated with CdLS, a fracture could occur. If the third molars and the front teeth have elicited pain or repeated infections, then there is no other choice to be made but to have them removed.
RM/ TK 7-13-10
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