Dentistry/impaction

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Question
Please take a look at this panaramic of my wisdom teeth. The two lower ones are erupted. One has a large amount of tooth loss/ cavities. The two upper ones have not erupted. But when I feel back there with my finger it feels like the upper ones are closer to erupting than they appear in the xrays. Because the gums feel close to the same level as the rest of my molars, and I feel something hard underneath them which has a toothlike feel.

I am 34 years old. My question is whether the wisdom teeth seem dangerously impacted. And is there a good chance that they will eventually erupt healthy?

I have images of the xrays taken. I could not attach them to this post, but please email me and I will send them.

Thanks for your time

Answer
Hi Noah and thanks for your question.

My email is doccwp@gmail.com, please attach the OPG X-ray so that I can advise you further. I will respond on this site again once I have received it. Take care.

Kind regards
Dr Craig Peck

Hi Noah, after examining the sections of the OPG which you kindly sent me (although the clarity has somewhat been lost along the way), in my opinion there is no need for concern. Your lower wisdom teeth have moved into good alignment and have erupted without further incident and would appear as if they are in stable occlusion with your upper molars. At the the age of 34, I feel there is little chance of your upper wisdom erupting anymore, although there does appear to sufficient room for them to do so distal of the 2nd molar. The angulation of the right one might well be prevented from erupting further due to its proximity and relation to the distal (back) part of the 2nd molar, being somewhat "locked-in" and preventing its further movement. I feel that, if after 34 years it has not been possible for them to erupt in a normal fashion yet, they are more likely to remain where they are and unless they are troubling you or so indicated by your clinician, I would suggest you leave them as is. Bare in mind also that there is a degree of enlargement that occurs with OPG's (up to 20%) and unless the quality of the X-ray is optimal, it is often very difficult to distinguish the soft tissue which radiographically less dense.

Another issue which I feel I should mention to you regarding your OPG, is the possibility that you may have some premature horizontal bone loss, which can be an indication of periodontal breakdown.  Don't get worried just yet, but I would like you to mention this to your dentist at your next appointment and I feel it would be worth doing a full 6-point perio charting of your pockets and using this as a baseline to evaluate the progression of any further breakdown. If this advances, then even consider a referral to see a periodontist to get this brought under control and managed effectively. But let your dentist assess the situation and advise you accordingly, just mentioned it for completion sake.

I hope this helps and wish you all the best further, take care.

Kind regards
Dr Craig Peck

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Dr Craig W Peck ( B.Med.Sc., B.Ch.D., Clin. Botox, Cosmet. Derm.)

Expertise

I am a General Dental Practitioner, with special interests in Cosmetic Dentistry & facial aesthetics and Periodontology, placing a strong emphasis on the establishment and maintenance of a healthy periodontium (the support structure of the tooth) before cosmetic options are considered. I uphold all principles of prevention above interventional treatment and try as far as possible, to remain conservative in my approach. I believe in detailed, open and honest patient discussion, establishing what the patients expectations are and what the reality is of achieving this and involving the patient at every level of the treatment. I have strong principles on ethical treatment and appropriate patient management. I have chosen to treat and rehabilitate many nervous and phobic patients, who, for whatever reason, find it impossible to take part in the very important task of even a routine check-up. I will accept questions relating to general and cosmetic dentistry (in conjunction with the use of facial cosmetic procedures) and dental fears/phobias. I will be more than willing to answer any academic questions in dentistry, biology, physiology, psychology and health sciences in general. As most dentists will tell you, there is often not only one way of dealing with a dental issue - so very often, there is no precise right and wrong way of approaching the problem. All clinicians vary when it comes to treatments and what works best in their hands is often the treatment that is advised. Be understanding of this and bear in mind that nothing lasts forever! Patients are happy to accept only a one-years warrantee when buying a new car, but seem to expect that dental work is going to last them their lifetime.

Experience

I have worked for many years in the UK and RSA as a general dental practitioner - within the NHS, private practice and the government dental health services. I am certificated for the administration of Botox and Dermal Fillers for facial lines and wrinkles as I have attended further courses in minimally invasive facial cosmetic procedures. I started seeing an increasing number of patients who presented with severe to moderate dental fears, even with full-blown phobias, so I started with the slow and patient task of tackling this problem and have successfully rehabilitated many patients. The key is good, effective, concise and understandable communication, shifting control from the dentist to the patient in order to slowly, but confidently, regain their trust back in dentistry, thereby giving them the feeling of achievement and this self-empowerment which drives them to the next level of treatment.

Organizations
Academy of General Dentistry. American Dental Education Association. IAPAM (International Association for Physicians in Aesthetic Medicine). Professional Speakers, Writers and Managements Consultants in Dentistry. The British Dental Association. UK Aesthetics Group. ARC - Aesthetic Professionals. Botox. Aesthetics & Beauty. American Association for Dental Research. FDI - World Dental Federation. SOURCE1uk. World Dental Hygiene Forum. ProDentalCPD. Public Health Dentistry. Dentist Network. LinkedIn. Who's Who of South Africa.

Education/Credentials
B.Med.Sc. Degree (Medical Physiology and Medical Virology; Physiology Cum Laude; Stell 1994). B.Ch.D. Degree (Bachelor of Dental Surgery; Clinical Dentistry Cum Laude; Stell 1997). CPR and CPR-Advanced Courses (2000/2001; UK). Clinical Botox (UK, 2001). Cosmetic Dermatology (Botox and Dermal Fillers; RSA 2011).

Awards and Honors
Placed on the Dean's List at University for academic achievement (1994). Highest achievement in the subject Dental Materials. Medal from 3M and the Radiology Association of South Africa for highest achievement in the subject Dental Radiology and Imaging. Medal from The Periodontal Association of South Africa for highest achievement in the subject Periodontology. Highest achievement for Oral Medicine. Highest achievement in Oral Pathology. Received the DASA (Dental Ass. of South Africa) Gold Medal for highest achieving dental student across the 5 1/2 years of the Degree. Passed the subject, Clinical Dentistry with distinction in final year.

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