Expert: Stephen J. Moss - 5/14/2004

Question
Dear Dr. Moss,
I greatly appreciate your response.  I am in between the metaphorical rock and a hard case in reference to my dental care.  In six weeks, I will be reporting to the U.S. Military Academy at West Point for Cadet Basic Training.  If I get any teeth pulled and develop a bad infection, West Point will turn me away.  They will not allow me to go through basic training with an oral infection.  I have already turned down acceptances from other colleges.  If West Point doesn't take me, then I will have nowhere to go to college in the fall.  Due to the absolutely huge effect this would have on my life, any risk of surgical complications is too much risk.  I simply can't afford the consequences. I find your advice so helpful because I can not follow the traditional advice of "pull them all", nor would I want to.  West Point also does not allow people to enroll if they have active orthodontic care.  That being said, I can receive treatment starting during my sophomore year.  My personal dentist said that I could easily wait a year before treatment.  The Army dentists reviewed my panoramic and bitewing radiographs along with my dental history.  They decided that I was qualified and did not need any dental procedures before I enrolled.  They do however know that the tooth is impacted and they will decide what to do in a year's time.  The upside of all of this is that money is no object.  The Army pays for everything.  The downside is that I have to work with whatever orthodontist they have on staff.  I can not get a second opinion or go to a different orthodontist.  This is why I am researching options over the internet. The dental staff will also outrank me which means that I am subject to whatever treatment they feel is best.  I apologize for the long post.  My question is, How can I convince them that extraction may not be the best option?  The Army does have practice guidelines for third molars.
The Army guidelines are lifted directly from "Parameters of Care-95" by the American Association of Oral and Maxillofacial Surgeons.  You may be familiar with these guidelines.  Unfortunately, they are binary.  The decision is to either pull the tooth or leave it alone.  How could I convince the Army dentists to consider an orthodontic option?

I thank you for your time, and I realize that this, unfortunately, may be a lost cause.

TK
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Followup To
Question -
My top two wisdom teeth are fully erupted and straight. Those two are fine. My lower right wisdom tooth is unerupted as of now, but, judging from a bitewing X-ray, my dentist said it will likely come in fine. My lower left wisdom tooth on the other hand will soon have a soft tissue mesial impaction. From what I can see, one small corner of the crown of that wisdom tooth is about to touch the neck of the second molar just below or at the gum line. This lower left wisdom tooth is partially erupted. (I helped it a little.  Maybe this was a bad idea.)My problem is not space. I have enough room in my mouth for 32 teeth, but this stupid one just decided to come in crooked. My dentist said there is a chance that this tooth will come in fine, but it isn't likely. My Dentist is acting like all four teeth need to be extracted.  Why should they remove three healthy, functional teeth because one of them is not right?  I do not want to have the tooth extracted, but I worry about developing pericoronitis because it is partially erupted.  I have a family history of SEVERE adverse reactions to anesthesia, but none of my relatives ever bothered to remember what they were allergic to.  I, personally, have never had a surgery. As of now, I have had no infections or inflammations around that lower left wisdom tooth. I'm doing a good job of removing food particles from the gum flap. My dentist didn't do a lot to explain any options beside extraction. I am wondering if there is anything that my dentist or I can do to help the tooth to come in straight. It's so close as it is, and the other three teeth are fine, so is there anyway to move it just a little? Braces, spacers, anything? I think a few degree shift would work wonders.

Your advice is politely solicited, and your time is appreciated,
TK

Answer -
TK
Stick with your instincts. You are quite correct, there is no reason to remove three good molar teeth. The tooth that appears to have difficulty coming into your mouth may be treatable by a simple orthodontic procedure, one where a small piece of copper wire is continuously tightened around the point of contact between the adjacent molar teeth. This eventually drives the posterior tooth backwards giving it room to erupt.
Keep trying to find someone to treat you, and don't get discouraged if an inflammation does develop around any of your molar teeth, inflammation can be treated and resolved quite easily.
Continue to ook for someone willing to work with you.
SJM

Answer
Tk,
relax, you have no acute problem. If you keep the area reasonably clean it should not bother you. If you do get a pericoronitis it might take an evening of vigorous mouth rinsing with hot salt water to make yourself feel better and the inflammation dissapear.
What I recommended can be done anytime by almost anyone. What  I have recommended  is not orthodontic therapy, and any pediatric or general dentist can thread a copper wire through the contact point and tighten it with a pliers, once or twice a month until the wire moves the teeth apart and the tooth erupts. Do it now, do it  in the next three years, there is no rush and no problem. You  dont need an orthodontist or orthodontic therapy.
A panoramic xray is quite crude and too often misenterpreted, the tooth is impacted yes  , but only slightly , and  obviously needs  no treatment.  A few years from now
show some helpful dentist my email and ask him to spend five minutes and run  a copper wire around the contact point and tighten it , tuck the end in, and  tighten again in a week or two ,repeat until the tooth erupts.

Go to school, forget about this it is not an acute, or a long term problem.
SJM