Third molars, wisdom teeth or wisdom teeth are the most common pathology in the maxillofacial surgeon’s office along with implant rehabilitation. Evolutionarily, wisdom teeth tend to disappear due to a readjustment in the relationship between the jaw bones and that is why on many occasions they do not erupt, or they do not completely erupt, being a source of pathology and therefore havin be extracted.

Indications for extraction include:

• because they cause an infectious pathology (pericoronitis): by not coming out completely and only a part of the crown erupts, it causes germs from the saliva to leak under the mucosa causing infections or causing decay of the wisdom tooth itself or what’s even worse, the anterior molar, which must be preserved at all costs.
• To complete an orthodontic treatment: either before starting orthodontic treatment, or during or at the end, it is advisable to remove these pieces to create space, avoid pressure on the anterior teeth or facilitate the eruption of other pieces.
• because they cause follicular cysts: the teeth are wrapped in a kind of sac until they erupt, in cases where they do not erupt, this sac can grow, just like a balloon that swells, causing bone resorption and thus weakening the rigidity of the jaw, making it much more susceptible to fracture with minor trauma.
• prevent them from pressing and crowding the teeth: There are theories that advocate the influence of the eruption of these pieces on the crowding of the teeth by a “push” effect, thus causing this situation.

For the extraction of wisdom teeth, it is not necessary to use general anesthesia or to perform surgery in a hospital operating room, not even in very complicated or “tilted” teeth. We perform the procedure under local anesthesia and minimize the incisions (most of the time they are not required) with a minimally invasive and fast surgical technique (in cases of complicated molars that require osteotomy and dividing the tooth it takes less than 15 minutes). This way, we achieve an outpatient treatment of the patient without the need for a postoperative period, thus reducing the stress and anxiety caused by a surgery of this type.

Sometimes, due to the proximity of the dental nerve to the molar roots, we perform a CBTC, a series of 3-dimensional images of the jaw bones that allow us to locate the exact path of the nerve and the proximity or lack of it with the molar, thus achieving greater safety during surgery for our patients and avoid aftereffects derived from damage to this nerve (for example, numbness of the lower lip)

For us, the SAFETY of our treatments is of utmost priority in order to AVOID COMPLICATIONS.

Wisdom teeth are not the only cause of problems when they do not erupt. The rest of the teeth can also be retained. The most problematic teeth are usually canines or fangs, in these cases we usually help them to erupt. It is also common to find that the incisors do not erupt because there is something that prevents it, in these cases it is usually due to supernumerary teeth (extra teeth) or mesiodens (extra abnormal tooth) or odontomas (amorphous dental tissue) that get in the way of the normal eruption teeth, requiring the removal these “obstacles” for a normal eruption.

Maxillary cysts are bone defects in relation to the teeth, they are like “balloons” that swell and cause bone resorption. The origin of these cysts can be diverse, of infectious origin, of genetic origin, of tumoral origin. The vast majority of them are benign, but it is necessary to intervene to avoid severe orofacial infections or weakening of the maxillary bones that make them more susceptible to pathological fractures.

Lesions in the oral mucosa can have many origins, the main ones being:

• Canker sores: they are sores or superficial ulcerations of the mucosa, painful and of benign nature and of unknown origin, although it is sometimes related to alterations in immunity and stress, its treatment is conservative
• Traumatic ulcers: they are common and related to rubbing of prosthetics, decaying teeth or fixed teeth against them. A differential diagnosis must be made with cancerous lesions that may have a similar appearance. Treatment consists of correcting the factor that causes them and the prognosis is very positive.
• White lesions: or leukoplakia, they can be fungal in origin (candidiasis or thrush) or due to hyperplasia of the most superficial layers of the mucosa. They are benign, although a biopsy is advisable to typify the lesion since in very rare cases they can become malignant.
• Blistering lesions and lichens: they are autoimmune and benign lesions. A biopsy is also advisable to establish the diagnosis and follow-up. Treatment is conservative.
• Mucoceles: they are bumps, usually on the lips, although it can also be in any part of the oral mucosa, which are caused by the lack of normal emptying of some minor salivary glands in the oral mucosa, which we have thousands of. Their treatment can be conservative, and if it does not remit, they are removed under local anesthesia.
• Fibroids, epulis, mucous lips …: they are thickening of the mucosa (such as calluses) normally caused by friction, suction, or poorly fitting dentures. They are easily removed under local anesthesia.
• Premalignant lesions: these are lesions in the mucosa that predispose to the appearance of cancer cells, especially if there are external factors such as smoking and consumption of alcohol. They must be diagnosed with a biopsy and treated surgically, removing them in early stages and thus avoiding the development of oral cancer.
• Cancer lesions: these are malignant tumors of the oral mucosa that sometimes resemble benign ulcers or other oral lesions. It is very important to establish an early diagnosis to be able to carry out an early treatment, thus improving survival, avoiding relapses and minimizing the aftereffects of the treatment they require. Treatment usually consists of surgery and is sometimes accompanied with cleaning of the cervical nodes and reconstruction of the defect that is generated after removal.

Los frenillos ocasionan problemas cuando son cortos, o bien se interponen entre los dientes o

Frenulum cause problems when they are short, they get in between the teeth or they pull on the mucosa causing recessions in the gums.

The short lingual frenulum causes a deficit in the mobility of the tongue that causes problems with sucking among newborns and difficulty in pronouncing certain consonants such as R among young children. Treatment must be early to allow full mobility of the tongue and thus correct articulation of the words. Sometimes the assistance of a speech therapist is needed to exercise mobility. Other times they need to be treated for orthodontic treatment.

The upper lip frenulum sometimes hardens and forms a fibrous cord that gets between the central incisors causing a diastema (separated teeth).

Treatment of these frenula should not be to give them a cut and a point, since the recurrence is almost guaranteed, on the contrary, it is necessary to perform plasty and lengthening techniques to ensure that it does not recur.