hey it's Dr Amanda with straight smile Solutions straightsmilesolutions.com and today we're going
to talk about when do we need to intervene with second molars especially or we call these sevens
in some other countries um in the US you're talking about teeth number two 15 18 and 31.
when do we need to intervene when is it a problem and this comes up fairly commonly when I work with
my clients especially my general and pediatric dentist clients they're taking perhaps a phase
two or a comprehensive Ortho case maybe for Invisalign and I'm like whoa you know pump the
brakes you know we're screening this this patient and we're looking and I said are you looking at
the panel and I'm not specifically talking about this panel but you know I always say all right
are you prepared this is this tooth might get stuck are you prepared to do an explosion Bond
um are you prepared to intervene are you prepared to go back and do sectional braces do a lower
braces do you know how to do say a Halterman Appliance and they're like no um so ligation and
issues with second molars is not the greatest for aligners I mean that's one of those rare things
where I mean I tell you guys you can do anything with Invisalign pretty much except except that
so that's one of the only things and I I have done a case and I've done some funny things with
cantilevers there's no way you guys are going to be able to learn how to do that that's something
you absolutely have to do in Ortho residency and it's even the stuff I don't even like to do but I
know how to do it because I went to University of Connecticut which is totally all about
biomechanics cantilevers intrusion arches and we learned how to bend funky stuff you know and how
to do moments and it's not even like a step bend in a wire I mean it's it's complicated and I don't
it's such a one-off at this point that I don't see any reason that a general or pediatric dentist
would need to train for that because it's such a one-off especially if you do early intervention
and you screening for phase one and you're doing what you need to do to prevent these things from
happening in an older patient so and here the beauty is you guys can always refer these Patients
Out please do refer them out to Ortho you know it's beyond the scope of what you can do so don't
take these cases unless you're prepared to take them all the way to the end if you're accepting
this d8080d8090 case you know comprehensive or phase two Ortho you're accepting all the issues
that come including this the impact is second molar so you need to screen them appropriately
and you know a good orthodontist with a lot of experience is going to be able to look at a panel
on a 10 year old and be like this this might become a problem in two years you know or an
11 year old it's not a problem yet we're going to put it on a watch we're going to do a few things
but we're prepared to go in and switch to braces when it happens so so when do I think something's
a problem well first thing I always recommend is just like you learn in dental school whenever
you're screening radiographs is you're looking at symmetry right so if let's say for example and I
I'm sorry I don't have the best x-ray here I mean I had to get one that had a release on it and I
didn't have one that was like really funky I see them all the time but you know if you see number
two or the upper right seven fully erupted and the left one is doing some funny things
well that's a problem anytime there's symmetry issues with symmetry same thing on the bottom
impactions most commonly happen on the lower and one of the easiest ways to intervene is to remove
the eights or the third molars even if the patient is 12. you know there's always an oral surgeon
who will do it and I know it's not normal to take third molars out if the patient is very young but
if you have a reason behind it they will you know they definitely will you don't have to all four
that's a major search they could just take out one and there's no reason they need to be sedated
for that it's a minor minor minor surgery and you know when it's a little ball right here it's well
these these would be big surgery right because they're way up but I'm talking about lowers when
it's a little ball it's pretty easy for them to do a mild incision and just pluck that sucker out
so what's the easiest thing you can do I also have a lot of other simple Interventional techniques if
you want to watch my other videos on second molar tricks and tips you can go into my YouTube channel
which is straight smile Solutions put in the keyword second molar or sevens and it should come
up impacted second ruler and you can I have like a spacer Technique we talk about the Halterman
Appliance there's a lot of stuff that you can do to intervene but that's the main thing just
look for symmetry obviously you're looking for teeth that are angulated measly that's a concern
whenever they're angulated measly once they get up over the height of Contour we're usually free and
clear so there's there's but there's definitely some things you can do obviously if you're doing
phase one if you're expanding The Arches to the right size when the when they're supposed to be
expanded not waiting until they're older but when they're little that gives more space so
that things don't get so bunched up you know and they're more likely to get around that height of
contour and to Upright themselves so do keep your eye on those intervene as needed take out
AIDS and keep in mind if it's crazy impacted occasionally you'll find one that's just like
horizontally angulated like 90 degree angle that's probably going to be very difficult to upright and
it may not happen successfully so sometimes in those cases before that tooth is fully developed
we're going to go ahead and Chuck out that second molar we're going to leave the third molar and
we're just going to hope and pray that it develops correctly and just kind of drips into place keep
in mind that that's a little bit of a confusing situation so if you do decide to do that first
of all I really don't want you guys as general and pediatric dentist to be pulling the plug on that
I don't want you guys making that decision I'd rather an orthodontist and oral surgeon make that
decision together I just don't think you guys have the experience to make that decision but you know
if you decide to make that decision and pull the second molar out at an early stage be it you know
age 9 10 11. you see one that's just going to be real bad and hope and pray that that thermolar is
going to develop you know vertically and or drift into place it may or may not happen usually it's
going to need a little bit of assistance from Ortho keep in mind by the time that third molar
erupts patient's going to be probably 16 17 18 19. so this may not be something that you're doing in
your regular comprehensive phase two braces right it just may it may not be so it might be something
they're gonna have to have another unit of braces later in life which is in different expense for
the additional expense for the family you know and that's something you need to let them know
so if you're not going to be treating them to the point of uprighting that thermalar as needed
or assisting it to come into place if it's even possible then you need to make sure the family
knows that so that they can plan accordingly and they can decide do they even want to do this phase
of braces now or do they want to wait until the child is older so that they can handle all the
problems at once but again again you can never make any guarantees with these things so just
keep that in mind all right hopefully that was helpful I know this was a lot of vague information
but I just feel like so many times docs are taking cases you know with 10 11 12 13 year
olds without realizing that they're responsible for all of the teeth that are coming in from seven
to seven so don't take the case unless you're prepared to handle all the issues that may come
up so it's always better to run your cases by an orthodontist first all right thanks so much