What are the signs of a ruptured appendix. How is a perforated appendix diagnosed. What complications can arise from a burst appendix. When should you seek medical attention for appendix pain. How is a ruptured appendix treated.

Understanding Appendicitis and Its Progression

Appendicitis is a condition characterized by inflammation of the appendix, a small pouch attached to the large intestine. This inflammation can occur when an abdominal infection spreads to the appendix or when an obstruction blocks the appendiceal lumen. If left untreated, appendicitis can progress to a more serious condition known as a ruptured or perforated appendix.

A ruptured appendix occurs when the inflamed appendix develops a small tear, allowing its contents to leak into the abdominal cavity. This can lead to severe complications such as peritonitis (inflammation of the abdominal lining) or septicemia (blood infection).

Key Facts About Appendicitis:

• Appendicitis typically begins with sharp pain near the navel that localizes to the lower right abdomen.
• Other symptoms include nausea, vomiting, constipation, and fever.
• Standard treatment is an appendectomy (surgical removal of the appendix).
• If not treated within 24 to 72 hours, the appendix may rupture.

Recognizing the Symptoms of a Ruptured Appendix

Identifying the symptoms of a ruptured appendix is crucial for seeking timely medical attention. While the initial pain of appendicitis may subside briefly after rupture, other symptoms quickly emerge.

Common Symptoms of a Ruptured Appendix:

• Pain in the lower right abdomen
• High fever and chills
• Nausea and vomiting
• Loss of appetite
• Abdominal swelling
• Feeling of rectal fullness
• Weakness and confusion

Can the symptoms of a ruptured appendix be mistaken for other conditions? Yes, the symptoms of a ruptured appendix can sometimes be confused with other abdominal issues. This is why it’s essential to seek medical attention if you experience persistent abdominal pain, especially if it’s accompanied by fever and other symptoms listed above.

Complications Associated with a Perforated Appendix

A ruptured appendix can lead to several serious complications if not treated promptly. Understanding these potential risks highlights the importance of early intervention.

Major Complications Include:

1. Abscesses: Pus-filled pockets that form around the ruptured appendix
2. Peritonitis: Inflammation of the peritoneum, the lining of the abdominal cavity
3. Septicemia: A serious blood infection that can lead to sepsis
4. Septic shock: A life-threatening condition causing severely low blood pressure and organ failure

How quickly can complications develop after an appendix ruptures? Complications can develop rapidly after an appendix ruptures, sometimes within hours. This is why immediate medical attention is crucial if a ruptured appendix is suspected.

Diagnosis and Treatment Options for a Ruptured Appendix

Diagnosing a ruptured appendix typically involves a combination of physical examination, medical history review, and diagnostic tests such as CT scans or ultrasounds. Once diagnosed, treatment is necessary to prevent further complications.

Treatment Approaches:

• Immediate surgery (appendectomy) to remove the ruptured appendix
• Cleaning of the abdominal cavity to prevent infection spread
• Administration of strong antibiotics
• In some cases, drainage of abscesses before surgery

Is surgery always necessary for a ruptured appendix? In most cases, surgery is required to remove the ruptured appendix and clean the abdominal cavity. However, in some instances, doctors may attempt to treat the infection with antibiotics and drainage before proceeding with surgery.

The Debate: Early vs. Delayed Appendectomy

The timing of surgery for a ruptured appendix has been a subject of debate in the medical community. While immediate removal of the appendix has been the standard approach, some research suggests that a delayed appendectomy might be beneficial in certain cases.

Factors Considered in the Debate:

• Presence of abscesses and their impact on surgical complications
• Recovery time and postoperative complications
• Patient’s overall health condition
• Availability of resources and expertise

What does current research say about early vs. delayed appendectomy? A research review published in the Cochrane Database suggests that more high-quality data is needed to definitively determine the benefits or harms of early versus delayed appendectomy in cases of complicated appendicitis. The review noted that it was unclear whether early appendectomy prevents complications compared to delayed appendectomy.

Prevention and Risk Factors for Appendicitis

While it’s not always possible to prevent appendicitis, understanding risk factors and maintaining good overall health can potentially reduce the likelihood of developing this condition.

Risk Factors for Appendicitis:

• Age: Most common between 10 and 30 years old
• Family history of appendicitis
• Low-fiber diet
• Gastrointestinal infections

How can one reduce the risk of developing appendicitis? While there’s no guaranteed way to prevent appendicitis, maintaining a healthy diet rich in fiber, staying hydrated, and practicing good hygiene to avoid gastrointestinal infections may help reduce the risk.

Long-term Outlook and Recovery After a Ruptured Appendix

Recovery from a ruptured appendix can be more complex and prolonged compared to uncomplicated appendicitis. The long-term outlook depends on various factors, including the severity of the rupture, the presence of complications, and the timeliness of treatment.

Factors Affecting Recovery:

• Extent of infection spread in the abdominal cavity
• Development of complications like abscesses or sepsis
• Patient’s overall health and immune system function
• Adherence to post-operative care instructions

What is the typical recovery time after surgery for a ruptured appendix? Recovery time can vary significantly, ranging from a few weeks to several months. Patients who undergo surgery for a ruptured appendix typically require a longer hospital stay and recovery period compared to those with uncomplicated appendicitis.

Advancements in Appendicitis Treatment and Research

Medical research continues to explore new approaches to diagnosing and treating appendicitis, aiming to improve outcomes and reduce complications associated with ruptured appendices.

Recent Advancements and Areas of Research:

• Improved imaging techniques for more accurate diagnosis
• Minimally invasive surgical procedures
• Antibiotic therapy as an alternative to surgery in select cases
• Biomarkers for early detection of appendicitis

Are there any promising non-surgical treatments for appendicitis on the horizon? Some research is exploring the use of antibiotics as a primary treatment for uncomplicated appendicitis in certain patients. While this approach shows promise, it’s still under investigation and not suitable for all cases, particularly those involving a ruptured appendix.

Understanding the causes, symptoms, and treatment options for a ruptured appendix is crucial for recognizing this potentially life-threatening condition. While appendicitis and its complications can be serious, prompt medical attention and appropriate treatment can lead to successful outcomes. As research continues to advance our understanding of appendicitis and its management, we may see improved diagnostic tools and treatment options in the future, potentially reducing the incidence of ruptured appendices and their associated complications.

It’s important to remember that any persistent abdominal pain, especially when accompanied by fever and other symptoms of appendicitis, should be evaluated by a healthcare professional. Early detection and treatment remain the best approach to preventing the serious complications associated with a ruptured appendix.

What Is a Ruptured Appendix? Causes, Treatment, and Complications

Your appendix can become inflamed and filled with pus (a fluid made up of dead cells and bacteria) if an abdominal infection spreads to the organ, or if an obstruction (stool) blocks the area inside of your appendix called the appendiceal lumen, or appendix lumen. (1,2)

This condition, known as appendicitis, is marked by sharp pain that begins near the navel and then localizes over time to the lower right abdomen, where the appendix is located. The pain gets worse with movement, deep breaths, coughing, and sneezing.

Other appendicitis symptoms include:

• Nausea
• Vomiting
• Constipation
• Diarrhea
• Inability to pass gas
• Loss of appetite
• Fever
• Chills
• Abdominal swelling

The standard treatment for appendicitis is an appendectomy, a surgical procedure to remove the appendix.

Complications of a Ruptured Appendix

Sepsis Symptoms and Diagnosis

But if doctors don’t remove the appendix quickly — usually within 24 to 72 hours after symptoms begin — the organ may rupture, or burst. (3) The result is a “perforated appendix.” It hasn’t popped like a balloon, but rather the appendix develops a small tear, which allows its contents to leak out into the rest of the abdomen and potentially cause other complications such as peritonitis, a severe inflammation of the intestinal lining, or a serious blood infection called septicemia.

Perforation is found in about 13 to 20 percent of patients who have symptoms of appendicitis. (4) Children younger than 5 have a higher risk of perforation because they may not be able to describe and talk about their symptoms as clearly as older children and adults. (3)

The Symptoms and Dangers of a Ruptured Appendix

More on Symptoms of a Ruptured Appendix

10 Essential Facts About Fevers

When your appendix ruptures, you may start to feel better as the appendix pain you originally had subsides.

But this generally doesn’t last long, because a perforated appendix can quickly lead to other health issues.

Pus-filled abscesses may develop around your appendix. Scar tissue and other abdominal structures will “wall off” the abscessed appendix and the seepage, preventing the infection from spreading. A ruptured appendix can be a serious emergency and the patient should seek medical attention immediately.

If you have an abscessed appendix, you may experience symptoms similar to appendicitis, including: (5)

• Pain in your lower right abdomen
• Diarrhea
• Lack of appetite
• Nausea
• Vomiting
• Fever
• Chills

You may also experience other symptoms not typically associated with appendicitis, such as weakness, chills, high fever, and a feeling of rectal fullness.

Additionally, the infected contents that have seeped out of your appendix may cause peritonitis, which is an infection of the peritoneum, the silk-like membrane that lines the abdominal cavity. (6)

The inflammation and pain can spread throughout your abdomen, and become worse with any kind of movement. Other symptoms of peritonitis can include:

• Decreased appetite
• Fever
• Nausea
• Extreme thirst
• Vomiting
• Chills
• Confusion
• Rapid breathing
• Urinating less than normal or not at all

Treatment Options for a Ruptured Appendix

In most cases of peritonitis, a surgeon will remove your appendix immediately and clean the inside of your abdomen to prevent infection.

Doctors sometimes try to treat the abscess or peritonitis with antibiotics and drainage before conducting an appendectomy. When an abscess is present, there’s a higher complication rate with surgery, so your doctor may try to resolve the abscess first if possible. (3)

Treatments usually involve draining any pus from the abdomen and fighting the infection with strong antibiotics for several weeks. (7) But some research suggests that immediately removing the ruptured appendix results in quicker recovery and fewer postoperative complications, particularly in children.

A research review published in the Cochrane Database compared early versus delayed appendectomy in cases of complicated appendicitis. (8) The review authors note that it was unclear whether early appendectomy prevents complications when compared with delayed appendectomy in these kinds of patients. They concluded that more and better-quality data — concerning length of hospital stay and health-related quality of life outcomes — is needed to determine what benefits or harms there might be in early versus delayed appendectomy.

A ruptured appendix can actually lead to death in some cases. If left untreated, peritonitis can quickly spread, resulting in septicemia, or bacteria in the blood. Your body releases chemicals into the bloodstream to fight this infection, triggering an inflammatory response throughout the body called sepsis. A cascade of reactions will follow, which can eventually lead to septic shock, which may cause severely low blood pressure and organ failure and death.

Additional reporting by Deborah Shapiro.

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Causes, Symptoms, Recovery, and Survival

Untreated appendicitis may cause your appendix to rupture (burst), resulting in an infection. Symptoms associated with a ruptured appendix include severe abdominal pain, fever, chills, and weakness.

Appendicitis is inflammation of the appendix. This small, thin, finger-shaped sac is located on the lower right side of your abdomen, where your small and large intestines connect. Most doctors think the appendix doesn’t have an important function and can be removed without causing harmful effects.

If your appendicitis is left untreated, your appendix can rupture (burst). When this happens, bacteria get released into your abdomen and can cause a serious infection.

A ruptured appendix, also known as a perforated appendix, can make you very sick and is sometimes hard to treat.

The risk of rupture increases the longer that appendicitis treatment is delayed. The risk is about 2% 36 hours after symptoms start. After that, the risk increases by about 5% every 12 hours.

The biggest risk factor for a ruptured appendix is delaying treatment for appendicitis. The longer you wait to address your symptoms, the higher your risk.

According to a 2018 literature review, younger children are more likely to have a ruptured appendix than older children. This is because they have more trouble explaining their appendicitis symptoms to others.

The exact cause of appendicitis is unknown, but experts think an infection triggers inflammation inside the appendix.

For instance, If something blocks the opening of the appendix, an infection can follow. Bacteria can get trapped inside the appendix and multiply quickly, causing appendicitis. Viruses, parasites, and stool buildup may cause the blockages and infections that result in appendicitis. Inflammatory bowel disease (IBD) is another possible cause of appendicitis.

When appendicitis isn’t treated promptly and correctly, bacteria or pus build up. As this happens, pressure increases and the appendix swells. Eventually, it swells so much that the blood supply to part of the appendix gets cut off. That part of the appendix wall dies, and a hole or tear develops in the dead wall. The high pressure pushes the bacteria and pus into the abdominal cavity.

A ruptured appendix usually oozes or leaks into the abdomen instead of bursting like a balloon.

Risk factors for appendicitis

Appendicitis can happen at any age, but it often affects children and teens between the ages of 10 and 20 years. It’s more common in people who were assigned male at birth.

Having other family members with appendicitis can increase your risk too. Children with cystic fibrosis are also more likely to have appendicitis.

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Appendicitis symptoms can be similar to those of other conditions that affect the abdomen, such as a stomach virus or an ovarian cyst. For this reason, it can be hard to tell if you have appendicitis.

The classic symptoms of appendicitis are pain starting around the belly button and then vomiting. Several hours later, the pain moves to the lower right abdomen.

If you have these symptoms and think it might be appendicitis, seek medical attention as soon as possible. Quick treatment is essential to avoid a rupture.

Other symptoms of appendicitis include:

• abdominal pain that may start in the upper or middle abdomen but usually settles in the lower right abdomen
• abdominal pain that increases when you walk, stand, jump, cough, or sneeze
• a bloated or swollen abdomen
• tenderness when you push on your abdomen, which may get worse when you quickly stop pressing on it
• an inability to pass gas
• fever
• nausea along with vomiting
• decreased appetite
• constipation or diarrhea

Keep in mind that not everyone who gets appendicitis has these classic symptoms. It’s common for kids and older adults to have more unusual symptoms.

In babies and children, the pain is often spread out all over the abdomen. Caregivers should look for pain that starts around the child’s belly button and moves to the right side, along with appetite loss and fever.

In older people, the abdomen may be less tender, and pain may be less severe.

Appendicitis inflames the appendix and causes it to swell. Without treatment, the pressure eventually reaches the point where the appendix bursts. This can happen as quickly as 48 to 72 hours after your symptoms start.

Once your appendix ruptures, you may have a variety of symptoms. At first, you may feel better for a few hours because the high pressure in your appendix is gone, along with your original symptoms.

Peritonitis

When bacteria leave the intestine and enter the abdominal cavity, the lining of your abdominal cavity becomes inflamed. This condition is called peritonitis.

Peritonitis can be very serious and very painful. It requires immediate treatment.

The symptoms of peritonitis are similar to those of appendicitis, except:

• the pain is in your whole abdomen
• the pain is constant and more severe
• your fever is often higher
• your breathing and heart rate may be fast because of fever, infection, or severe pain
• you may have other symptoms, including chills, weakness, and confusion

Abscess

When you have an infection in your abdomen, the surrounding tissues sometimes try to wall off the infection from the rest of your abdomen. The wall forms an abscess, a closed-off collection of bacteria and pus.

Symptoms of an abscess are also similar to those of appendicitis, except:

• the pain may be in one area (but not always the lower right abdomen), or it may be in your entire abdomen
• the pain can be either a dull ache or sharp and stabbing
• the fever doesn’t go away, even when you take antibiotics
• you may have other symptoms, such as chills and weakness

Sepsis

When left untreated, the bacteria from a ruptured appendix can enter your bloodstream, causing a serious condition called sepsis. Sepsis is inflammation throughout your entire body.

Symptoms of sepsis include:

• fever or a low temperature
• fast heartbeat and breathing
• chills
• weakness
• confusion
• low blood pressure

The treatment for a ruptured appendix is to remove your appendix with surgery.

Doctors sometimes wait to perform surgery on a child who isn’t in any immediate danger. The surgeon will drain infected fluid from the abdomen, have the child take antibiotics, and remove the appendix later. The name for delayed surgery is interval appendectomy.

Peritonitis

The treatment for peritonitis is to clean bacteria out of the abdomen during surgery.

You’ll usually get antibiotics through a vein, at least for the first few days. You may need to receive hospital treatment for 10 to 14 days to ensure the infection is gone.

Abscess

Often, your appendix will be removed right away. If there’s a large abscess, your doctor might want to drain it before surgery. A tube inserted into the abscess lets the bacteria- and pus-filled fluid drain out.

This process can take several weeks. You might go home with the drain in place, and you’ll need to take antibiotics while the drain stays in place.

Once the abscess is drained and the infection and inflammation are controlled, your doctor will perform your surgery.

Sepsis

Antibiotics are the main treatment for sepsis. It’s important to start taking these medications as soon as possible, because the infection is life threatening if left untreated.

Duration of treatment may vary, but shorter treatment courses are generally preferred, according to a 2020 study.

You’ll need to take antibiotics once your ruptured appendix is removed or a drain is put into an abscess. You’ll typically take antibiotics before, during, and after surgery.

The length of antibiotic treatment will vary. Your surgeon will analyze your case to determine the best plan for you.

One 2021 study recommended that postsurgical antibiotic treatment be limited to 3 to 6 days.

Open surgery (instead of minimally invasive laparoscopic surgery) is typically used for a ruptured appendix. It helps your doctor ensure all of the infection is cleaned out.

After surgery, you’ll need to keep the incision clean and dry. Avoid taking a bath or shower until your doctor says it’s fine to do so.

It can take up to 6 weeks to fully recover from open surgery. Try not to lift anything heavy or participate in sports or other strenuous activities during this time. Your recovery will take longer if you have a drain inserted and shorter if you have a laparoscopic procedure.

You may take strong prescription pain medication for a few days after surgery or after a drain is placed. After that, you can usually manage the pain with over-the-counter (OTC) medications such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol).

Your doctor may encourage you to get up and walk as soon as possible after surgery. You may have to adjust your diet and eat smaller meals while you heal.

You should be able to return to work or school around 1 week after surgery, depending on how you feel.

Considerations for children

A child whose appendix has ruptured may need to stay in the hospital for 1 week or so.

A 2022 study recommended that children who’d undergone laparoscopic surgery and had a normal white blood cell count discontinue antibiotics at the time of their hospital discharge.

Others may come home with a special tube called a peripherally inserted central catheter (PICC line) so they can get antibiotics through a vein at home.

Kids should stay on a liquid diet for a couple of days after surgery. They should wait until they have their follow-up visit with the surgeon, and get the surgeon’s approval, before going back to their regular activities. This could take up to 3 weeks.

Without quick treatment, a ruptured appendix is a life threatening condition.

When the appendix hasn’t perforated, the risk of death is under 1% according to a 2020 literature review. The risk can be as high as 5% if the appendix has perforated.

Treating a ruptured appendix increases the odds of survival.

If you get medical attention right away for appendicitis, you have a better chance of fully recovering if your appendix ruptures. That’s why it’s important to see a doctor if you have any symptoms of appendicitis.

There’s no way of knowing when or if appendicitis will happen, so you can’t prevent it. However, you can avoid a rupture if you get immediate treatment.

The key is to know the symptoms of appendicitis. If you have any abdominal pain combined with nausea or other symptoms, get medical help immediately.

See a healthcare professional even if you’re unsure if your symptoms are appendicitis. It’s better to find out that you don’t have appendicitis than to wait and have your appendix rupture.

Acute appendicitis

Acute appendicitis is an acute inflammation of the appendix (vermiform appendix of the caecum), requiring urgent surgical treatment, one of the most common inflammatory diseases of the abdominal organs.

What is the “appendix” and why does it become inflamed?

The appendix arises from the lower end of the caecum (the beginning of the large intestine). It is believed that the appendix is ​​one of the links of the immune system, since the mucous membrane of the appendix is ​​rich in lymphoid tissue. It is generally accepted that inflammation of the appendix may occur due to blockage of the appendix lumen by enlarged lymphoid tissue, fecal stones (hard stools resulting from chronic constipation), a foreign body, and sometimes helminths. Blockage leads to expansion of the appendix cavity, the rapid development of infection and inflammation. However, the exact cause of this common disease is not clear.

Symptoms of acute appendicitis

Manifestations of acute appendicitis depend on the location of the appendix, the time elapsed from the onset of the disease, the severity of the inflammatory process in the appendix and the involvement of nearby organs and peritoneum, as well as the age of the patient and the presence of concomitant diseases.

Since the appendix is ​​a mobile organ, its inflammation can mimic almost any disease. In some cases, doctors have difficulty in making a diagnosis, since the main symptom of appendicitis – pain – can occur not only in the right lower abdomen, where it should be located according to the anatomy of the caecum, but also in the navel, in the groin, above the pubis , in the lower back, in the right hypochondrium and disguised as diseases of the liver, kidneys, female genital organs.

As a rule, the disease begins with the appearance of pain in the upper abdomen, which gradually increases, moves to the right iliac region (right lower quadrant of the abdomen). The pain is aggravated by coughing and movement. Usually there is a subfebrile body temperature of 37.2-37.5 ° C. Examination of the abdomen reveals involuntary tension of the muscles of the anterior abdominal wall and pain in the right iliac region. The pain is constant and may be accompanied by nausea and sometimes vomiting. There is often loss of appetite and refusal to eat, as well as stool retention caused by restriction of intestinal motility due to inflammation spreading through the peritoneum.

Unfortunately, these classic signs of appendicitis are observed in just over half of patients with acute appendicitis. The pain may not have a clear localization, especially in children under 3 years of age. In elderly and senile patients, reduced reactivity of the body, connective tissue replacement of all layers of the appendix wall and its blood vessels contribute to poor symptoms of acute appendicitis and a large number of complicated forms. In pregnant women in the second and third trimesters, a uterine appendix may cause an atypical clinical picture. Therefore, so often patients with acute appendicitis come to the emergency surgery department already with complications (perforation of the appendix, peritonitis).

What is “phlegmonous” and “gangrenous” appendicitis?

If the patient’s symptoms of appendicitis are mild, but, nevertheless, the inflammatory process develops (the pain is not very strong, there is no nausea and vomiting), he is in no hurry to seek medical help, and then catarrhal appendicitis turns into a phlegmonous form. The appendix fills with pus and ulcerates. Inflammation begins to spread to the surrounding tissues: the walls of the intestine, the peritoneum. The pain becomes more pronounced, aggravated by the tension of the abdominal muscles; in thin people, the inflamed process can be felt as a dense roller.

Phlegmonous appendicitis can turn into a gangrenous form, when the inflammatory process develops already in the abdominal cavity. With gangrenous appendicitis, there is a decrease or complete absence of pain associated with the death of the nerve endings of the appendix, but signs of general intoxication, deterioration of the general condition: weakness , pallor, bloating. If at this stage the patient is not helped, the patient’s life is at risk due to the development of peritonitis.

How is appendicitis diagnosed?

If acute appendicitis is suspected, the patient must be urgently admitted to a surgical hospital. In the EMC Surgical Clinic, emergency operations are performed around the clock for acute appendicitis and its complications.

At the stage before hospitalization, even in the presence of a pronounced pain syndrome, one should not take painkillers, as this may complicate the diagnosis of the disease. You should also not use antibiotics, as this can blur the picture with the further development of complications (perforation of the process, diffuse peritonitis).

Diagnosis begins with a thorough questioning and examination, as well as taking a blood test (a complete blood count usually reflects inflammation – an increase in the number of leukocytes, leukocytosis occurs). In the classic course of acute appendicitis (high temperature and pain in the right iliac region from tolerable to very strong), the diagnosis is not difficult. For patients with questionable or unclear symptoms, doctors may order an abdominal and pelvic ultrasound and/or computed tomography when admitted to the hospital.

In some cases, a diagnostic Laparoscopy can be performed, a diagnostic procedure in which a thin fiber optic tube with a camera is inserted into the abdominal cavity through a small opening in the abdominal wall. Laparoscopy allows you to see the appendix and other organs of the abdominal cavity and pelvis and assess their condition.

Acute Appendicitis Emergency

Surgery to remove an appendix (inflamed appendix) is called an “appendectomy” in which the inflamed appendix is ​​removed.

In the presence of perforation (rupture) of the appendix, the surgical intervention becomes technically more difficult to perform. There is a need for a thorough “washing” of the abdominal cavity from pus. Consequently, both the operation itself and recovery can be delayed.

Removal of the appendix is ​​preceded by intravenous antibiotics to prevent complications. If there is a perforation of the appendix, antibiotic treatment continues until the blood tests normalize (approximately 5-7 days). The question of the abolition of antibiotics is decided by the attending physician.

Laparoscopic Appendectomy

As a general rule, in EMC, most of the surgical interventions for acute appendicitis, even in the case of severe forms of the disease, are performed laparoscopically, which guarantees a minimum of pain and a shorter recovery period. In uncomplicated appendicitis, if the appendix has not been perforated, the patient is usually discharged the next day. Patients with a perforated appendix may stay in the clinic longer (up to 7 days), especially if peritonitis has developed.

However, there are some cases where traditional open surgery (open appendectomy) is preferred.

With timely surgical intervention, recovery occurs quickly.

Wisdom teeth – malocclusion and eruption

Alexander Spesivtsev
orthodontist, clinical director Star Smile

Do we need wisdom teeth?

I use a single compound word. In biology, there is such a concept0062 RUDIMENT – a part of the human body that has lost its function in the process of evolution. The most famous rudiment is the vermiform appendix of the intestine or appendix. So – a large number of doctors and people believe that there is nothing superfluous in the body and wisdom teeth can serve a person at an older age, when the main teeth are lost and the doctor can use figure eights to install, for example, a bridge prosthesis.

Unfortunately, in most cases this is impossible and even wrong!

Most people simply don’t have room for their eighth teeth in their jaws, and mother nature will start mocking them (and, of course, our doctors) in every possible way: painful eruption, irregular shape, incorrect size of the tooth itself, poorly developed root system – all of the above leaves no chance for the correct use of “eights”.

How wisdom teeth are formed

Unlike other teeth, the rudiments of wisdom teeth are not formed in the process of prenatal development, but at the age of 3-5 years, when the child’s body is preparing to change milk teeth to a permanent dentition. At this age, you can determine the number of future eights (and there can actually be from one to four). But at this age, it is not yet possible to detect any possible developmental pathologies.

It becomes more or less clear a little later, the crown part of the wisdom teeth begins to form. The process of formation starts in a child at about 12 years old, but at the same time, the development of the root part of the figure eight takes several more years and can continue even after teething. Considering that the most common age for the appearance of wisdom teeth is 18 – 25 years, the eruption of eights occurs already in quite an adult age. It was not in vain that I said earlier the phrase “actually from one to four”, since approximately 10 – 15% of the eight are absent in principle. That is why it is normal to consider the number of teeth in an adult from 28 to 32. These are wisdom teeth, right? How unwisely they treat us and make puzzles!

Fix it
bite or defect of the dentition with the help of invisible
aligners
Find out what it is

Teething of wisdom – a continuous “headache”

“Born into the world” a wisdom tooth in the oral cavity is always painful. The main causes of the pain effect are thick walls of the dental sac, thickened mucous membrane and reduced growth factors. In addition to the pain of the process itself, the eruption of eights can cause many other complications. What? Let’s talk about this in a little more detail.

The wisdom tooth sometimes does not erupt completely, restricting the surrounding teeth. This situation, as a rule, entails local inflammation and pain.

The time during which a wisdom tooth is cut can be quite long, and inflammation can constantly bother you, manifesting itself as an increased temperature of the whole body and sensitive pains, which sometimes make it difficult even just to open your mouth! This condition is fraught with inflammation of the tissues surrounding the problematic tooth, up to the bone, and therefore requires the immediate intervention of a qualified dentist.

The first problem of teething eights – caries

Often, at the time when the wisdom tooth is growing, its effective cleaning is difficult (due to the location of the wisdom teeth in the depth of the jaw). This is how caries occurs. Incorrect position during the eruption of the wisdom tooth also increases the risk of caries on the adjacent tooth due to difficult access to the spaces between these teeth. If symptoms of caries appear, you should consult a dentist and carry out appropriate treatment. Very often, in this case, the removal of a wisdom tooth is recommended, especially if all other teeth are developed normally.

In practice, it happens that a wisdom tooth erupts already … sick, that is, it becomes infected with caries while still in the gum. In such cases, the figure eight should be removed immediately so that the diseased wisdom tooth does not negatively affect the rest of the teeth.

Second problem – cyst

In rare cases, in the tissues surrounding the erupting wisdom tooth, a cyst and swelling may occur, which requires immediate surgical intervention by a dental surgeon.

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Third problem – malocclusion

In the case of an incorrect position of the wisdom tooth during eruption, it is highly likely that such a tooth will significantly affect the position of the remaining teeth, which causes a change in bite. And the appearance of aesthetic problems – the teeth begin to stand crooked in the mouth. And this entails orthodontic treatment, bringing the dentition in order.

The fourth problem is language dysfunction

In addition to aesthetic problems, this can also cause functional problems. For example, if the wisdom tooth is displaced towards the vestibule of the oral cavity, serious injury to the mucous membrane of the cheeks, lips or tongue can occur, causing erosions and ulcers.

Fifth problem – the wisdom tooth wanted to, but could not erupt

Rarely, but there is a situation when, with a lack of space in the dentition or in the case of an incorrect inclination of the wisdom tooth itself, an anomaly develops, called “submerged wisdom tooth”. Such “submerged” teeth are usually removed.

It is possible that the wisdom tooth does not erupt at all. Despite its absence, such a tooth is dangerous for its complications. It can damage the roots of neighboring teeth or provoke neuralgic pain. In this case, you need to contact the surgeon and, most likely, the figure eight will have to be removed.

Sixth problem – pericoronitis

At the moment of eruption of the lower (!) wisdom teeth, when only part of the tooth appeared, acute inflammation and even accumulation of pus in the formed hood between the gum and the tooth can occur. This causes such a serious disease as pericoronitis (pericoronitis).

The main symptoms of the inflammatory process in pericoronitis are pain and swelling of the gums surrounding the wisdom tooth, bad breath and an unpleasant aftertaste.

In case of the appearance of the listed symptoms during the period of wisdom teeth cutting, you need to urgently consult a dentist

The seventh problem of wisdom teeth – periodontitis

When the figure eight erupts quite smoothly, due to its inconvenient location when cleaning, the wisdom tooth is not properly cleaned of plaque. It is also problematic to remove tartar and plaque on this tooth in dentistry. Because of this, bacteria begin to accumulate around the wisdom tooth, causing inflammation of the gums – periodontitis, which can then turn into osteoperiostitis. In this case, the tooth must be removed.

Total – seven problems of wisdom teeth. What conclusions do we draw?

Dentists have such a saying that if the patient did not notice how his wisdom teeth erupted, then he was very lucky. In many ways, this statement is true, because according to statistics, for most of us, the appearance of “eights” does not pass without complications.

You can get a quality consultation on wisdom teeth in your city

I want to check my “eights”!

Treat or remove eights?

Now with regard to orthodontic treatment and wisdom teeth. Believe me, it is very unpleasant for us doctors, as well as for patients, to make radical decisions. But there are good reasons! These are your stories. The stories of patients who underwent treatment with braces in adolescence achieved excellent results and….

All the beauty of even teeth, especially the lower incisors (they just started to enjoy a beautiful smile) – it disappears in 20 years and beyond. It is when most of us fully have these very “eights”. Two, three and even four years of medical “torment” to correct crooked teeth, turning them into a beautiful / sweet / courageous smile, as they say, down the drain … Yes, yes – the only option to become the owner of beautiful teeth again is repeated orthodontic treatment. Whether it will be aligners or braces again, it doesn’t matter anymore, the important thing is that there is a good saying: forewarned is forearmed! No one is immune from mistakes and relapse.

Our body is beautiful and magical in that it almost always adapts and compensates for almost any pathology. Therefore, the “eights” with difficulty, but cut through and after themselves deform very important teeth in front!

So what do we do with the eights?

The moral of this fable is this – trust qualified and educated doctors, and not kind and humane “neighborly” advice. Be wise. Especially at such crucial moments in life, when wisdom teeth make themselves felt. And in general, I wonder who was the first to call them “wisdom teeth”?

Moreover, an interesting point from medical practice: if you (what if?) Decided to remove the eights, it’s not a fact that they will be removed for you. The reason is banal – the removal of wisdom teeth should be carried out exactly according to the indications. A normal doctor will never remove a healthy tooth just because you feel like it.

You have decided to have your wisdom teeth removed. How traumatic is it?

If the wisdom tooth has grown normally, its roots are not intertwined, the extraction usually takes place, without any complications. The edges of the tooth socket after extraction are often not even sutured.

What is most important after removing the figure eight is to let the hole of the newly removed wisdom tooth heal. Quite a big wound.

What to do is absolutely impossible? Do not rinse vigorously, even with such seemingly useful solutions as chamomile or calendula.

What to do. To get rid of food debris, you need to gently take water into your mouth and do short mouth baths without intensive rinsing. Instead of water, you can use a solution of chlorhexidine, miramistin or analogues, which is specially sold in pharmacies, – they disinfect the oral cavity. And so – at least three days. If this recommendation is neglected, the hole may become inflamed. Then the dentist prescribes treatment with drugs, up to antibiotics.

What if the roots of the insidious wisdom tooth are intertwined or fused?

Alas, in this case, complications are not excluded – soft tissues can be damaged. If an inflamed tooth is removed, in rare cases, the neurovascular bundle (!) of the lower jaw is injured. In this case, separate treatment may be required.

When is it advisable not to remove wisdom teeth?

There are situations when the “seventh” or “sixth” chewing teeth are to be removed. And in this situation, a wisdom tooth that has grown correctly can still come in handy. It will become one of the two supports for the future bridge prosthesis. However, in this case, a healthy sixth (or fifth) tooth will suffer, because it will have to be processed under the supporting crown.

A little now about the sad . It will take 10-15 years, the bridge will “work out” the prescribed time of operation. And sometimes it will not work to insert an implant – the jawbone atrophied under the bridge will not allow: in the absence of teeth, any person develops adentia of bone tissue. So, on the horizon of life, removable removable dentures of the jaws and newfangled gels appear, making them easier to wear.

Now a little about the positive . In such situations, you can initially consider dental implantation in specialized medical centers, where they will help restore bone volume and take control of the situation with the teeth.

What do we do after removing the eights?

We evaluate the possible damage that eights could cause to neighboring teeth. If the adjacent teeth are deformed, then the pathology can spread according to the domino principle, and here it is already necessary to carry out systemic orthodontic treatment aimed at correcting the malocclusion.

Aligners are the most sparing and aesthetic type of teeth correction today. The site contains a lot of information on aligners, but I would like to say about one indisputable advantage, namely, the patient can see the result of his treatment on aligners without even starting it! How so, you ask? The answer is simple – all future treatment of the patient is calculated using modern computer technology. The example below shows a real clinical case, a patient with crowding of teeth, caused just by the pathological effect of “eights” on adjacent teeth.

See how wisdom teeth lead to crowded teeth

And how crowded teeth are eliminated with Star Smile aligners

The video shows how the 3D setup is done. I am commenting on the video, orthodontist Alexander Spesivtsev, clinical director of Star Smile, a doctor with many years of experience in the successful use of aligners in orthodontic practice. To restore even dentition, the wisdom teeth themselves – figure eights – had to be removed.

At Star Smile – more precisely, at the clinics of its partners (and this is more than 70 cities in Russia), any treatment begins with a diagnosis and a virtual setup. The doctor takes photographs of the patient’s face, dentition, as well as x-rays and dental casts. With the help of special software, the obtained data is processed and a three-dimensional model of the patient’s dentoalveolar system is obtained. And already this allows you to calculate the trajectory of tooth movement, the duration of treatment, the required number of sets of caps. Also, the final result of the treatment will be visualized – the patient will be able to evaluate the aesthetics of the smile after the treatment. Patients really like this approach – to see their future smile, their straight teeth. The prediction of a 3D setup when teeth are aligned with aligners comes true in almost 100% of cases. You see, this is completely different from the “blind” bite correction, as is usually the case with braces. Everything is clear here, without any guesswork and assumptions.

Gevorkyan Oscar Vladimirovich

Candidate of Medical Sciences, Maxillofacial Surgeon, ZNIIS, Scientific Consultant Star Smile

” awn”?

feel free to contact the doctors of Star Smile company, they will help you understand this sometimes difficult, but very important life problem for many. Do not delay the decision in order to avoid possible complications in the future”

in your city, where you can discuss the problem of wisdom teeth and determine the best solution for you.