Dear Dr. Hall,
I read with interest your comments regarding wisdom tooth extraction. I have had my wisdom teeth for my whole life (I am 34 now), as they did not cause me any problems growing in. Unfortunately, I did not care for them properly and, although the rest of my teeth are in pretty good shape, my wisdom teeth have all started to decay, to the point that they are basically about half gone. For some reason, the process of this decay has not caused me very much pain or discomfort.
My question relates to the fact that I would prefer to just let them decay on their own until they are gone, rather than risk the complications inherent to wisdom tooth removal at my age. I assume the surgery would be all the more complicated by the fact that there are bits and pieces of the teeth for the surgeon to pull on rather than the full teeth. What are the potential consequences of simply allowing them to decay on their own? Is it possible for this to happen without experiencing infection or complications? Would it be less dangerous than the surgery? Keep in mind that, thus far, one of them seems to be almost completely gone (although there are a few pieces still there), and the other three are half gone. So far, no sign of infection or pain. Thank you so much for your time and insight. I really enjoy perusing your web site.
– Jeremiah from California
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Jeremiah,
You raise some interesting questions. Yes, decayed teeth do eventually crumble and go away. There is some risk in letting that happen, though. Let me help you understand that risk, and then you can figure out what you want to do.
If a tooth appears to be intact but yet has deep decay, that decay will reach the living pulp tissue of the tooth, cause it to become infected, and that infection will spread through the end of the tooth, through the root, and deep into the jawbone. When these infections are encased either in bone or in a relatively intact tooth, that causes pressure to build up and pain. If the infection breaks through the bone and starts to drain, that relieves the pressure and thus relieves the pain. That will also tend to slow the advance of the infection in the bone, because the infection has an outlet. If the infection doesn’t find an outlet, though, it can get very nasty. For example, infections of lower teeth can cause swelling on the inside of the mouth. This swelling can move down the throat and threaten to close off your windpipe. Also, upper molars are not that far from the brain and there are blood vessels present that can carry the infection to the brain. So this isn’t something to mess with.
If a tooth breaks off, it does two things that help make the infection less serious. First, it creates a wide open situation where the infected, inner portion of the tooth becomes exposed, which gives the infection an outlet and helps prevent its spread down into the bone. Second, every tooth has slight eruption forces that are always operating. These forces tend to push the tooth further out into the mouth until it meets an obstacle, which is usually the opposing tooth in the opposite jaw. When the tooth breaks off, it no longer has contact with its opposing tooth, and those forces will tend to push the tooth out of the jaw a little. If it keeps decaying, then little pieces will continue to break off. Eventually, the tooth could be completely pushed out.
But be careful about judging just by what you see. Sometimes you can just see a small portion of the root, and it looks like nothing important is happening, but an x-ray will show that this root is quite long and goes down deep into the bone.
Another problem is that if you have one badly decayed tooth, you can have decay bacteria spreading over all your teeth and accelerating decay everywhere in your mouth.
As far as comparing the risk of letting your wisdom teeth fall out on their own versus extracting the wisdom teeth, I believe having them extracted would be less risk, no matter what the condition of the teeth. If they have started to push themselves out, making it so there is less risk for the infection getting deep into the bone, that also makes for fewer complications if you have them removed. But then extracting them is a whole lot more expensive than letting them fall out.
Dr. Hall
Other links: Read more about tooth infection, and antibiotics for teeth.
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
Leaving a piece of the wisdom tooth in the jaw
Hi Dr Hall, I just have my wisdom teeth minor surgery today. The doctor tried to pull my wisdom teeth solidly but she cant because she said the teeth nerves is too hard. Scared of effecting my nerves, she just drill the teeth and there’s a part of my wisdom teeth still inside my mouth. My question is, is it a standard procedure to left the teeth just like that in order to protect my nerves? Do i need to operate again to pull out my whole wisdom teeth?
– Azila from Kuala Lumpur
Azila,
Thank you for your question. I must say that it doesn’t cease to amaze me that this website is being read in places like Kuala Lumpur. One of the things that first got me excited about websites back in 1995 when I started this site was when I discovered that people in far-flung places around the globe were noticing what I was posting on my website.
Anyway, to your question. Yes, if the root tip, say, is close to the main nerve that goes through your lower jaw, and it breaks off during surgery, the standard practice is to just leave it there rather than risk damaging that nerve in trying to get it out. The chances of a small root tip of a wisdom tooth giving problems later if it is left in the jaw are small.
Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
I can’t afford to have my infected wisdom tooth removed.
Dr. Hall,
Have a rotting and decaying wisdom tooth, that is causing sever throbbing and pain. the Surrounding teeth are also starting to decay, some already have holes in them. Ive started to get a minor pressure just to the side and below of my eyebrow, right along my left cheek bone closer to my ear. Should I rush to the ER or just get antibiotics and have it handled by a dentist when its affordable?
– Eric from Alberta
Eric,
A very bad idea to try to get by or to try to just take some antibiotics.
There’s a story from about three years ago where a boy died from a tooth abscess. I wouldn’t trifle with an infected wisdom tooth. It’s swelling around your eye now. What if this infection spreads to your brain? What will you do then?
Scrape together the money and get this wisdom tooth extracted. If you try to get by with antibiotics, there is no way to heal an abscessed tooth with antibiotics because they can’t reach the source of the infection. So what ends up happening is you tamp down the infection for a short period, and then it comes back, and this time the bacteria are resistant to the antibiotic. It can really make a mess of things. You’ll probably need some antibiotics to get the infection somewhat under control, and then get the tooth extracted while you are in the middle of the antibiotic treatment. That will usually cure you.
Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
Should I wait until my wisdom teeth bother me before having them out?
I am 26 years old and am having trouble with my wisdom teeth. I only have 3 wisdom teeth (2 on top, 1 on the bottom). All three are impacted. I have an appointment to have the top two removed and am trying to decide if I should have the bottom tooth removed. The roots of the bottom tooth are past the nerve. The surgeon told me that the risk of nerve damage was low (but my risk was slightly higher because the roots are past the nerve) and that I had a few options.
Option 1 – leave it until it starts bothering me.
Option 2 – pull it.
Option 3 – remove the tooth part and leave the roots and hope it doesn’t get infected (if it gets infected they’ll have to go back for the roots).
I was leaning towards just waiting but I’m feeling some pressure in that area of my mouth (although I don’t know if it’s from the bottom tooth or just the general pain I’ve been feeling from the top tooth). Also, I’m not fond of the idea of going through surgery a second time. I would like to know what your opinion was on my options and how likely an infection would be if I just go ahead and have the tooth part removed but leave the roots. Thanks!
– Mary from New York
Mary
The problem is that with your impacted wisdom teeth, they get much more difficult to remove the older you get. Every dentist I know of who has taken out many wisdom teeth always advises people to have impacted wisdom teeth removed when you are young (as you are), and the reason is that they know from experience how much more difficult these tooth extractions get the older you get.
The difficulty of extracting them and the risks of complications go up exponentially the older you get. You’re 26 now. When you are 30, your risks may double, at age 35 they may be double that, and so on. And if they are impacted, it is only a matter of time before they give you trouble. What happens is your bone gets harder and stiffer as you get older and the roots can tend to thicken. Why wait until they are infected and the situation becomes an emergency? My advice is to take care of this problem now when you can do it on your own timeline rather than waiting until the time picks you.
As far as leaving the root, that is a reasonable option, though I wouldn’t leave the entire root – only the root tip. If the piece of root is small, the body rarely has a problem with it. Though if I were the surgeon, I would suggest letting me make that determination during the surgery. Often the surgery goes more easily or is more difficult than anticipated, and that decision can be made with more clarity, in my opinion, once I’m in the middle of it.
– Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
How much risk, really, of nerve damage with wisdom tooth removal?
Dr. Hall,
I am 37 and have always been very nervous about getting my wisdom teeth out. Recently I got a small infection in one of my lower wisdom teeth that is slightly covered with tissue. This caused me to get my wisdom teeth evaluated. They did a 3D scan of my wisdom teeth and said the top 2 would be easy but the bottom 2 are close to the nerve. One wisdom tooth on the bottom is pushing on on the second molar but not covered by tissue and the other bottom wisdom tooth is not pushing on the second molar but is slightly covered with tissue. The oral surgeon said that they were both close to the nerve but the one that is pushing on the 2nd molar is slightly closer, about 1 mm away from the nerve. I was wondering how risky is 1 mm of space between the tip of the root and the nerve? What are my chances of it being damaged? And if my chances are high of damage…..will it be slight or could it be severe? Thank you very much.
– Tiffany from Ohio
Tiffany,
Because of the legal climate in this country, the smartest thing for oral surgeons and other dental specialists is to overstate the risks involved in these procedures. Risk exaggeration is a great way to help insure that they won’t be the target of a malpractice lawsuit if something goes wrong.
So you come to me for a little more honesty, and that’s what I’m here for. Here’s the story on the risk of damage to the inferior alveolar nerve – the nerve that runs to the jaw and the lip – with a wisdom tooth extraction. If the nerve truly is one millimeter away from the tooth, and you have an experienced oral surgeon who has taken out hundreds of wisdom teeth, that is a very minimal risk. In order to damage the nerve, the surgeon would have to take the tooth out and then drill down into the bone another millimeter, and why would they do that? Or they would have to break the tooth and then make the mistake of applying downward pressure on the remaining root fragment in an attempt to get it out. They are all taught techniques for avoiding that downward pressure during an extraction.
I have taken out wisdom teeth that were sitting right on top of the nerve, with no space between the nerve and the tooth, and never had a permanent nerve injury. On rare occasions, the nerve would be fine right after the surgery, but then the next day it would start to feel tingly or abnormal. In those cases, there is swelling that is pressing down on the nerve, and I would need to prescribe a steroid for a few days to control the swelling to avoid compressing of the nerve. But if the nerve is protected by even one millimeter of bone, there isn’t really much chance of even that temporary problem happening. I even had one case where the nerve ran right through the middle of the tooth. I was able to split the tooth around the nerve without nicking or severing the nerve. However, the operation stretched the nerve, which damaged it, but the nerve was able to repair itself over time.
I hope this is helpful. When a wisdom tooth gets infected, there is little choice but to have it out. Moral – tell all your friends and your friends’ children that if there is any chance of wisdom teeth causing problems later in life, have them out when you are young (like under 25) when the operation is much easier on everybody.
I hope this is helpful,
– Dr. Hall
About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
Which Oral Surgeon should I go to?
I am 43 and in good health. I have 2 impacted wisdom teeth on my left side and am beginning to have some jaw discomfort and some sinus issues. I have had one consultation with an OS (referred by my dentist who is great but the OS was pretty matter of fact about the situation and did not make me feel comfortable either way). I was wondering if you could give me some recommendations on some OS in the greater Phoenix area whom you would deem “great all around, hence their experience, bedside manner of understanding and making the patient feel good about their decision and what he recomments, etc….” I have never had any surgeries and am quite concerned about any permanent nerve damage. Thank you so much.
Lynnette in Phoenix.
Lynnette,
I really don’t have any comparative information about oral surgeons in the Phoenix area. A practicing dentist in Phoenix would have more information and insight and have heard more about this.
I can tell you that, in order to protect themselves legally, oral surgeons will tend to overstate the risks involved in the surgery. If they don’t, and something goes wrong, patients will sue their pants off. That’s just the world we live in. They’re protecting themselves.
If there is any reasonable chance of your wisdom teeth on your right side of ever bothering you, and if your oral surgeon agrees that they would be better to come out, I would have them out at the same time. The healing time is the same, and the discomfort is about the same, whether you have two out or four. If it were me, I’d get them all out and be done with it.
Meanwhile, tell all the teenagers you know and parents of teenagers to have these wisdom teeth extracted before they’re 25. When the patient is under 25, the incidence of complications is much much less.
Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
Should I have wisdom teeth out at age 59?
Dr. Hall,
I am going on 59 years of age and the dentist advised me to pull two of my wisdom teeth. The teeth are not giving me any problem and because of my age, complications appear to be a factor with the surgery. My question, since I did not have my teeth removed when I was younger, should I removed my wisdom teeth if they are not giving me any problems? I would like a second opinion or some advice that would help me to make an intelligent decision. I don’t mind having them removed if my health is at risk. On the other hand, I don’t believe pulling teeth for the sake of pulling teeth is a wise choice. Please give me your honest opinion on this matter considering my age. Also, would you give me some questions that I can ask my dentist to put the wisdom teeth surgery in some perspective. I am having serious second thoughts, because I am not thoroughly convinced. Thanks.
– Leon in Texas
Leon,
It’s hard for me to advise you on your specific situation without seeing your wisdom teeth for myself or seeing x-rays. I can say this much. If your wisdom teeth are fully erupted and not causing you any problems, I would advise against having them out. If they are fully impacted, not bothering you, and you are 59 years old, I would also advise against having them out.
If they are partially erupted, it would depend on all the circumstances.
If wisdom teeth are fully impacted – they are completely under the surface, I generally recommend having them out if you are under 40. As you get older, the chances of complications increase if they are extracted, and the chances of trouble with them decrease if you leave them alone.
But if they are partially erupted – partially above the surface and partially below – then there are much greater chances that they will cause problems, and the worry is that they will cause problems when you can least afford to have trouble – when there is some other health urgency that really complicates having them out.
I hope this is helpful.
Dr. Hall
Links: Click here to ask Dr. Hall a question.
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
Do I need to save my second molar?
What’s so bad about wanting to have a back molar extracted rather than go to the expense of a root canal, a crown, and a possible second root canal if the first one should fail. It’s the last molar in the back, and my teeth are somewhat too crowded on that side of my mouth anyway. So, why do dentists always want to save a tooth instead. I’d just rather have it extracted and be done with it and have no future problems with that tooth. Your opinion, please?
– Monica
Monica
If you’re going to lose a tooth, the one that will cause you the least complications is the last molar. In most people, that will be the second molar. There is no tooth behind it to tip forward if that tooth is missing. If it’s a lower last molar, you will probably also end up losing the upper molar, because it will now have no opposing tooth and will drift down until it starts to bite on the gum, but that will be the extent of your problems. And if you have all your premolars and front teeth, you can get along okay with just first molars and no second molars – that is enough teeth to chew on adequately.
Having said that, I believe it’s always best to save a second molar. It can come in handy especially if you later lose a first molar. And it will reduce your chewing efficiency. But I can understand if your finances are limited that you may not want to put that much money into it. And the chances of the root canal failing shouldn’t be that great if the root canal treatment is done well. Maybe 5% would fail.
But a first molar, on the other hand – if you lose that your entire bite on that side of your mouth will be disrupted because everything will tip into that space.
I hope this is helpful.
Links:
Read more about tooth extraction and root canal failure.
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
Should I have my wisdom teeth out at age 42?
Wisdom tooth removal.
I am 42 yrs old and have been told I need all 4 removed. My dentist said 1, the oral surgeon wants to remove all 4. Only one has come through the gum and has given me trouble. The other 3 don’t bother me at all. In your opinion, is it necessary to remove all 4? I am worried about complications and really only want the one removed in hopes to reduce risks of complication and recovery time.
– Mary from Texas
Mary,
I don’t know what your x-rays show as far as the potential for these wisdom teeth bothering you, but I can give you some general guidelines that hopefully will help.
If your wisdom teeth aren’t erupted at age 42, they should have been taken out when you were around 20. The chances for causing complications increase with increasing age. When you’re 20, they are fairly easy to remove. They are considerably harder now. They will be harder yet in 20 more years. I don’t know how long you’ve been going to your current dentist, but if this tooth has been poking through the gum, he should have recommended having it out as soon as he saw it.
Another principle is that it is usually best to take them all out at the same time. If there is any significant potential for them causing you trouble and they aren’t in a particularly risky position, I would advise having them all out. The amount of discomfort is only a little more and the healing time is the same. I can tell you from going through this experience with a number of patients that it is an awful pain to deal with four surgeries, one after the time that each tooth starts to bother you, instead of just one. And it’s much better to choose the time when you have them out rather than have the time thrust upon you. What if they start to bother you when you are having some medical crisis? It could be a really nasty time for you.
Another useful piece of information is that complications surrounding the extraction of upper wisdom teeth are minor and transitory. They are much easier to take out.
Hopefully you have a feeling of trust in your surgeon that you will get straight, honest answers. I would ask this question about the lower wisdom tooth that isn’t the current problem tooth. Is it totally impacted in the bone – totally underneath the surface of the bone – or is it poking through the bone and could be exposed by merely raising a soft tissue flap? If it is totally impacted in the bone, the chances for it causing you trouble later on are much less. If it is poking through the bone, there is a greater chance of infection getting in around the tooth. Often it’s just a matter of time before they become infected. In my practice, I always advised that patients have all their impacted wisdom teeth removed, except if they had reached the age of 40 without them causing any trouble and they were totally impacted in the bone. I reasoned that if they had gotten this far without them bothering the patient, and there was no easy path for infection to get to the teeth, that the risks of surgery began to outweigh the risks of leaving the teeth alone.
I hope this helps.
Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
Does root resorption mean you can’t save the tooth?
Dr. Hall,
I hadn’t been to a dentist for treatment in 5 years – though I had x-rays and a treatment plan 2 years ago, I never went through with it due to cost and not trusting the dentist’s opinion. So I finally went to the dentist this month. I got a couple cavities filled by the general dentist, but while attempting a root canal on my upper molar, #14, the endodontist said I have root resorption, which he didn’t realize beforehand when looking at the x-ray – it had appeared I just had a cavity very close to the root. So he said unfortunately he can’t save the tooth and it would need to be pulled and I’d have to get an implant.
Was it necessary to pull the tooth in the first place because of the root resorption, or was the endodontist forced to pull it because he had already started the root canal and couldn’t finish it?
– Erin from California
Erin,
When root resorption is at the end of the root, it may be caused from the infection that started inside the tooth, and it may be possible to still save the tooth. But it sounds like your root resorption was on the side of the root. There is no way we know of to treat that type of root resorption, so yes, I believe the tooth was not saveable and needed to be extracted.
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
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