Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

April 13, 2018

My wisdom tooth is touching the nerve. Will it cause nerve damage to take it out?


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Hi Dr. Hall,

I am most grateful I came across this website. I have read the posts and I can’t say how much appreciation I have to see your honest and direct feedback and opinions.
I would be very very grateful if you could shed some light with your experience in my situation:
1. I have an impacted lower left wisdom tooth, I did an x-ray and the doctor (surgeon specialist) said it is close to the nerve and he recommended me to take a CT scan, which I did.
2. CT scan came back and he told me the tooth is touching the nerve (how much I don’t know), but I asked him what is the probability of damaging the nerve? He said 10% chance to damage the nerve, but after reading your blog about the risk of nerve damage, it seems like with a tooth touching the nerve – chances of damaging the nerve should me much higher? please would very very much appreciate your thoughts on this.
I am turning 30 years old this year.
One more piece of information – the impacted wisdom tooth is lying horizontal and food gets stuck there most of the time when I eat.
– Dennis

Dennis,
You referenced my earlier blog post on what are the real chances of nerve damage from wisdom tooth removal. The main point there is that the surgeon is more likely to exaggerate the chances of nerve damage rather than minimize it. I would take the 10% chance of nerve damage that he has quoted you as a fair estimate. And I would add to that that the damage would most likely be temporary. The most likely type of damage would be compression or bruising of the nerve, and not severing the nerve. I’m not saying that permanent damage isn’t possible but that it isn’t likely.

The use of CT scans is decreasing the chances of damage to the nerve because the surgeon can now tell, in advance, exactly where the nerve is in three dimensions. When I was doing this, if the nerve appeared superimposed over the tooth, I didn’t know whether it was in front, behind, touching, 1 millimeter away, or anything like that. So I had to be very cautious and allow for multiple possibilities.

Your surgeon just has to avoid any pressure in the direction of the nerve and, in sectioning your tooth prior to removal, has to stay away from the nerve. Then, post-operatively, you need to be aware that there will be swelling that could press against the nerve. If you notice any prolonged tingling or numbness after the novocain has worn off, advise the surgeon, and he will likely prescribe a steroid to hold down the swelling and minimize that pressure against the nerve.

– Dr. Hall

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

August 4, 2017

Preventing Dry Socket


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Dry socket is a potential complication of tooth extraction, and studies have shown that it occurs after anywhere from 15% to 30% of the time after the extraction of an impacted mandibular third molar (wisdom tooth). However, in my practice, I went the final ten years of my practice doing hundreds of extractions of mandibular third molars, including many full bony impactions, without a single incidence of dry socket. Let me tell you how I did it.

As I began my practice, I had a special interest in oral surgery. In dental school I had won the award as the outstanding oral surgery student of my graduating class. I considered specializing in oral surgery, but decided I really wanted to be a general dentist. I did decide, however, to try to tackle difficult extractions, gradually increasing in difficulty until I didn’t refer any of them to oral surgeons unless the patient was over 40. With these extractions, I had a normal incidence of dry socket in my patients.

One day, when I had two patients return to me with dry socket, I realized that in the case of both of these patients I had used a great deal of force in extracting the teeth. This gave me the idea that forceful compression of the mandibular bone was a precipitating factor for dry socket. From then on, if I couldn’t get a lower wisdom tooth out with moderate elevator force, I would section the tooth and/or remove bone until I could. I was very pleased that this dramatically decreased my incidence of dry socket. Over the next seven years I had only two dry sockets in my patients. This was up until around 1991 or ’92.

Then I read a study in a journal where the researchers had tried placing a square of Gelfoam soaked in a suspension of clindamycin antibiotic into the socket after the extraction and suturing the tissue over it. They did this on one side of each patient, and left the other side untreated. For every patient that developed dry socket after the extractions, it never occurred on the side that was treated with clindamycin. I am unable to find what journal that was in, but I was able to find an online reference to that study on the website of a Dr. Ted Rothstein.

I found the study very persuasive, so I applied this practice routinely for every impacted lower third molar that I extracted, and for the next ten years, extracting all sorts of impacted lower wisdom teeth, didn’t have a single incidence of dry socket. And I did not shy away from any difficult extractions. I did partial and full bony impactions including horizontal impactions, disto-angular impactions, whatever.

The “inside-the-box” thinking on the causes of dry socket is pretty rudimentary. The blood clot is missing, therefore the patient must have sucked it out! So therefore, don’t suck through a straw and that will reduce the incidence of dry socket. Similarly, if you smoke after the extraction you will suck it out. There are no clinical studies that give any credence to these simplistic theories. I don’t believe them and didn’t pass them on to my patients.

– Dr. Hall

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

August 1, 2017

Why do I feel pressure in my nose after getting my wisdom teeth out?


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Hi Dr. Hall,

About 10 days ago I had all 4 wisdom teeth extracted (all bony impactions). 3 days ago I had my recheck where the surgeon explained how to flush the sockets and said all was going well. He told me the upper sockets would not need to be flushed, but a day later I started tasting a salty taste from each of the extraction sites, predominantly from where the upper left molar had been extracted. I decided to flush the area and when I did a yellow discharge came out. When flushing directly into the socket, I sometimes feel a pressure on the left side of my nose (I assume this is the sinus). Is this a sinus perforation? Does this sound like a serious situation/infection? Is there anything I should be doing to speed up the healing process? After the 6 day mark my pain has been slowly subsiding and has been increasingly mild and has not flared up much with the discharge.
– Kayla D.

Kayla,
Nothing you’ve told me sounds abnormal. The key here is that, while it seems that the healing is happening slowly, it is getting better steadily. Some bacteria are bound to settle in the sockets, but it appears that your body is handling that.

As you read in the post about a perforated sinus, the roots of upper molars can be very close to the sinus. This is why you are feeling pressure in the area of your nose as you flush this socket. If there were a perforation, the solution would be actually coming out your nose as you flushed into the socket. Since it’s not, that membrane is intact and doesn’t need any extra attention.

What to do? Just be careful and flush, if you must, very gently, so that you don’t rupture the sinus membrane. You also want to leave the blood clot in the socket because that will end up forming a framework for the formation of new bone as the extraction site heals, so you don’t want to flush that out either.
– Dr. Hall

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

October 18, 2016

All impacted wisdom teeth do not need to be extracted


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Hello Dr. Hall,
I am at age 41 and have fully impacted horizontal bony wisdom teeth. My dentist said to remove them to avoid issues in future. Is it worth removing this late in age? I have a pano x-ray which I can send. I appreciate any honest feedback you can give.
– Ajay from Arizona

And here is the x-ray that he sent. I have cropped out the parts we don’t need for this post.
impacted wisdom teeth

Ajay,
This is an interesting subject area, the prophylactic (preventive) removal of wisdom teeth that aren’t causing any problems currently.

Prophylactic Removal of Wisdom Teeth

I addressed the general question back in January in a post titled, Is Wisdom Tooth Removal a Racket? There are some articles in the popular media asserting that there is no need to remove any wisdom teeth unless and until they cause a problem. They assert that this is a scam perpetrated by oral surgeons who want to make money taking out wisdom teeth. I did a little investigating on the source of this erroneous thinking and found that a lot of this thinking is pushed by a Dr. Jay W. Friedman, who, it turns out, is actually an insurance company consultant. So the truth is that the idea that your shouldn’t preventatively remove wisdom teeth is a scam perpetrated by the insurance industry because they are trying to save money at the expense of the patients. You check with any dentist who removes many wisdom teeth, and I am pretty confident that their children have had their own wisdom teeth removed. That speaks to their sincerity.

But Not Every Impacted Wisdom Tooth Should Be Removed

However, I do believe the rule needs to be tempered. There is a judgment call to be made here. Let me explain how I would make that judgment, because, from the x-ray you have sent me, without the benefit of other clinical information, it doesn’t appear that you need to have these wisdom teeth out.

This is a risk-vs-benefit proposition. There are benefits to having wisdom teeth gone because there are problems that they can cause. I have seen some of those problems, and they can be nasty, even life-threatening in some cases. But there are significant risks associated with removal of wisdom teeth including pain, swelling, possible post-operative infection, nerve damage, dry socket infection, trismus, and other problems. So we weigh the risks of leaving them alone against the risks of removal and come up with a decision.

In your late teens and early twenties, the risks associated with wisdom tooth surgery are the lowest. These operations are fairly straightforward. The bone in the jaw, at this age, is fairly pliable. In addition, the roots of the wisdom teeth may not be fully formed, thus greatly simplifying extraction. But as you age, the roots not only get fully formed but they tend to add cementum, making the teeth in some cases fatter at the end of the root than near the crown of the tooth. Removal of teeth like this can be difficult. In addition, the bone becomes less flexible. All of this magnifies the risks of complications.

On the other hand, the longer you go with your wisdom teeth, not having had any problems, the lower the risk that you will have problems in the future.

The Partially Impacted Wisdom Tooth

a partially impacted wisdom tooth

A partially impacted wisdom tooth

The wisdom tooth that is partially erupted and partially under the surface has by far the greatest risk of causing problems. Here is a photograph of such a wisdom tooth.
A partially impacted tooth like this is practically certain to cause a serious infection at some point, possibly when the patient is the most vulnerable. They tend to flare up during pregnancy or when the patient is weakened from some other illness. You can see in the photograph that the tissue that is over the tooth has a bluish tinge and looks puffy. Peeking under the tissue on the buccal side (opposite the tongue) you can see redness there. There will be a persistent low-grade infection around these teeth. Food gets under the tissue flap, and bacteria multiply freely because the pocket is impossible to clean. The pocket is also a source of unpleasant mouth odor. If an aggressive strain of bacteria gets into this pocket, or if the patient becomes weakened from some other illness, the infection will flare up and start to swell and hurt. I would tell my patients with partially impacted wisdom teeth that they were much better off choosing the time to have these teeth removed rather than having the time choose them.

The Completely Impacted Wisdom Tooth

The fully impacted wisdom tooth is a different story. With no opening to the oral cavity, there is no real risk of infection. There is a risk of cyst formation. I was taught about these cysts in dental school, but in over 20 years of dental practice I never saw a patient who had one, so I figured that this risk is fairly small. In younger patients, with the roots of the teeth not fully formed, there is a risk that the tooth could surface partially and thus become infected later. There is also a risk that a wisdom tooth could damage the roots of the second molar in front of it.

So that brings us to your case, Ajay. You can see from the x-ray you sent me that each of these teeth is fully under the bone—i.e. is a complete bony impaction. So the risk of them causing you problems is on the small side. Additionally, you have made it from age 20 to age 41, over twenty years so far, without them causing you any problems. And then if you look at the roots of these teeth, you’ll see that they have fattened up quite a bit from about twenty years of cementum deposition, so removing them will be a nasty experience. In addition, look at the nerve canal that goes through the middle of your jawbone back in the area of these teeth. Notice that on the left side the roots of that wisdom tooth impinge on this nerve canal. This greatly increases the risk of damage to the inferior alveolar nerve that goes through this canal. Damage to this nerve can cause you to lose all feeling in your lower lip on that side and all feeling to your teeth—a nasty complication.

I’m not going to prescribe treatment for you, since I don’t have any direct observation information or anything other than this x-ray. For that I refer you to your own dentist. But I will tell you this much. In my practice, I drew the line at age 40 for completely impacted wisdom teeth. If a patient got to age 40 without the tooth causing them any problem, I almost always recommended that they leave the tooth alone.

I will add that in your case, I would want a better look at your left side. That wisdom tooth appears, from the angle of this x-ray, to be pushing directly against the root of your second molar. I would want an individual periapical x-ray of that area at a different angle to see if that is the case and to inspect the root of the second molar for any damage. There could be something going on there that would argue for extraction.

I hope this is helpful.

– Dr. Hall

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

January 30, 2016

Is wisdom teeth removal a racket?

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.

Digg is an online magazine, a news aggregator, and yesterday they published a particularly ignorant article under the banner, “Wisdom Tooth Removal Is a Racket and Other Facts.” It definitely needs a response.

The author, Rob Wile, relates his own bloody wisdom tooth removal experience, which ended in his catching pneumonia. His description of the experience leaves me wondering if he is exaggerating, it seems so far out of the normal, but let’s accept it as true.

He says that he had his wisdom teeth removed when he was in his early teens. If that is true, that could explain some of his problem. At that age, if the wisdom teeth are even present as tooth buds. they are round and slippery and often deeply embedded in the bone. Because of their shape and slipperiness, sectioning them is difficult, so you have to cut a hole in the bone as big as the tooth to get them out. And even then, it’s difficult to grab them. In my practice, I took out hundreds of wisdom teeth. It’s easiest to take them out when the roots are mostly, but not completely, formed, and the teeth are close to the surface, which usually happens in the later teens.

He then cherry-picks some published articles by various scientific journals to give credibility to his argument. None of the articles, however, would lead to the extreme conclusion that he draws that wisdom tooth removal is a scam. But let’s examine a quote from one of them, a Dr. Jay Friedman. Wile’s article says this, quoting Dr. Friedman:

“It is specious to contend that less than 3 days of temporary discomfort or disability is a small price to pay to avoid the future risks of root [destruction], serious infections, and cysts,” he wrote in his paper. “Also ignored is the risk of incidental injury such as broken jaws, fractured teeth, damage to the [mouth] joints, temporary and, especially, permanent paresthesia or dysesthesia (numbness and dysfunction of the lower lip and the tongue).”

I looked up this Dr. Friedman. He’s a dentist, it turns out. He had an article published in the American Journal of Public Health titled “The Prophylactic Extraction of Third Molars: A Public Health Hazard.” In there he lists what he calls myths about wisdom teeth removal. One is given thus: “Myth Number 2–early removal of wisdom teeth is less traumatic.” That is simply not true, and no one who has taken out many wisdom teeth would say that. Actually, I don’t think any dentist who has taken out many teeth of any type would say that. As patients get later into their 20s, 30s, and older, the bone gets increasingly unyielding. The roots of the teeth also get fully formed and then begin to accumulate more cementum, often making them fatter toward the end of the root than they are closer to the surface, a factor which greatly complicates their removal. That’s a well-known fact among all dentists who do many extractions on patients of varying ages.

So I decided to check out this Dr. Friedman. Turns out he is not a practicing dentist. He’s a dental insurance consultant. I should have known. He has a DDS degree and then a Masters in Public Health, and has been working as an insurance consultant since 1962. Clearly it is in the interests of his insurance company to discourage the removal of wisdom teeth. In his Linked-In profile he describes himself as a “consumer advocate” and a “gadfly.” You don’t say!

In the cited American Journal of Public Health article he states: “Furthermore, dry socket, secondary infection, and paresthesia are less likely to occur in persons aged 35 to 83 years than in those aged 12 to 24 years, who experience more third-molar extractions.” As one who took out hundreds of wisdom teeth in my career, I will tell you that is completely foreign to my experience. I witnessed all of those complications in my practice, but never in a teenager. If you can take out the wisdom teeth when the roots are not quite completely formed and the tooth is close to the surface, the surgery is predictably straightforward and quick.

But what annoys me the most about Rob Wile’s article is the impugning of the integrity of the dental profession. Now I am one who has been highly critical on this blog of many dentists. Nevertheless, from my observation, as a whole, the dental profession has more integrity than any other profession with which I have been closely associated. And from dealing with the dental insurance industry, of which Dr. Friedman is a member, it has been clear to me that they have a lower average level of integrity than dentists. By far.

Here’s a challenge for anyone who feels that wisdom tooth removal is a scam. Ask the families of oral surgeons who extract a lot of wisdom teeth. Do they have the wisdom teeth extracted on their own children? I’ll wager that they do, but you can go ahead and do a survey. I extracted the wisdom teeth on my children, all when they were in their late teens, because I’m confident it was in their best interest. And I’m confident that other dentists feel the same way.

Do you have a comment? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

July 3, 2012

My opinion on removing useless wisdom teeth

Dr. Hall,
I recently had my bottom 2 wisdom teeth extracted, but my top 2 wisdom teeth are healthy, they just point out instead of down. The back of my wisdom teeth is in line with the front of my molar. Should they be removed for this reason, even if there is no decay?
– Stacy from California

Stacy,
So you are telling me that your upper wisdom teeth are useless. Instead of meeting with any lower teeth, they point sideways, toward your cheek. And that brings up the question, “How do you feel about useless things?” Do you like things clean and tidy, or do you like clutter and hanging onto stuff? Because these teeth are truly useless and they are clutter.

I say this as a dentist who is fervent about saving teeth. I would go to great lengths to save the teeth of my patients, but I would spend my efforts on teeth that fulfilled some purpose.

I’m not sure why the dentist who took out your lower wisdom teeth didn’t urge you to have the uppers taken out at the same time. Even if your upper wisdom teeth were pointed in the right direction, with no companion teeth in the lower arch to chew against, they don’t do anyone any good. And the younger you are, the easier the wisdom tooth removal goes, the less pain and swelling, and the fewer complications. And I would dare say that had you had them extracted with the lowers, it would have added maybe five minutes to the procedure and would have added nothing to your healing time. You see, there is a down side to retaining them – they make it harder to clean your second molars and can promote decay and/or gum disease on your second molars. They create a nifty food trap there in a place that is hard to clean.

Dr. Hall

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

May 24, 2012

Tooth sensitive to cold after wisdom tooth extraction

Dr. Hall,

I had my wisdom teeth removed three weeks ago, and the gums appear to be healing well. However I have been experiencing increased tooth sensitivity to the cold. It began just at the sites where the extraction occurred but has now spread to most of my top teeth. I plan to buy some tooth sensitivity toothpaste, but was wondering if this is a normal side effect? Will it go away with time? And is it a concern that the sensitivity has spread through my mouth?

Regards,
Miffy from Australia.

Miffy,
Occasionally, after the extraction of a wisdom tooth, the tooth right in front of it will become more sensitive to cold or air. This happens rarely on the lower and a little more often on the upper. The reason is that, with the removal of the wisdom tooth and possibly some of the bone that was holding it in, part of the root surface of the adjacent tooth becomes exposed making the tooth sensitive. While this root can be treated to make it less sensitive, it is easier and less expensive to begin brushing with a toothpaste for sensitive teeth, such as Sensodyne. If that doesn’t work, then I would ask your dentist to see if he or she has any desensitizing treatments available in the office.

This sensitivity could increase with time as the tissue at the extraction site heals and shrinks, but it should not spread to other teeth. Sometimes one tooth can be sensitive and it can feel like the teeth around it are also sensitive. To be on the safe side, I would go back to your dentist to see if there is something else wrong. Perhaps there is some deep decay or something else is going on here.
– Dr. Hall

Link: When is a tooth sensitive to air?

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

December 28, 2011

Dry socket after wisdom tooth extraction

Filed under: Wisdom teeth — Tags: , , — mesasmiles @ 1:44 pm

Dr. Hall, I recently got 2 lower wisdom teeth removed (no issue other than that they were wisdom teeth and hence could have created problems in the future) and one lower left (19) molar removed as I had a root canal on it but now the cap came off so my dentist recommended a dental implant. Today is the 7th day after my surgery – I am doing ok. Statistically speaking, do I now have a very little chance of getting dry rot/any infection/complication or should I stay alert to infections? If yes, then for how many days? What precautions should I take? I only started taking semi-solid foods today.
– Jane from Massachusetts

Jane,
When you say “dry rot,” I assume you’re meaning to ask about dry socket, which is a frequent complication of wisdom tooth extraction. Dry socket, if it happens, will happen two or three days after the surgery. If you have made it to seven days, you are in the clear. Dry socket is characterized by an intense pain. The surgical site has started to feel better, it’s two or three days after the surgery, and then you get this dramatic increase in pain. Some dentists believe that it is caused by sucking the blood clot out of the socket, but they are confusing the symptoms with the cause. The symptom is that there is no blood clot in the socket. The cause is a breakdown in the bone of the socket, and occurs more often with difficult extractions of lower wisdom teeth where the dentist had to put a lot of pressure on the tooth to get it out, which compresses that bony socket. Putting a clindamycin dressing in the socket right after the extraction makes it much less likely that you’ll get a dry socket.

Another common complication is post-operative infection. If the surgical site gets infected, that is also likely to happen in the first few days after the extraction. So if you’re in your seventh day, it should be mostly uphill from here!
– Dr. Hall

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

December 26, 2011

Tina’s reply to our “Buccal nerve damage” post

Last week I answered a question from Tina from California, who was told she has buccal nerve damage as a complication of the removal of her wisdom teeth. I suggested that she may have an entrenched infection that needs a long-term course of antibiotics. Here is her reply:

“Thank you so very much for your insight into my unusual case. I do feel that you could be exactly correct and this is combination of two things. Infection and nerve damage. I was prescribed a good strong dose of clindamycin. I will complete the duration and then reevaluate. Of course I will absolutely join you on Facebook. I really appreciate your reply!”
– Tina from California

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

December 23, 2011

Buccal nerve damage after removal of wisdom teeth?

Dr. Hall,
I am 32 years old and in July of this year I began having complications with my upper right wisdom tooth. The top and bottom (all four) wisdom teeth had always been impacted however the upper right had began to break through the gum and was pushing on all the teeth on that side causing swelling and pain. I consulted with an oral surgeon and decided upon his advice to have all four removed. I had the surgery the following day.

Surgery went as planned and recovery appeared to be on schedule. I had the knots on both jaws and I did notice that the right side was more painful and a pressure and numbness when I bit down. I believed it was part of healing. Three months later(October) I woke up to the entire right side of my face being swollen. I called the oral surgeon and saw him immediately. It appeared that I had an infection so he opened the area back up and cleaned it out. I was back to square one recovering from the extraction.

Again, recovery went well and at the follow up appointments I appeared to be healing well. Three weeks later I began feeling the numbness and pressure again, which I now knew was not normal. I went to the surgeon and he took a cat scan among other films. I again was told that he believed it to be an infection and that it needed to be cleaned out again. That was in November. I again healed well and again had the numbness and tingling return three weeks into recovery.

I was then referred to a nerve specialist. I was told this week by the nerve specialist that I have buccal nerve damage and that there is not much I can do about it. My question … How common is this? Is this negligence by my surgeon? Long term can the damage improve? Thank you so much and I have enjoyed all of the informative information your site!
-Tina from Texas

Tina,
You are having some unusual complications from your wisdom tooth surgery. I’m not going to be able to tell you anything specific about your case, because it sounds like nobody is too sure, but I can tell you some general principles that could help.

There can be, in rare situations after wisdom tooth surgery, a resistant pocket of infection that takes an extended period of antibiotics and time to heal. It sounds like this may have happened in your case, because the follow-up treatment by the oral surgeon each time seemed to help. But it’s unusual that your problems would return three weeks into recovery. Were you taking antibiotics all this time? Did you stop taking them? That’s a possibility that I would investigate, that you may have stopped taking them because the prescription ran out and the oral surgeon should have given you a longer prescription.

If the neurologist is correct that you have buccal nerve damage, it is difficult for me to attribute this to negligence by your surgeon, mostly because it appears that the damage wasn’t caused directly by the surgery. The buccal nerve in some patients can run close to the lower wisdom tooth, and it could be severed if the surgeon makes too wide a cut. But this isn’t what happened in your case, because of two reasons. If you have any feeling at all, such as tingling, the nerve wasn’t severed. And second, the numbness and tingling is occuring three weeks into recovery, so it is an indirect result of other things that are going on, not the surgery.

As far as how long this will last, nerves do recover, though it is slow. If you have tingling, the nerve is only damaged and not destroyed, so it should recover in time, though it can take up to a year.

Has anyone considered the possibility that maybe the area should be just left alone, without further surgical intervention, and just keep taking antibiotics for a month or two?

And, as a parenthetical note, this is a great illustration of the desirability of prophylactic removal of the wisdom teeth when you are young. I am confident that, had you had these wisdom teeth removed when you were 18, this would not have happened. The likelihood and severity of complications increase dramatically with increasing age, because the bone gets more dense and the roots of the teeth enlarge with time. I saw this time after time in my practice. Read my post of just one week ago where I addressed the issue of prophylactic removal of wisdom teeth.

Dr. Hall

Read Tina’s reply, where she says that it sounds like we are right: Reply to buccal nerve damage.

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

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