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.
Dr. Hall,
My name is Fidelis Tan and I am currently 24 years old. I will be having my bottom two wisdom tooth removed in a month. However, both of them are close to the nerve. On my right side, the wisdom teeth is on top of the nerve or in between. I am so afraid after my doctor told me that I have a 50/50 chance of suffering from a permanent nerve damage. I couldn’t sleep or eat well because of this issue. It’s driving me nuts.
Response by Dr. Hall –
Fidelis – If I could see the x-ray, I could maybe shed more light on this matter. I also don’t know what you mean by “on top of the nerve or in between,” so I can’t give you a second opinion on how much risk there is for you. But I can tell you this: I do know that many dentists will over-state the risks involved in order to protect themselves against possible lawsuits if something should go wrong.
Is this wisdom tooth surgery being done by a general dentist or by an oral surgeon? If it is your general dentist giving you this risk assessment, I would ask for a referral to an oral surgeon and see what they say about your risks and then have the oral surgeon extract the wisdom teeth. If there is indeed a high level of risk here, you want the highest level of expertise for this surgery. If you are already in the hands of an oral surgeon, I would stay there.
One thing I would NOT do is procrastinate this surgery. You are 24. As you get older the roots of the wisdom teeth tend to thicken, the bone gets less flexible, and the risks only increase. Your best odds for this surgery are now.
Dr. Hall,
Here is the link to my X-ray. The risk is being informed by my oral surgeon. Thank you. My left wisdom teeth is partially erupted so it move away from the nerve a bit but the doctor is concern about my right side. I am having both of them removed next month.
https://m.imgur.com/TGX4Ews
Response by Dr. Hall:
Fidelis,
I looked at the x-ray, and I do think that your oral surgeon is over-stating the risk somewhat. Yes, there is a risk. But I have a couple of things to add to what you’ve been told that in my mind mollify the risk.
First, the x-ray is a 2-dimensional picture of the situation. The nerve canal is either behind or in front of the tooth and it isn’t possible from the x-ray to tell exactly how close it is.
Second, there don’t appear to be extra complications with the shapes of the roots. They look tapered, which makes it easier to take them out. The normal procedure I would do in extracting a tooth like this would be to first section off the crown of the tooth and then section between the roots and remove each root separately. It looks like they should come out cleanly. If the roots had thickened, which they tend to do as you get older, and the nerve were right up against those roots, there would be strong risk of bruising or even crushing the nerve as the root is forced out of the socket. But with tapered roots, yes, there is still a risk, but it isn’t as great.
I do want to add that you absolutely need to have these wisdom teeth out. They will, at some point in your life, cause an infection, and if you wait until that time to have them out your risks will be higher.
And I will add that if it were me, I would have the surgeon remove the upper wisdom teeth at the same time. They are useless to you, are at risk of causing you problems down the road, and would be relatively easy to have removed at the same time. I doubt you would notice any difference in your post-operative recovery to have those added to your appointment.
I also took the 3D scan. I had infection already with the lower wisdom teeth. That’s how I realize I have wisdom teeth. I will definitely go back and take out the upper wisdom teeth as well. It just they need authorization for that and it take another month to get it. I want to get the lower wisdom teeth out asap. But thanks for your advice. Your advice really eased my mind.
Is there any risk in taking out the upper wisdom teeth?
Answer by Dr. Hall:
On the lower wisdom teeth – I don’t want to say there is no risk. Yes, there is a risk of nerve damage which could be either temporary or permanent. I’m just saying that putting that at 50/50 seems to me like an exaggeration.
About the upper wisdom teeth, there is always risk, and they may try to make that sound scary, too. The risks are post-operative infection, swelling, pain, possibility of sinus perforation, and maybe they would mention some other things. None of those are really serious, and the upper wisdom teeth are situated where it would be pretty easy to take them out and the risks look minimal to me.
Dr. Hall, I am not sure if my message will reach you. I had to have braces and got 4 extractions done however my dentist left a root in and whenever I asked him about this he said it would fall out itself. I proceeded to get braces with him. However later on I decided to have a second opinion. . . . –Mozna
Note: I felt that this comment deserved a blog post of its own. You can read Mozna’s more complete story and my response here: http://www.mynewsmile.com/blog/will-taking-out-this-tooth-root-risk-nerve-damage/
I suffer from severe anxiety and panic disorder. Yes I’m “that guy” who reads far too much into things on the internet regarding all concerning things ( in this case my lower bony impacted wisdom tooth being removed next week). My dentist told me the tooth does not appear close to the nerve and shouldn’t cause any problems. I am going to see the surgeon tomorrow for my consultation, but I must say as I sit here typing this I am on roughly 10 hours sleep the past 4 days. My mind is racing and I cannot stop thinking about it. Generally speaking how often does a bony impacted wisdom tooth cause permanent loss? Ive read its roughly 0.2 percent to 2.13 percent of removals can cause this issue. Essentially, even though this article is basically a calming article, I was curious if you see it often. I really do need a piece of mind and I have a hard time expressing my concerns to new people (oral surgeon) and will probably just nod my head at whatever he tells me and walk out. But this fear will plague me. I actually went so far as to paying a premium cost to see my Doctor JUST to get his opinion on it and to see if he has ever ran into a patient who has had this problem. 130 dollars later he simply said no he hasn’t seen it but there is always risk. Is there any other evidence you can provide to show we are all just researching way too much into this? I know this sounds crazy, but it would make sense, as I truly feel I’m losing my mind ( its been a dental Hell for the past 2 years ) . I appreciate your article and any response I receive.
Response by Dr. Hall:
If the wisdom tooth isn’t close to the nerve, then there is no risk of damaging the nerve. Even if the tooth is close to the nerve it is difficult to imagine how a reasonably skilled surgeon could damage the nerve. To have nerve damage, the nerve has to be actually touching the tooth.
As far as the frequency of nerve damage from wisdom tooth extraction, I can just go on my own experience, so I would suggest relying on published research. I will say that in my career I took out hundreds of lower impacted wisdom teeth and never had a case of permanent nerve damage. I did have one patient where the nerve actually ran right through the tooth. I was able to section the tooth around the nerve and, while it wasn’t possible to avoid bruising the nerve, it remained intact. There was loss of feeling in the nerve that lasted about a year.
Hi Dr. Hall,
I am utmost 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 . . . .
Dennis
(from Dr. Hall – I answered Dennis’s question in a separate blog post about nerve damage from wisdom tooth removal.
Hi there
I’VE RECENTLY STARTED HAVING A PAIN SENSATION WHERE IT FEELS LIKE ALL MY TOP AND BOTTOM TEETH HURT. IM 32 AND HAVE ALL 4 WISDOM TEETH FULLY IMPACTED.ALL LIE ON THE MAIN NERVE. MY QUESTION IS IT POSSIBLE
FOR THIS PAIN TO GO AWAY OR IS SURGERY THE ONLY WAY TO FIX THIS? IM DEATHLY AFRAID OF NERVE DAMAGE BUT IM IN PAIN TAKING ANTI INFLAMM. EVERY COUPLE HOURS. MY GENERAL DENTIST HAS ALREADY MADE ME AWARE OF NERVE DAMAGE I DKNT KNOW WHAT ELSE TO DO.
– LINDA POWERS
Response by Dr. Hall
Linda,
I really don’t know what to tell you. There are various reasons all your top and bottom teeth could be hurting. And how much chance of nerve damage there would actually be in your case is not something I can tell from here. My advice would be to get two or three different opinions and make a judgment based on what dentists tell you. – Dr. Hall
Hello,
I am 32 and just had all 4 wisdom teeth removed. Believe me, I would have done it when I was younger, but every dentist I saw said it wasn’t necessary and if they are not causing issues, no need to remove them. Long story short, they did finally start moving when I was about 29 and I finally got them out. The bottom left tooth was the hardest to get out from what I am told. It will be a week tomorrow and I am having stabbing nerve pain in my other teeth. It is really painful and I am just worried that it won’t go away. I called the dentist and they said it can be normal, but I am a worry wort and this is pretty bad pain. I plan on going in to see the dentist if it doesn’t get better by the end of the week. Do you think this is common and will it go away? Am I just worrying too much? Any advice on this kind of pain is appreciated. Thank you!
Erika
Response by Dr. Hall:
Erika,
This sounds to me like mild nerve damage. The pain is in other teeth – I’m assuming that is your lower teeth. Nerve damage could cause pain sensations in the other teeth served by that nerve, and the nerve that goes by the roots of lower wisdom teeth serves all the lower teeth on that same side of the mouth as well as the chin and lower lip on that side. Mild damage is good news. Nerves do heal from mild damage, though they are slow to heal.
Hi Dr Hall
I have read all the responses you gave to patient having to get their wisdom teeth out. Unfortunately I am not 23 or 30. I am 64 and I have a bottom wisdom tooth impacted and they said is laying in the nerve. I am extremely afraid of the dentist over the years of horrible dentistry. Can you shed some light on this? Will I be left numb? Please if you can give me some advice whether I should get it out. One dentist said it looked like Swiss cheese either decaying or disintegrating – is that possible?
Theresa Chiara
Response by Dr. Hall:
Theresa,
Why do you have to get this wisdom tooth out? While I am a big fan of having these wisdom teeth out when there isn’t room for them to erupt normally WHEN YOU ARE YOUNG, it is a different story when you are older and the risks of complications are much greater. If it is disintegrating, why can’t you just let it disintegrate? I need more information here.
– Dr. Hall
I just want to say that this information is invaluable. It’s so hard to find first hand unbiased information. I appreciate you Dr. Hall for sharing your expertise and experience.
Dr Hall
I had my 4 wisdom teeth pulled out last week. I am still having sever numbness on my right lower side. . . .
– Elizabeth
To read the rest of Elizabeth’s question and Dr. Hall’s answer, you can visit this blog post: Numbness in her jaw after wisdom tooth removal.
Forget to mention, tooth broken off and since the prior dental surgeon cut away some slightly …so that’s it in a nutshell.
Hello Dr. Hall,
I am terrified to get my lower left wisdom tooth out. I am a 34-year-old female. The tooth is partially exposed with a cavity, and partially under gum and bone. . . .
– Keri
Read the rest of Keri’s comment, her question, and Dr. Hall’s answer in this post about her risks of having the wisdom tooth extracted.