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
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