Dr. Hall,
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. Long story short they tried to remove the root but couldn’t and now I have to get general anesthesia and I am told the root is sitting on a nerve after having X-ray done. I am beyond petrified for this procedure, my surgeon said there are risks involved and I could have numbness. I fear any facial paralysis.
Thanks,
Mozna

Mozna,
I would have been helpful to have known which tooth we’re talking about here. It sounds like it would be a lower premolar. I’m going to make some assumptions here to try to be helpful to the general audience. If I’m off a little concerning your situation, hopefully I’ll be helpful to others.

First of all, on leaving the root in. As you can now see, your first dentist was incorrect. Tooth roots that are left in do not fall out on their own. The bone heals around them and they remain in place, buried in the bone. Now they don’t always have to be removed. If it is just a small root tip, say, in the case of a wisdom tooth extraction, there could be significant risk in going after that root tip, while the chances of it causing any trouble down the road are very small.

In your case, however, if this is a lower premolar and you’re getting braces, that space that is left by the extraction will need to be closed, and the root could get in the way of that. I’m fuzzy about whether or not you had these braces yet or not. If you haven’t, the root probably needs to be removed. If you have already had the braces and are pleased with the results, I’m not sure why the root would need to be taken out. Are you having some kind of trouble?

I’m also noticing that you are using the term “root” and not “root tip,” seeming to indicate that this is a pretty sizeable chunk of the tooth that is left. But if it is large it would have gotten in the way of moving your teeth with the braces. So I’m not sure what your condition is or how to advise you here.

But now let’s go to the surgeon and the risks of having this tooth root removed. Unfortunately, the courts and lawyers have created a climate where dentists are very afraid of lawsuits. To protect themselves, they will exaggerate the possibility of risks. When I was practicing, I resisted this tendency, because I didn’t want to cause unnecessary anxiety in my patients. So while I tried to give an accurate assessment of the risks that could be involved in various surgeries, I didn’t exaggerate them as many dentists do. I don’t ever remember telling a patient there could be a risk of nerve damage for any extraction other than a lower wisdom tooth. The roots of lower premolars are often near what is called the mental foramen, which is where the mental nerve comes out of the bone. This nerve goes to the lower lip and chin. Severing this nerve would cause a loss of sensation in the lip and the chin. “Paralysis” is too strong a word here, in my opinion, because that implies a loss of movement, which would not occur–only a loss of sensation. And it is very easy for the surgeon to see this foramen on an x-ray, and very easy to find it surgically. With good surgical technique, there should be no difficulty for the surgeon to avoid damage to this nerve.

Hopefully, this eases your anxieties.

Dr. Hall

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