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. I’ve been to a surgeon who said there is a risk of nerve damage but he did not do a 3D scan to see how close it is to the nerve. I’ve sent you a copy of my recent x-ray:
A dentist said I am high risk because of the terrible angle of my tooth and because the tooth is next to a molar with a root canal. I don’t know if high risk means its a dangerous procedure, or high risk of nerve damage. Also terrified of this procedure changing my face. Thank you.
(See Dr. Hall’s answer below.)
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So you’re 34 years old. Oh, this would have been so easy 15 years ago. I am really bothered by a minority of dentists and some others who tell people to not do anything about their wisdom teeth until they bother them. You’re a great illustration of why that thinking is so wrong-headed. Before the roots fully form and before they start to thicken and before the bone gets denser, these wisdom teeth are fairly easy to take out. Now, for you, they are clearly going to be a lot more difficult. But your lower left wisdom tooth absolutely needs to come out—it will only get riskier and harder for you the longer you wait. And it’s only a matter of time before it develops an infection. But I think I can set your mind at ease somewhat.
This lower left wisdom tooth does not look like it impinges on your nerve at all. Yes, any responsible oral surgeon is going to need to tell you that there is some risk, because there is some risk. But with the help of a 3-D scan, he or she should be able to navigate around the nerve. Please remember that the tendency of many oral surgeons is to exaggerate the risk when they explain this. They do this to protect themselves against possible lawsuits.
I am less certain about your wisdom tooth on the other side, and I’m hoping that one never gets to the point where it bothers you. The way the roots are more radiolucent right where the nerve canal goes by them makes me think that the roots are very close indeed to the nerve, maybe even wrapping around it.
The angle of the tooth is not a risk. It’s a complication making the extraction more difficult. And being close to the tooth with the root canal means that the surgeon needs to be more careful, but a skilled surgeon shouldn’t have that much problem with that. I don’t see how this procedure could change your face. Yes, your face will be swollen after the extraction, but that will go down after a few days and you’ll be back to normal.
I would be sure you have an excellent oral surgeon taking this out for you, and I would have the surgeon take out both your upper wisdom teeth while he or she is at it. They are also impacted and need to come out, and will be much easier than the lower. I would also have the surgeon evaluate, with the 3-D scan, the position of the nerve in relation to the lower right wisdom tooth and consider taking that one out also, unless it actually does impinge on the nerve.
– 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.