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.

February 14, 2018

Days of pain after a root canal treatment


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Dear Dr Hall,

I found your page on post root canal pain the be very reassuring, thank you.

I was hoping that you might be able to advise on my particular case.

I had quite a traumatic root canal (my first ever) done over 3 sessions in October 17. It remained painful so I didn’t get it crowned as I wanted to wait . The discomfort persisted and I was referred to an endodontist who after reviewing X-rays suggested that a canal might have been missed. Based on that I decided to have it redone.

During the procedure no missing canals were found. I could feel discomfort close to the bone where it felt raw and exposed, the root canal was completed and I was advised I would be in discomfort for a few days.

I am now on day 4 of immense discomfort and I intend to ring up for some advice tomorrow. I feel worried that things haven’t worked and I’ll have to have the tooth removed.

How long should it take to calm down do you think before I jump to conclusions and assume something nasty is happening in there? This has been a worry for 5 months now, I just don’t know what to do and I don’t want anybody else fiddling with my tooth anymore.

Your advice would be greatly appreciated.

Regards,
Michelle from the UK

Michelle,
The key in evaluating your tooth and whether or not the root canal treatment is successful or not isn’t how long you are in discomfort, but the direction the discomfort is going. Is it getting better, albeit slowly? If so, I’d be optimistic.

The fact that your endodontist predicted that this would hurt for a few days adds to my optimism here. If the treatment weren’t working, you could be having some increased swelling. I take it that isn’t happening in your case.

The root canal failure at the hands of your general dentist apparently wasn’t the result of a missed canal, but may have been an inadequate seal at the end of the root.

Dr. Hall

Do you have a comment or a question or anything else to add? 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.

September 9, 2017

Swelling after a tooth extraction


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Dr. Hall
The tooth right beside my lower left wisdom tooth was extracted last Wednesday. There was swelling already on my jaw before the extraction. After extraction, the dentist prescribed amoxicillin for the infection. After 3 days, the swelling has worsened and pain killers are no longer helpful. The swelling below my jaw hardened and is larger than half of a golf ball.
– Jem from the Philippines

Jem,
It sounds like your infection is getting worse, even with the antibiotics. You need to report this to your dentist and he or she should switch antibiotics. I don’t think your dentist has done anything wrong here—amoxicillin is a good first choice for an infection from a tooth. But there are many infections that won’t respond to amoxicillin, sometimes because the bacterial strain has developed amoxicillin resistance.

These infections in the jaw can become quite serious, so I wouldn’t mess around with this but work with your dentist to find an antibiotic that will get this infection under control.
– Dr. Hall

Do you have a comment or a question or anything else to add? 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.

April 27, 2010

Surprised at the amount of swelling after wisdom teeth removal

Filed under: Wisdom teeth — Tags: , , — mesasmiles @ 8:50 am

My son had 4 wisdom teeth removed two days ago, and from the removal his face is severely swollen on the left including his eye. I am seriously concerned could he possibly have nerve damage that is affecting his eye and! jaw which would require additional surgery? Or will anti-inflammatory medication, time, washing with warm salt water and penicillin help decrease the swelling? Thank you From Mother with frustrated son
Angela in Maryland

Angela,
You’re e-mailing me two days after this surgery, which is typically the worst day for the swelling, and then it tends to go down after that. I’m not hearing anything from you suggesting any nerve damage. The swelling comes from the surgery and always happens when you have impacted wisdom teeth removed. If the upper left wisdom tooth was a little difficult and required removing bone to get it out, as they often do, that tooth is very near the eye and the swelling will be up in the eye area. Now I can’t examine him, so I’m just going by what you are telling me. But you’re not telling me anything unexpected, really.

I would just follow the instructions of the dentist who took them out, and I would expect steady improvement. After tomorrow, if at any time his situation gets worse – the swelling increases instead of decreasing, or there is an increase of pain from one day to another, then you should tell your dentist, and your son may need additional help.

You may give some feedback to the dentist that took them out. We always tried to brace our patients for the worst, and we described a worst-case scenario of what they would experience afterwards, so they didn’t worry if that happened. It’s not smart to paint too rosy a scenario for the patient – I would put my optimistic outlook aside and describe the worst I thought could reasonably be expected. If you weren’t expecting this, maybe your dentist could use a little lesson in post-operative instructions.

– Dr. Hall

Related link: read about tooth infection.

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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