Wisdom Teeth Removal Nerve Damage
So, a patient came into my office with severe wisdom teeth pain and wanted them out. However he told me he had seen several other dentists, who all had told him that if was to get his wisdom teeth out, he wouldn’t be able to feel his face anymore and not be able to speak correctly in the future. I told him although his wisdom teeth were very close to the roots, that what they told him was a grossly incorrect.
Now, this is this patient’s two-dimensional panoramic radiograph that we typically like to take before we examine and consult a patient before taking out their wisdom teeth. First thing that I see is that the lower wisdom teeth back here highlighted in red are very close to the nerve here highlighted in blue. The nerve in question is what we call the inferior alveolar nerve. As you can see, it is this nerve that we can trace out on both sides of your jaw. The function of this nerve is to basically innervate the teeth and the lips and chin area on each respective side of your jaws. It is a sensory nerve. It is not a motor nerve, meaning that it does not move anything. It is literally just a sensory nerve that helps us to know what’s going on with our teeth, to feel any changes in our teeth, to also be able to feel sensation on our lips and our chin.
So, whenever we’re taking out wisdom teeth, we’re always worried about damage to this inferior alveolar nerve. As we take a look here, again, with this two-dimensional radiograph, it is almost impossible to tell how close this is to the nerve because again, this is a two-dimensional radiograph and the roots are superimposed over this. Now because this panoramic X Ray is limited in its ability to diagnose potential nerve damage, that’s why I like to refer to the 3D x-ray and this is what we call the 3D CBCT scan. So, what I do is I have to evaluate in the third dimension of where the nerve is.
When I look at a case like this and I see the proximity of that nerve to the roots I would say maybe 10%, 20% chance that you might get some sort of numbness of the nerve, paresthesia of the nerve, after you get your wisdom teeth out. What does this mean? It means you may get some tingling or numbness on your lips, whether it lasts for a few days or maybe it could even last up to a few weeks or worst-case scenario, several months to the rest of your life. I only give a bad percentage like this because I like to under promise and overdeliver.
Realistically, if this was my mouth, how long would I expect to be numb if that was the case? I’d say the overall percentage is maybe 5% to 10% chance. Most likely it might last for a few days to a few weeks. That’s realistically what I saw. He had visited multiple dentists who had told him that he would not be able to feel his whole side of that face and that he wouldn’t be able to talk properly after this. I do not believe the dentists he saw earlier knew what they were talking about and had much experience. Another thing that concerns me about these other dentists is I asked him specifically, did any of these other dentists show you this 3D scan before giving you this advice or telling you the likelihood of potential nerve damage. His answer was that he had never seen this time of scan before.
My advice is do not get your wisdom teeth removed without getting a 3D CBCT scan. I would not remove any sets of wisdom teeth anymore without this. 9 years and 10,000 cases of wisdom teeth experience has taught me there are so many different variations with anatomy with different people that you want every bit of knowledge that you possibly can have before getting your wisdom teeth removed. This 3D scan just gives us so much more extra information that it’s the right thing to do.