Impacted wisdom teeth

Via email Wensday.February, 24, 2010. Anonymous.

Q: A friend of mine has recently been examined regarding some pain in his jaw that one dentist already misdiagnosed as cavity pain. It turns out that after being examined by specialists at a very good university research hospital that in fact he has some very seriously disoriented wisdom teeth – teeth that are growing horizontally inside the gum and the roots are tangled up with nerves that control feeling in the tongue. They say that operating will very likely cause a loss all feeling in his tongue..for life. That sounds pretty horrible and there seems to be no alternate solution. What advice can you give in a case like this? Is a good surgeon really likely to damage the nerves in this area or are they just ‘speaking cautiously’? Are there any alternative options?


A: Thank you for the question. First off, I am glad that he has got a second opinion from a specialist, I am assuming the specialist he saw was an oral surgeon. Wisdom teeth unfortunately can form and be impacted (under the jaw either interfering with other teeth or imbedded in the jawbone itself). It sounds like in your friend's case his are horizontally impacted which would then mean they would be moving towards his teeth in front of the wisdom teeth and in near the inferior alveolar nerve. In many cases where the wisdom teeth are impacted in this way they interfere or are intertwined near this nerve, this is when the decision whether to take the wisdom teeth out or leave them in comes to play. It sounds like he is having discomfort with the wisdom teeth and the teeth they are impeding on, in this case the decision to extract them needs to be weighed with the possible side effect of developing paraesthsia (numbness) due to damage to the nerve during the extraction. In some cases this cannot be avoided as the nerve is directly around the wisdom tooth.

I would suggest your friend think about the decision to extract after a thorough discussion with the oral surgeon he is being examined by.

A wisdom tooth protrudes outwards from the gumline at the back of the lower teeth.

"Just Take It Out, Doc" - Better Yet, Not So Fast!

Yes, some teeth cannot be saved, no matter what heroic measures are taken to try and save them.

Other teeth can be saved, but the patient wants them removed because of the immediate tooth pain, or perceived financial pain to save them. In the long run, pulling a tooth that can be fixed is a mistake. Period.

Here are some of the things that can happen when one or more teeth are pulled:

• Adjacent teeth or opposing teeth (the ones the extracted tooth once chewed with) will shift;
• The bone that once supported the tooth's root will resorb (melt away) reducing the strength of your jaw;
• As teeth shift, the remaining teeth will meet at odd angles, increasing the wear to those teeth, and increasing the risk of fracture;
• Also, as teeth shift, gaps may appear in areas where the teeth once touched. This allows for more food to be caught between the teeth, and causes the gums be become irritated and inflamed;
• If many teeth are lost, and consequently much jaw bone is lost, there is a potential increase of jaw fractures;
• If not many teeth remain, the stability and retention of removable dentures decrease;
• As teeth are lost, and if they are not replaced, diet and nutrition suffer, as the diet becomes one of soft foods; and
• The way your face looks will change - sagging of the skin, skin folds around the mouth and wrinkles increase.

Lost teeth can be replaced with many different restorative options. A patient can have a flipper, a Maryland bridge, a traditional bridge, an implant or a denture depending on the number of teeth that are missing, the overall dental and medical health of the patient, the time available for treatment, and the cost of the treatment.