Complicated wisdom tooth extraction situation. Panoramic X-Ray photo included.

[agold2009]

Complicated wisdom tooth extraction situation. Panoramic X-Ray photo included.

I visited an oral surgeon today due to pain in my upper right molar area. It seems that the wisdom tooth is putting pressure on the root of my last tooth which is causing the pain.

I have put off removing my wisdom teeth for a few years now due to the concern of my lower wisdom teeth being too close to the nerves (more specifically the left side).

I have decided to go forward with the upper extraction, even though the surgeon explained that the extraction of the upper is slightly difficult but not much more than a normal extraction.

On the other hand, the lower wisdom teeth are under bone, and close to the nerve. This could cause nerve damage, and as the doctor explained, the surgery associated with removing the lower wisdom teeth would be quite difficult.

I spoke with another dentist friend of mine after showing him the x-rays and he recommended, if possible to extract the lower wisdom teeth, as it could cause future problems with the roots (or something of that nature.. I forgot exactly the reasoning why) of my other lower teeth.

At this time, I only have pain in my upper left side, but I figure if I'm going under the knife to remove the top two, why not just do the bottom as well. This is my dilemma as I am very concerned about the nerve damage and the associated difficulty in removing the lower teeth impacted under bone.

The likelihood of nerve damage in my case is obviously elevated so I really don't know what to do at this point.

Any recommendations and help would be greatly appreciated!

 

[decan]

Re: Complicated wisdom tooth extraction situation. Panoramic X-Ray photo included.

One option may be to do a cone beam CT to see how close the teeth really are to the nerve. A panoramic is a 2D representation of a 3D object. It may look like the tooth is really close to the nerve (and in the image it absolutely does). But in reality the nerve may pass in front of, or behind the tooth.

Good luck!

 

[agold2009]

Re: Complicated wisdom tooth extraction situation. Panoramic X-Ray photo included.

One option may be to do a cone beam CT to see how close the teeth really are to the nerve. A panoramic is a 2D representation of a 3D object. It may look like the tooth is really close to the nerve (and in the image it absolutely does). But in reality the nerve may pass in front of, or behind the tooth.

Good luck!

Thank you for the advice. Assuming that I did a Cone beam CT and the nerve was not as close as it seems, do you believe a extraction of lower teeth are warranted or best to leave them alone unless they are causing pain, discomfort etc.

Thanks again

 

[DrMike]

Re: Complicated wisdom tooth extraction situation. Panoramic X-Ray photo included.

Hi
Obvioulsy it is hard to advise when unable to see inside the mouth, however the xray does give alot of information.
You should go with whatever opinion you trust the most and the following is just my personal opinion based on the information I have.
If you have not had any pain with the lower wisdom teeth, current recommendations stipulate that you should leave them alone. Yes a CT scan will show exactly where they are, but even from a panoral I can see that these are deeply placed, and likely to be close to the nerve.
If these were my lower wisdom teeth and they had been causing no pain, I would 100% decide to leave them as they are. There is a good chance that they won't move from where they are and they will stay 'stuck', under the bone. This is fine however they should be xrayed every few years. If they are partially erupted (which doesn't look to be the case)- then plaque and food can trap between the wisdom tooth and the back of the 2nd molar- causing decay and in some cases tooth loss. There is no sign of that happening in your case- looking at thee xray. It is rare that I would offer strong clinical advice on the forum without seeing inside the mouth of the patient, however, everything I can see here is pointing towards the fact that you should leave the lowers as they are. The chance of problems with the nerve following wisdom tooth removal is generally low, however it is increased when the root is close to the nerve (which is true in your case). many people have to accept these low risks as they have no other option really other than to remove a decayed or painful lower wisdom tooth. My strong feeling is - why risk it when there is no obvious clinical indication to remove them?

With regards to the uppers- it sounds like you have settled on having them out. Be aware however that there is a chance that the pain you have had could have been sinusitis. I may be barking up the wrong tree, however, these wisdom teeth are close to the floor of the sinus, and it would be easy to confuse a sinus issue with pain from wisdom teeth. Have you had a cold/had a blocked nose recently?
Although upper wisdom teeth are generally easier to remove, again in your case, they have not come through very far yet and are potentially close to the sinus. This means there may be a risk or a communication developing beetween the mouth and the sinus itself when the teeth are removed. Your oral surgeon should chat to you about this and if they are concerned that there is a risk in your case. Again, if I were the clinician, I'd want to be sure that the pain is coming from the upper wisdom teeth, and that there is no room for them, before removing them and risking any complication.
Sometimes there will be a bit of 'teething' pain as wisdom teeth erupt. From where they are and what you have said, I'm guessing that you are in your early to mid 20s? If the pain is low level, and infrequent, it may be worth hanging on a few more years to let them erupt further. This would make them easier to remove.

Hope all goes well whatever you decide- I hope my thoughts are of some help.
Best wishes
Dr Mike

 

[coolin]

Re: Complicated wisdom tooth extraction situation. Panoramic X-Ray photo included.

I'm curious about the seemingly 'poles apart' view on what to do about wisdom teeth between the US and the UK. It almost seems routine to extract no matter what in the US yet here in the UK we leave them alone. At the age of 40 plus I have all of mine with only occasional minor discomfort over the years.
And anyway - what are wisdom teeth for?

 

[DrMike]

Re: Complicated wisdom tooth extraction situation. Panoramic X-Ray photo included.

The UK recommendations by the National Institute for Clinical Excellence- (aka NICE) changed about a decade ago.

The current recommendation is to leave wisdom teeth alone unless they are infected, decayed, causing pain, damaging other teeth or it is evident that they will cause problems. These guidelines are based on the NICE panel of experts looking at all the available evidence based literature.

Opinions on treatments will always vary from dentist to dentist, and country to country (even state to state). In the UK, we have to comply to national regulations, which are set by bodies such as NICE, and which are then upheld as best practice so far as the General Dental Council are concerned. I am not sure how the process works in the US, but I am aware that each state has it's own set of regulations, meaning that there are probably different regulations and guidance state to state.

Of course, each case has to be individually assessed, and the wishes of the individual patient taken into consideration and discussed before advising on the best options!

Hope this sheds a little light on the topic!

Regards

Dr Mike

 

[DrMike]

Re: Complicated wisdom tooth extraction situation. Panoramic X-Ray photo included.

oh, and in answer to your other question- wisdom teeth are a throw back from when human jaws were bigger. also- by the time someone reached their 20s, there was a strong chance that they may have lost some back teeth. The wisdom teeth then erupt into fill the space.
With modern dentistry we tend to keep our teeth. This combined with having smaller jaws means- they often get trapped!