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Nerve damage is a potential complication of wisdom tooth removal, but it is uncommon. Imaging allows us to evaluate the position of the tooth and nearby nerves before surgery so treatment can be carefully planned to reduce this risk.
Why Can Wisdom Tooth Removal Affect a Nerve?
Nerve injury can happen if a nerve is stretched, compressed, bruised, or otherwise affected during surgery. The risk is not the same for every wisdom tooth. Lower wisdom teeth may require more careful planning because of their position in the jaw and the structures around them.
Factors that can influence surgical difficulty and nerve risk include:
- The shape and position of its roots
- The angle of the tooth
- The amount of bone surrounding it
- How close the tooth is to the nerve canal
Nerves Near the Lower Wisdom Teeth
The inferior alveolar nerve travels through a canal inside the lower jaw and provides sensation to the lower teeth, lower lip, and chin. This is the primary nerve evaluated when imaging shows that lower wisdom tooth roots may be close to the nerve canal.
The lingual nerve runs through the soft tissue along the tongue side of the lower jaw. Although it cannot be assessed on dental imaging in the same way, it may also be affected during lower wisdom tooth surgery and can cause changes in tongue sensation or taste.
Evaluating Nerve Position Before Wisdom Tooth Removal
A panoramic dental X-ray is often the starting point. It provides a broad view of the jaws and can show the wisdom tooth roots in relation to the canal that contains the inferior alveolar nerve.
Sometimes that image provides enough information to plan surgery. If the roots appear very close to the canal, however, a two-dimensional X-ray may not show the complete relationship. That is when a CBCT scan can be especially useful.
CBCT Imaging
Cone beam computed tomography creates a three-dimensional view of the teeth and jaw. It can show whether the nerve canal runs:
- Beside the wisdom tooth roots
- Below the roots
- Between or very close to the roots
This additional detail gives us a clearer view of how closely the tooth roots and nerve canal are related.
Treatment Options When a Tooth Is Close to a Nerve
Finding that a wisdom tooth is close to the nerve does not automatically mean it cannot be treated. We look at why the tooth needs treatment, its position, root health, and its relationship with the nerve. Depending on those findings, complete removal may still be appropriate.
For certain high-risk lower wisdom teeth, another option is a coronectomy. During a coronectomy, the crown of the wisdom tooth is removed while healthy, stable roots are intentionally left in the jaw. The purpose is to address the tooth while avoiding unnecessary movement around roots that sit very close to the inferior alveolar nerve.
What Does Wisdom Tooth Nerve Damage Feel Like?
Because these nerves carry sensation, nerve injury causes changes in feeling rather than weakness or problems moving the muscles of the face.
Symptoms involving the inferior alveolar nerve may include:
- Numbness in the lower lip or chin
- Tingling or pins-and-needles sensations
- Reduced sensation
- Unusual sensitivity or altered feeling
If the lingual nerve is affected, symptoms may involve:
- Numbness or tingling along one side of the tongue
- Reduced sensation in part of the tongue
- Altered taste in some cases
It is important to separate nerve symptoms from normal numbness caused by local anesthesia. Your lip, chin, or tongue can remain numb for several hours after surgery simply because the anesthetic has not worn off yet.
Careful Planning Starts Before Wisdom Tooth Removal
The goal of wisdom tooth treatment is not simply to remove a tooth. We also want to protect the important structures around it.
At Foley & Le Oral Surgery, Dr. Benjamin Foley, Dr. Thao Le, and Dr. Michael Schiappa carefully evaluate the position of your wisdom teeth and nearby anatomy before recommending treatment. When a tooth presents a higher risk, we use that information to plan the safest appropriate approach.
If you have been referred for wisdom tooth removal or have questions about a wisdom tooth close to a nerve, book an appointment at our oral surgery office in Boulder, CO, call (303) 444-2255 or visit us at 1420 28th St, UNIT 100, Boulder, CO.
FAQs
How common is nerve damage after wisdom tooth removal?
Nerve injury is an uncommon complication of lower wisdom tooth surgery, and the individual risk varies greatly depending on the position of the tooth and its roots. Teeth that are closely related to the inferior alveolar nerve require additional consideration during treatment planning.
Can upper wisdom teeth cause nerve damage?
The nerve concerns discussed with wisdom tooth removal mainly involve lower wisdom teeth. Upper wisdom teeth have different nearby structures, including the maxillary sinus, so the surgical considerations are different.
Can a damaged dental nerve heal on its own?
Some nerve injuries improve on their own, particularly when the nerve has been stretched, compressed, or bruised rather than severely damaged. Recovery varies, so ongoing changes in sensation should be monitored.
What happens if my wisdom tooth roots are wrapped around the nerve?
Imaging is needed to determine the actual relationship between the roots and nerve canal. If removing the roots is considered high risk, we may discuss whether a coronectomy is an appropriate alternative to complete extraction.
