Taking out an impacted wisdom tooth intertwined with or compressing a nerve presents multifaceted risks in oral surgery. As the last molars develop, often between ages 17 to 25, wisdom teeth situated at the very back, top, and bottom gums become impacted when there is insufficient space for them to erupt properly. These deeply embedded teeth may then cause extensive problems like infection, cysts forming, and destruction of neighboring teeth. In particular, when the wisdom tooth grows horizontally, or the roots wrap around critical sensory nerves such as the inferior alveolar nerve running through the lower jaw, extracting it poses further difficulties and the chance of nerve injury. Careful review and planning are warranted to mitigate complications when removing wisdom teeth that are anatomically hooked under or pressed upon nerves.
Evaluating the Tooth-Nerve Relationship
According to one of the best dentist in Scarborough, the first step is diagnostic imaging to visualize the anatomy and determine the tooth positioning and its spatial relationship to the nerve canal. Two common methods are cone beam CT scans and panoramic X-rays. The images show the number, shape, and depth of wisdom tooth roots, root curvature, and contact points with the nerve canal. This informs the orthodontist on risks like nerve exposure during extraction. Additional critical factors are root development – ankylosed or hooked tips may require sectioning, the tooth angle sideways into the jawbone, and bone density to assess the difficulty of tooth removal.
Surgical Approaches to High-Risk Extractions
For high-risk impactions, oral surgeons may use coronectomy, a selective removal technique that extracts the crown but leaves the roots intact to protect the nerve. Other surgical approaches include odontosection, sectioning the tooth into smaller, easier-to-remove pieces if the roots are curled, and orthodontic extraction, which uses appliances to reposition the tooth first gently. During any extraction, surgeons take precautions like tooth sectioning under irrigation coolant to prevent bone heating and minimize manipulation of root tips near nerves. They may use products like GelFoam to insulate exposed nerves.
Nerve Injuries: Symptoms and Recovery Rates
Despite best efforts, removing wisdom teeth hooked under nerves holds an inherent risk of nerve damage from manipulation pressure or root fragment displacement. Nerve injuries cause several typical sensory symptoms like pain, numbness, or tingling in the chin, lips, tongue, teeth, or surrounding areas, which indicate possible compression, stretching, or laceration trauma. Most often, the inferior alveolar type affects the lower lip and chin regions. In a study across high-risk cases, 15.5% showed altered sensation after 6 months. However, many nerve impairments significantly recover over time. Complete recovery rates increased from 60.8% at one month to 78.7% after 6-8 months. Knowledge of expected outcomes helps manage patient expectations.
Supportive Treatments to Restore Nerve Function
While most nerve damage repairs naturally, therapies can support and hasten the process. Using anti-inflammatory drugs helps decrease swelling pressure on affected nerves. Corticosteroid injections may modulate healing for faster regeneration. Low-level laser therapy and therapeutic ultrasound use targeted energy waves to stimulate nerve cell rebalancing and growth. Acupuncture can improve blood circulation and activate repair mechanisms as well. Finally, chewing gum helps prevent biting injury and overclosure from lack of sensation. Implementing adjunctive treatments soon after wisdom tooth removal surgery optimizes outcomes when managing difficult impactions.
