37M: Freaking out; could someone please look at my X-rays and tell me if my bottom wisdom tooth's root is near any nerves


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I am 37M, non-smoker.

About 3 weeks ago, I extracted my upper left wisdom tooth and a week ago, I extracted my upper right wisdom tooth.

My dentist had strongly encouraging me to extra the bottom 2 wisdom tooth, both left and right. His advice is that the bottom 2 wisdom tooth will eventually erupt upwards as there is no longer a counter-force from the upper wisdom tooth, which is now gone. Is he correct? I am freaking out because he said there is a 1% to 3% chance that it might cause damage to the nerve ending. I am very afraid that I could sustain serious injury to my nerve, and I saw some posts on reddit where people had to suffer with the consequences for the rest of their live.

Could someone take a look at my X-ray and tell me if my roots of my lower wisdom tooth, both left and right, are close to my nerves?
I am not able to, for some reason, insert the photos of my X-Rays here but I have saved it in imgur and have posted an IMGUR link below:

Thank you very much!
 
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Dr M

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Good day

Your dentist is correct. Over-eruption does occur when the opposing tooth is no longer present. This occurs over months and years and not over days.
On the PAN it does look like both your wisdom teeth are in close proximity to your inferior alveolar nerve. A competent dentist, trained in oral surgery, or an oral surgeon will still be able to remove this without the risk of complications, since the teeth seem to have erupted into the oral cavity
 

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Good day

Your dentist is correct. Over-eruption does occur when the opposing tooth is no longer present. This occurs over months and years and not over days.
On the PAN it does look like both your wisdom teeth are in close proximity to your inferior alveolar nerve. A competent dentist, trained in oral surgery, or an oral surgeon will still be able to remove this without the risk of complications, since the teeth seem to have erupted into the oral cavity
Hi Dr M, thank you very much for you reply. Yes, both my bottom wisdom teeth have erupted, I can see them in the mirror but the sides of both wisdom teeth are still covered by gum. Is an erupted wisdom tooth easier to extract?

I was worried and rushed down to get a second opinion from another dentist. This dentist took X-rays again and he assessed it as "low risk" of nerve damage, which I was initially relieved. But his charges are a lot more expensive.

Just curious, how many times in a day is it safe to take dental X-rays? I had taken 2 X-rays on 29 June and another 2 x-rays today on 7 July but am thinking of getting a third opinion.
 

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Dr M

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Erupted wisdom teeth are usually easier to extract, because it might not need any surgical drilling. Just maybe a small releasing incision over the gum tissue that is covering the tooth.
I agree that your teeth have a low risk of nerve damage.
With modern digital x-rays, the radiation dose is very small, so you don't have to worry.
 

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Erupted wisdom teeth are usually easier to extract, because it might not need any surgical drilling. Just maybe a small releasing incision over the gum tissue that is covering the tooth.
I agree that your teeth have a low risk of nerve damage.
With modern digital x-rays, the radiation dose is very small, so you don't have to worry.
Hi Dr M, thank you very much for your reply. I was a bit worried about radiation because I took 2 bitewing x-rays on 29 June and another OPG X-Ray on 7 July.

I am surprised to hear that surgical drilling is not necessary. The below are some photos I took of my tooth; do you think it will be a difficukt extraction:

Althought it dosnt look that way, this is actually the lower wisdom tooth on left from my perspective, which I think is tooth number 17 under the "universal numbering system" (aka American system)
20220706_225741.jpg

20220706_225652.jpg


This, on the other, is the lower wisdom tooth of my right fron my perspective, which I think will make it tooth number 32 under the "universal numbering system" (the American system):

20220706_230109.jpg

20220706_230202.jpg
 

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Dr M

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From the photos, the teeth are erupted into the oral cavity. There is a high chance that this will only be normal extractions.
 

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MattKW

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I am 37M, non-smoker.

About 3 weeks ago, I extracted my upper left wisdom tooth and a week ago, I extracted my upper right wisdom tooth.

My dentist had strongly encouraging me to extra the bottom 2 wisdom tooth, both left and right. His advice is that the bottom 2 wisdom tooth will eventually erupt upwards as there is no longer a counter-force from the upper wisdom tooth, which is now gone. Is he correct? I am freaking out because he said there is a 1% to 3% chance that it might cause damage to the nerve ending. I am very afraid that I could sustain serious injury to my nerve, and I saw some posts on reddit where people had to suffer with the consequences for the rest of their live.

Could someone take a look at my X-ray and tell me if my roots of my lower wisdom tooth, both left and right, are close to my nerves?
I am not able to, for some reason, insert the photos of my X-Rays here but I have saved it in imgur and have posted an IMGUR link below:

Thank you very much!
I've been a dentist for 40 years, and now semi-retired and teaching extractions at Uni. In your case, there is a small risk of nerve damage, about the same risk as when you cross the road as a pedestrian. I consider the difficulty to be low-medium. The difficulties I see with your lower wisdoms are:
  1. There is limited access for dental instruments way back there. If you have the right instruments and skills, it won't be too worrisome.
  2. The bone behind your wisdoms is higher than for other teeth in a more forward position, so more effort and care will be required.
  3. The roots (2 or 3?) are quite divergent for lower wisdom teeth. Usually they are more cone-shaped and easier. I see that your upper wisdoms were also quite divergent, so if your dentist coped OK with the uppers, then he is probably quite capable of removing the lowers. Sometimes divergent roots require them to be drilled into separate roots to make the overall extraction easier.
  4. In the sort term (5-10 years), there is little risk of problems if you leave the lower wisdoms in there. But... I would also recommend their removal sooner rather than later because the difficulty starts to increase significantly over the age of 30yo, and if you are young and in good health, it will be easier and you will heal better.
    The long-term risks is that if you wait till you are 60yo+, then it is quite likely you might have other health issues (diabetes, high blood pressure, osteoporosis, blood thinners) that would make it a much more risky procedure requiring possible day hospital and specialist removal.
 

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I've been a dentist for 40 years, and now semi-retired and teaching extractions at Uni. In your case, there is a small risk of nerve damage, about the same risk as when you cross the road as a pedestrian. I consider the difficulty to be low-medium. The difficulties I see with your lower wisdoms are:
  1. There is limited access for dental instruments way back there. If you have the right instruments and skills, it won't be too worrisome.
  2. The bone behind your wisdoms is higher than for other teeth in a more forward position, so more effort and care will be required.
  3. The roots (2 or 3?) are quite divergent for lower wisdom teeth. Usually they are more cone-shaped and easier. I see that your upper wisdoms were also quite divergent, so if your dentist coped OK with the uppers, then he is probably quite capable of removing the lowers. Sometimes divergent roots require them to be drilled into separate roots to make the overall extraction easier.
  4. In the sort term (5-10 years), there is little risk of problems if you leave the lower wisdoms in there. But... I would also recommend their removal sooner rather than later because the difficulty starts to increase significantly over the age of 30yo, and if you are young and in good health, it will be easier and you will heal better.
    The long-term risks is that if you wait till you are 60yo+, then it is quite likely you might have other health issues (diabetes, high blood pressure, osteoporosis, blood thinners) that would make it a much more risky procedure requiring possible day hospital and specialist removal.
Thank you very much.

My dentist did okay with my upper left wisdom but struggled with my upper right wisdom tooth. The procedure for my upper right wisdom tooth took longer than expected and he was visibly struggling and panting. He told me it was due to my "bone is very strong", in his words. A bit of my "distal bone" came out as well.
 

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So happy to see well educated people here, yes - your dentist is correct indeed and Mr. MattKW did a great job explaining the difficulties in-depth.
Keep this post updated, would love to see how this works out for you, Roland. All the best!
 

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So happy to see well educated people here, yes - your dentist is correct indeed and Mr. MattKW did a great job explaining the difficulties in-depth.
Keep this post updated, would love to see how this works out for you, Roland. All the best!
Thank you so much to all the dentists here. My appointment is only in 6 hours time. I am going down, hear my dentist talk one more time. I am trembling with fear and worried and it does not help that I am still in the office struggling with my workload.
 

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MattKW

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Thank you very much.

My dentist did okay with my upper left wisdom but struggled with my upper right wisdom tooth. The procedure for my upper right wisdom tooth took longer than expected and he was visibly struggling and panting. He told me it was due to my "bone is very strong", in his words. A bit of my "distal bone" came out as well.
The bone around upper wisdom teeth is "softer" than lowers. However, I saw that your upper wisdoms had divergent roots, so it doesn't surprise me that he found them harder than usual.
 

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The bone around upper wisdom teeth is "softer" than lowers. However, I saw that your upper wisdoms had divergent roots, so it doesn't surprise me that he found them harder than usual.
Thank you very much for your advice, much appreciated! :)

I am now heading towards the dentist on the metro train, one hour and 15 mins to go till my appointment. A strange fatalistic feeling has come over me. Hopefully, the extraction goes smoothly, my recovery will be smooth and I don't incur any nerve damage!
 

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The bone around upper wisdom teeth is "softer" than lowers. However, I saw that your upper wisdoms had divergent roots, so it doesn't surprise me that he found them harder than usual.
Thank you.

Just to give everyone an update, I just came out from the dentist.

He took a look at my wound and decided not to do an extraction. He said he wanted to give my gums some time to heal first before doing an extraction. The next appointment will be on 12 August.
 

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Thank you.

Just to give everyone an update, I just came out from the dentist.

He took a look at my wound and decided not to do an extraction. He said he wanted to give my gums some time to heal first before doing an extraction. The next appointment will be on 12 August.
Great to hear this, I trust you're in good hands.
 

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So happy to see well educated people here, yes - your dentist is correct indeed and Mr. MattKW did a great job explaining the difficulties in-depth.
Keep this post updated, would love to see how this works out for you, Roland. All the best!
Just to keep everyone in this thread updated, tomorrow is the date for my lower left wisdom tooth extraction.

The last time I met the dentist, at least this time, he made the effort to explain a bit more.

He explained that as my lower left wisdom tooth roots extended downwards in a vise-like pincer grip, he will need to saw my teeth into half and then extract them one-by-one.

Also, with regards to nerve damage, he said that as my nerves pass below the roots, rather than in-between, he rated it as "low-to-medium" difficulty.
 

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The bone around upper wisdom teeth is "softer" than lowers. However, I saw that your upper wisdoms had divergent roots, so it doesn't surprise me that he found them harder than usual.
Thank you very much for your reply.

Just to check, are divergent roots the part of the roots that extend upwards like a pincer (according to my x-ray)?
 

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