Wisdom teeth, or third molars, are the last set of teeth at the back of the mouth that usually emerge in late adolescence or early adulthood. However, not all wisdom teeth grow properly. In some cases, they can become impacted, meaning they do not fully erupt through the gum line or are positioned at an angle that can lead to complications. One concern for people with impacted wisdom teeth is whether these teeth can cause nerve damage. Understanding the potential risks involved can help individuals make informed decisions about their oral health and whether treatment, such as removal, is necessary.
What Are Impacted Wisdom Teeth?
Impacted wisdom teeth occur when there is not enough space in the jaw to accommodate the normal growth of these molars. The teeth may be unable to emerge fully or may grow at an angle, pressing against neighboring teeth or the jawbone. Impacted wisdom teeth are common, with estimates suggesting that around 80% of people experience some form of impaction.
There are several types of impaction, including:
Partial Impaction: The tooth partially erupts through the gum line but does not fully emerge.
Complete Impaction: The tooth remains entirely beneath the gum line, unable to erupt.
Angled Impaction: The tooth grows at an angle, potentially pressing against adjacent teeth, the jaw, or nerves.
Vertical Impaction: The tooth grows straight but remains trapped beneath the gum line.
Impacted wisdom teeth can cause a range of symptoms, including pain, swelling, difficulty opening the mouth, and infection. However, even if these symptoms are not immediately apparent, the long-term consequences of impacted wisdom teeth, such as nerve damage, can be serious.
Can Impacted Wisdom Teeth Cause Nerve Damage?
The short answer is yes, impacted wisdom teeth can potentially cause nerve damage. This is especially true for those who have teeth that are angulated or located near important nerves in the jaw. The nerves that are most commonly affected by impacted wisdom teeth are the inferior alveolar nerve and the lingual nerve.
1. Inferior Alveolar Nerve Damage
The inferior alveolar nerve runs through the lower jaw and supplies sensation to the lower lip, chin, and teeth. This nerve passes close to the roots of the lower wisdom teeth. If a wisdom tooth is impacted in a way that it presses against or is close to this nerve, it can result in nerve damage during extraction. Nerve damage may occur if the tooth is removed without proper care, or if the tooth roots are positioned in close proximity to the nerve.
Symptoms of inferior alveolar nerve damage include:
Numbness or tingling in the lower lip, chin, and teeth.
Loss of sensation in these areas.
Difficulty speaking or eating due to the lack of feeling.
Persistent discomfort or a “pins and needles” sensation.
Although rare, severe nerve damage may result in permanent numbness in the affected areas. However, most nerve injuries caused by wisdom tooth extractions are temporary and improve over time.
2. Lingual Nerve Damage
The lingual nerve runs along the tongue and provides sensation to the floor of the mouth, the tongue itself, and parts of the gums. Impacted wisdom teeth in the upper jaw or lower jaw can also come into close contact with this nerve. If a wisdom tooth is impacted in such a way that it presses against the lingual nerve, particularly during extraction, it can cause injury.
Symptoms of lingual nerve damage may include:
Numbness or loss of sensation in the tongue or floor of the mouth.
Difficulty tasting food or a decreased sense of taste.
A feeling of tingling or burning on the tongue.
Swelling and discomfort in the affected areas.
Lingual nerve damage is more commonly seen in lower wisdom teeth extractions but can occur in both upper and lower teeth. While most lingual nerve injuries are temporary and resolve after several weeks or months, some cases may result in permanent sensory loss.
Why Do Impacted Wisdom Teeth Cause Nerve Damage?
Nerve damage from impacted wisdom teeth generally occurs when the roots of the teeth are positioned very close to or even encroach upon the nerves in the jaw. This is particularly common with lower wisdom teeth because the inferior alveolar and lingual nerves are located in close proximity to the lower jaw’s molar area. The more angulated and deeply impacted the wisdom teeth are, the higher the risk of nerve injury.
Several factors contribute to the potential for nerve damage, including:
Position of the Tooth: Teeth that are angled toward the nerves or positioned directly above them can place pressure on the nerve during extraction.
Root Structure: Wisdom teeth with long, curved, or multiple roots are more likely to be in close contact with nerves.
Depth of Impaction: The deeper the wisdom tooth is embedded within the jawbone, the more likely it is to cause nerve damage if not extracted carefully.
Inexperienced Surgery: The skill of the oral surgeon performing the procedure also plays a significant role in avoiding nerve damage. Surgeons with more experience are more likely to avoid complications during extraction.
How Is Nerve Damage Diagnosed?
If a person is concerned that their impacted wisdom teeth may cause nerve damage, the first step is to seek a professional evaluation.
Dentists and oral surgeons will use a combination of methods to assess the position of the wisdom teeth and determine the risk of nerve involvement:
X-rays: Standard dental X-rays or 3D imaging (Cone Beam CT scans) help the dentist visualize the position of the wisdom teeth in relation to nearby nerves.
Clinical Examination: A physical exam to assess any swelling, pain, or numbness in the affected area.
Patient History: The dentist will ask about symptoms such as pain, tingling, or numbness in the chin, lip, or tongue.
By carefully reviewing the X-rays and other diagnostic tools, the dentist or surgeon can plan the best course of action to avoid nerve damage during extraction.
Can Nerve Damage Be Prevented?
While it may not be possible to eliminate the risk of nerve damage entirely, there are several ways to reduce the chances of nerve injury during the removal of impacted wisdom teeth:
Early Detection: Identifying impacted wisdom teeth early, preferably before the roots have fully developed, can make removal easier and reduce the risk of nerve involvement.
Advanced Imaging: Using advanced imaging technology like Cone Beam CT scans allows for a more accurate understanding of the teeth’s positioning relative to critical nerves.
Experienced Surgeon: Choosing a skilled oral surgeon who specializes in the removal of impacted teeth can significantly reduce the risk of complications. Surgeons are trained to navigate around the nerves carefully.
Non-Surgical Alternatives: In some cases, if the wisdom teeth are only partially impacted and are not causing major symptoms, a conservative approach involving monitoring and pain management may be used. This can delay or even prevent the need for surgery.
Treatment for Nerve Damage
If nerve damage occurs as a result of impacted wisdom tooth removal, the severity of the damage will determine the treatment approach. In cases of temporary nerve damage, no specific treatment may be necessary, as the nerve may recover naturally over time. However, for more severe or permanent damage, additional interventions may be needed, including:
Medication: Pain relievers and anti-inflammatory drugs can help manage symptoms of nerve damage, including discomfort and tingling.
Nerve Repair Surgery: In rare cases, surgery may be required to repair damaged nerves. This is typically done if there is significant loss of sensation or function.
Physical Therapy: For individuals with long-term sensory changes, physical therapy and exercises can sometimes help the body adapt and improve function.
Conclusion
While impacted wisdom teeth can indeed cause nerve damage, it is important to note that such complications are relatively rare. Advances in dental imaging and surgical techniques have significantly reduced the risk of nerve injury. However, if you have impacted wisdom teeth or are experiencing symptoms like pain, numbness, or swelling, it is essential to consult with a dental professional.
