Wisdom Teeth: The Tooth, the Whole Tooth, and Nothing But the Tooth?
The removal of wisdom teeth is now recognized as a necessity for the vast majority of the population. It is also widely known that their removal in the mid-teenage years enables the quickest patient recovery while minimizing the potential risks associated with wisdom tooth removal.
One of the risks of wisdom tooth removal is inadvertent bruising or damage to the nerve underling the lower wisdom teeth, the inferior alveolar nerve. Wisdom teeth tend to be the lower teeth that are located the closest to this nerve, which is a purely sensory nerve. It does not move any facial muscles, but it does provide feeling to both sides of the lower lip and chin, the lower gingival (gums) and teeth,
and there is a nearby nerve on each side that provides sensation and taste to each side of the tongue.
When Oral Surgeons remove wisdom teeth, this risk of this occurring is rare, especially if the patient is in their teenage years before roots have grown to their full length and extend closer to the nerve. Often, however, we find ourselves having to remove wisdom teeth on older adults, either due to dental decay or dental cysts and tumors that form around the clinical crown (top) of a tooth that has never erupted (is impacted). In these cases the roots are fully formed and may be in proximity to or engaged in the nerve. What is one to do in these cases to be able to treat the pathology without damaging the nerve?
In recent years, a good body of research has shown that in many instances, the problematic “top” of the tooth can be removed while leaving behind the portion of the roots that may be close to the nerve, thus minimizing any risk to the nerve. Will this cause problems? Surprisingly, patients report no more discomfort than if the entire tooth were removed. As for the roots left behind, more often than not, bone fills in over the top of them and the socket heals normally. On rare occasion a minor infection might occur at the site, which generally can easily be treated with antibiotics, but the incidence of infections at these sites is no greater than if the tooth were removed in its entirety. The only other occurrence that has been reported is that the roots left behind might begin migrating towards the surface over time. This is actually a benefit because as they migrate upwards, they move away from the nerve and can then be removed easily and safely.
Essentially, there are cases where the incomplete removal of a tooth is the preferred treatment and the removal of the whole tooth is actually not in a patient’s best interest.