Last updated on February 10, 2022
This article is for those who are told that their wisdom teeth are close to the nerve.
A dentist supervises the writing of this article on whether a tooth can be extracted, the risks involved, and how to examine it.
It also explains how to treat nerve palsy if it should occur.
What are wisdom teeth?
There are 32 human teeth, including wisdom teeth, on the top, bottom, left, and right sides.
Wisdom teeth are the eighth tooth to erupt at the very back.
For Japanese people, wisdom teeth grow out around high school age for those who have them early, and in their early 20s for those who have them later, but depending on how the wisdom teeth grow, they may not grow out.
If wisdom teeth do not grow in, they may be congenitally absent or may exist laterally.
Therefore, some people have all four wisdom teeth, some have only two, and some have none.
Why do wisdom teeth hurt?
Wisdom teeth are very difficult to self-care because they exist at the very back of the mouth.
Therefore, plaque tends to accumulate around wisdom teeth.
This makes wisdom teeth more susceptible to tooth decay. If wisdom teeth are embedded, the tissues around them are more prone to inflammation.
It is common for people to have cavities only in their wisdom teeth, even though the rest of their teeth are very clean.
Therefore, wisdom tooth pain can be of two types: pain due to progressive tooth decay or pain due to inflammation of the tissues around the wisdom teeth.
Do I need to have my wisdom teeth removed?
This is because Japanese people have smaller jaws than Westerners,Wisdom teeth grow sideways.Often the case is Even if it grows horizontally.If completely embedded in boneis less painful due to infection, but boneIf a tooth protrudes even slightly from theare at risk of infection.
In addition, there is a risk of tooth decay if wisdom teeth grow out of the gums even slightly.
In such cases, it is better to extract the tooth.
Even if wisdom teeth are firmly in place and bite well at the top and bottom, they should be extracted if they are difficult to self-care for and are at high risk for decay and infection.
If wisdom teeth are present, it is a good idea to discuss the risks of extracting and keeping them with your dentist to determine whether or not to remove them.
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Be careful when removing upper wisdom teeth.
When removing upper wisdom teeth, it is important to note that the tip of the root is in close proximity to a part of the nasal cavity called the maxillary sinus.
Extraction of a tooth may result in an accidental hole in the maxillary sinus.
If wisdom teeth are present in a deeper position, such as in an x-ray, the probability of a hole is slightly increased.
In addition, upper wisdom teeth basically do not cause nerve palsy.
In high-risk cases, it is recommended that wisdom teeth be extracted in a clinic that is accustomed to extracting wisdom teeth.
Be careful when removing lower wisdom teeth.
One thing to keep in mind when you want to remove a lower wisdom tooth is that the tip of the root must be carefully analyzed for proximity to the mandibular canal, a bundle of nerves and blood vessels, before extraction.
The mandibular canal contains the inferior alveolar nerve and inferior alveolar artery, both of which areThey are important nerves and blood vessels responsible for sensory receptors in the teeth and jaws and for maintaining tissue metabolism.
ifInjury to the mandibular canal can cause massive bleeding and nerve paralysis.
The inferior alveolar nerve, which runs through the mandibular canal, is a sensory nerve, so paralysis will not cause the mouth to open or the cheeks to droop, though,Sensory numbness as if anesthetized all the time.causes the
Also, although very rareIf the lingual nerve is injured, the sense of taste may be abnormal.This basically does not happen because the nerve is located quite deep, but if it is in the wrong place, damage to the lingual nerve could be one of the risks of having lower wisdom teeth extracted.
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Examination necessary to determine the position of the mandibular canal and
In order to determine the position of the mandibular canal in relation to the root tip of the tooth, a dental combi-beam CTRecommendation.
The cost of imaging diagnosis is covered by insurance.About 3,500 yen at 30% of the costIt is.
Compared to conventional medical CT, Combine CT has a lower radiation dose and can be developed immediately after imaging because it is digitally processed.
When the images are taken, it is possible to determine the three-dimensional relationship between the root tip of the tooth and the mandibular canal.
The Comb-beam CT can provide information that is difficult to obtain with two-dimensional radiographs, because the mandibular canal branches in some people and the root tips of wisdom teeth may be more fused to the mandibular canal than expected.
Since not all dental offices are equipped with a combi CT, if the root tip and mandibular canal are in close proximity on normal radiographs, it is recommended that the tooth be extracted at a dental office with a combi CT.
Does paralysis actually occur even in fairly close proximity?
Even if the root tip and mandibular canal are quite close after combi-beam CT imaging, the dentist will take this into consideration when extracting the tooth, so nerve palsy rarely occurs.
However, there is no zero risk.
If the tip of the root is very close to the mandibular canal, the dentist will always explain the risks.
After the explanation, the patient is usually asked to write a consent form.
It is a consent form that says that even if nerve palsy should occur, you have obtained explanatory consent.
If you have any concerns about tooth extraction or nerve palsy, you should consult your dentist at this stage.
After taking into consideration the imaging diagnosis of the x-ray or combim CT, the patient's general condition, and other factors, the dentist may decide to refer the patient to an oral surgeon who is experienced in many difficult extractions that are close to the nerve, or may recommend that the extraction itself should be canceled.
What if nerve palsy occurs?
If a nerve palsy were to occur, treatment for the nerve palsy would be initiated.
In most cases, the nerves are only slightly damaged, so medication such as vitamins, ATP preparations, and steroids are used to activate the nerves from the inside, or lasers or far infrared rays are applied to activate them from the outside.
In some cases, nerve block injections may be given.
Even if nerve palsy occurs, it is often cured after such a response, but some nerve palsy can be semi-permanent.
Although rare, surgery to connect the nerves may be performed if the nerves are completely divided.
summary
Wisdom teeth are less risky in the future if they are extracted early, depending on how they grow.
Of course, there is a possibility of temporary pain and swelling after wisdom teeth removal,
Teeth extracted at a younger age heal faster than those extracted at an older age because of their higher metabolism.
Especially before lower wisdom teeth are extracted,
Proximity to the mandibular canal."
If your dentist tells you thatConsider the risks carefully before extracting a tooth.
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Written by dentist/issy
After graduating from the National School of Dentistry, he trained at the Tokyo Medical and Dental University Dental Hospital, and is currently working in general and orthodontic dentistry.
Member of the Japanese Society of Oral Implantology
Japanese 
English 
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