Why Wisdom Tooth Removal Isn’t Just Routine

Wisdom teeth—also known as third molars—are the last set of permanent teeth to emerge. For most people, this occurs between the ages of 17 and 25. While some individuals experience no problems at all, others face complications such as crowding, infection, or pain when their wisdom teeth begin to erupt. In these cases, extracting wisdom teeth becomes essential for protecting oral health and avoiding damage to other teeth.

Although wisdom tooth removal is a common surgical procedure, it’s not without risk. Among the most important concerns—especially when extracting lower wisdom teeth—is the potential for nerve injury. In rare cases, patients may experience changes in sensation due to contact or trauma to nerves during surgery.

This article is your comprehensive guide to understanding which nerves are at risk, how complications happen, and most importantly, how oral and maxillofacial surgeons plan and execute safe, effective tooth removal procedures. Whether you’re preparing for surgery or considering your options, knowledge is your best tool for a smooth and confident experience.

 

Understanding Impacted Wisdom Teeth and the Need for Extraction

What Are Impacted Wisdom Teeth?

The term impacted wisdom teeth refers to third molars that do not erupt in the correct position. This is typically due to a lack of enough space in the jaw or interference from nearby teeth. As a result, the teeth may grow sideways, become stuck in the gum tissue, or remain trapped within the jawbone.

 

Types of Impaction:

• Soft tissue impaction – the tooth is covered by gums
• Partial bony impaction – part of the tooth is encased in bone
• Complete bony impaction – the entire tooth is buried in bone

 

These conditions are more than just inconvenient. Over time, impacted teeth can cause:

• Pain and swelling
• Tooth decay in adjacent molars
• Gum disease due to difficult cleaning
• Cyst or tumor formation in the tooth socket

 

If untreated, impacted wisdom teeth can also damage the roots of other teeth or compromise orthodontic treatment.

 

Why Remove Impacted Wisdom Teeth?

The decision to remove impacted wisdom teeth is often based on a preventative philosophy. Extracting them before complications arise can help you avoid more invasive treatments in the future.

 

Benefits of Early Removal:

• Lower risk of infection and dry socket
• Shorter healing time at a younger age
• Easier surgical access and simpler procedures
• Reduced chance of nerve damage, especially before roots fully form

 

An experienced oral surgeon will assess the positioning of your third molars, the proximity to nearby nerves, and the likelihood of future problems. If the wisdom tooth is already causing pain, damage, or infection, prompt surgical removal is often the best course of action.

 

What Nerves Are at Risk During Wisdom Teeth Extraction?

When lower wisdom teeth are removed, particularly those that are deeply impacted, there’s a small but real chance of affecting nerves in the lower jaw. The two nerves most often involved are the inferior alveolar nerve and the lingual nerve.

 

Inferior Alveolar Nerve

The inferior alveolar nerve (IAN) runs within the jawbone and is responsible for sensation in the lower lip, chin, and lower teeth. This nerve is in close proximity to the roots of lower wisdom teeth, especially when the teeth are deeply embedded in the bone.

If the IAN is bruised, compressed, or severed during surgical removal, patients may experience:

 

• Numbness or tingling in the lower lip or chin
• Altered sensation in the affected area
• Rare cases of permanent nerve damage

 

Lingual Nerve

The lingual nerve lies near the surface of the gum tissue on the tongue-side of the lower molars. It governs taste and sensation in the anterior two-thirds of the tongue. While less commonly injured, it can be affected by incisions or instruments during surgery.

Injury to the lingual nerve may result in:

• Tingling or numbness of the tongue
• Difficulty tasting food or experiencing a bad taste
• A burning or painful tingling sensation

 

Who Is at Greater Risk for Nerve Injury During Tooth Removal?

Although nerve injury is uncommon, certain risk factors increase the likelihood of complications during wisdom tooth extraction.

Risk Factors Include:

• Deep impaction: The deeper the tooth, the closer it may be to the inferior alveolar nerve.
• Older age: As people age, bone becomes denser, and nerve tissue may be more vulnerable.
• Complex root anatomy: Curved or hooked tooth roots may wrap around nerves.
• Poor imaging or diagnosis: Without proper pre-operative imaging, nerve damage occurs more frequently.

 

Patients with these risk factors may face a greater risk of complications, especially if treated by a provider without advanced training in oral and maxillofacial surgery.

 

How Imaging Helps Reduce the Risk of Nerve Damage

One of the most effective tools in preventing nerve injury during wisdom tooth removal is diagnostic imaging.

 

Common Imaging Techniques:

• Panoramic X-rays: These give a broad, two-dimensional overview of the jaw.
• CBCT scans (Cone Beam Computed Tomography): These provide high-resolution, three-dimensional images that allow for precise mapping of the tooth and its relationship to nearby nerves and anatomical structures.

 

This level of detail allows the oral surgeon to plan a safer surgical procedure, or even alter the approach altogether, such as performing a coronectomy instead of full tooth removal.

 

Surgical Techniques to Prevent Nerve Injury

Once imaging reveals a risk to the nerve, oral and maxillofacial surgeons have several techniques at their disposal to mitigate complications.

1. Coronectomy

In cases where tooth roots are in direct contact with the inferior alveolar nerve, the oral surgeon may recommend a coronectomy. This procedure removes only the crown of the tooth, leaving the roots in place to avoid damaging the nerve.

2. Flap Design and Tissue Management

During the surgical procedure, careful handling of the gum tissue and strategic flap designs help avoid stretching or cutting the lingual nerve.

3. Sectioning the Tooth

Rather than removing the impacted tooth in one piece, surgeons often divide it into sections to make extraction safer and more controlled.

 

Symptoms of Nerve Involvement After Tooth Extraction

After a surgical removal of wisdom teeth, patients may experience residual effects as the tissues heal. It’s important to differentiate between normal recovery symptoms and those that may indicate nerve involvement.

Normal Recovery Symptoms:

• Minor swelling in the affected area
• Mild soreness or jaw stiffness
• Temporary numbness for a few hours due to local anesthesia
• A healing tooth socket that gradually closes

 

Signs of Possible Nerve Damage:

• Persistent numbness or tingling beyond 10–14 days
• Lack of sensation in the lower lip, tongue, or chin
• Changes in taste or a persistent bad taste
• Altered sensation that feels “electric” or painful

 

If these symptoms persist for a few weeks or worsen, it’s critical to follow up with your oral surgeon to explore treatment options.

 

Managing and Treating Nerve Damage

Though permanent nerve damage is extremely rare, early intervention is key to improving recovery outcomes. If symptoms of nerve injury persist, your provider may suggest:

• Anti-inflammatory medications
• Vitamin B-complex supplements
• Corticosteroid therapy
• Neurological evaluation for severe cases
• Surgical repair in rare, advanced cases

 

 

When to Contact a Specialist

Not all wisdom tooth extraction cases are equal. If your general dentist suspects a higher level of complexity, they may refer you to a maxillofacial surgeon. You should also consider a referral if:

• You’re experiencing symptoms of nerve damage
• You’ve had prior complications from tooth extractions
• Imaging reveals close proximity to the inferior alveolar nerve or lingual nerve
• You prefer to explore advanced treatment options

 

Our Montreal-based team welcomes patients for second opinions and consultations, even if you’re unsure about whether to proceed with extraction.

 

Safety Is in the Details

While it’s natural to feel concerned about wisdom tooth removal, the reality is that with careful planning, experienced hands, and the use of advanced imaging, the procedure is overwhelmingly safe. Complications like nerve injury or dry socket can usually be prevented or managed effectively, especially when patients are educated and engaged in their care.

By working closely with an oral surgeon, asking about imaging options like a CBCT scan, and following your recovery plan diligently, you can ensure a smooth, safe, and comfortable experience when it comes time to extract wisdom teeth.