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Oral Surgery/Wisdom Tooth Issue

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Question
I would like to ask a question about a lower impacted wisdom tooth. My wisdom tooth on my bottom right hurts slightly now and then, my regular dentist referred me to an oral surgeon to have it extracted. When I went to the Oral Surgeon and he took the panoramic x-ray he had a concern about where the Lingual nerve was in relation to the tooth so he sent me for a Cat Scan of my lower jaw. After reviewing the Cat Scan he told me there was no way the tooth could be extracted without damage to the Lingual nerve and he said any damage that occurs would be permanent. He has decided to refer me to an endodontist to have a root canal on the tooth instead of an extraction. He says the tooth is decayed and the nerve is starting to become exposed and when it hurts me, its hurting because of the exposed nerve.

Now, I do prefer a root canal as opposed to an extraction but my concern with the root canal is that this tooth is partially impacted, the back is still underneath the gum and the front is exposed and the portion that exposed is very decayed, after a root canal wouldn't a crown need to be placed on the tooth? Would I have room back there for a crown and can a tooth be crowned if its only half-erupted through the gum? I was supposed to see the endodontist over a month ago and have put it off because I don't know what to do. I obviously don't want nerve damage from an extraction but I am also worried about a root canal on a damaged tooth.

Any advice would be so helpful to me!
Thanks so much!

Answer
Matthew - You are correct to be concerned.  A tooth such as you describe which needs a root canal treatment to keep it, will wind up costing you more than the root canal.  Some type of restoration of the tooth to remove the decay and keep the tooth whole will be very expensive.  A crown in that area often will create a situation that is more prone to developing periodontal disease and the tooth may be eventually lost anyway.  

I fully understand your apprehension about the proposed treatments.  Of course, without examining you or viewing xrays of the area it is a little difficult for me to tell you what is the correct treatment.  My main question is the problem with the Lingual Nerve.  Damage to that nerve is very rare with the extraction of even the deepest and badly positioned wisdom tooth.  There is another nerve in the bone below the tooth that is more common to be injured.  

My suggestion is to get a second opinion from a different board certified oral and maxillofacial surgeon.  If you are aware of a different surgeon near you, get back to me, tell me where you live and I will send you names of board certified oral and maxillofacial surgeons near you. I think a second opinion from a second surgeon is a wise move. So if you don't know other surgeons, get back to me.  

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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