Some questions for pre-wisdom removal !

[Zammo]

Hi. I am having my lower right wisdom tooth out this Friday. Just wondered some advice. I have included a few photos and panoramic scan to help. I have always been a "wait and see" type person with teeth, as I hate seeing dentists, but I have been told it is important I have this tooth removed, as I had awful pain at Christmas which was cured by antibiotics, and I have needed the bite lowered twice as it kept raising up. I still wanted to put it off, but have finally decided to go for it, but I have some concerns. I have been totally pain free for 5 months now. I do though have a slight redding colour on the gum near the tooth, only slight, not sure if this denotes anything.

1) I have been told I will need bone cut away and the tooth sectioned when removed. I personally was hoping just an elevator tool could be used to jack the tooth out, but what are your opinions on it ? Is there an easier way than having to cut bone and cut the tooth up ? Surgical extractions always cost a lot more than simple.

2) My dentist a few months back shaved down my wisdom tooth as I complained of high bite, they seem to have shaved it down a lot, is this why it is harder now to remove due to not much grip ? Or given the tooth has a massive hole in it, would it likely have needed surgical removal anyway ? I have included a side view and how flat it looks now since bite reduction, before reduction it was around the same height as the 2nd molar you can just see, although still with the big 2 holes.

3) I thought the nerves looked good on the x-ray as they were far away from the roots, but the dentist said they are still close, around 2mm. Should I be concerned about them given this is a surgical removal ? To me they look further than 2mm away from the root, but then I am not a dentist.

4) How concerned also about the lingual nerve should I be ?

5) Looking at the tooth, if I decided to just leave it, would that be wise ? Or a bad idea ? I am not sure whether to let sleeping dogs lie. I am 40 years old.

Thanks for any help, so much appreciated, I am panicking a bit for Friday. Sorry for so many questions. Oh and on the questions, the side view was taken when I had a temp cream coloured filling cover on my tooth, that has since gone, as seen in other photo.

 

[MattKW]

You've been here before. I remember the crease in the X-ray.

1. He might be able to loosen it a bit with an elevator and grab with forceps. It's an upright tooth with uncomplicated roots.
2. The hole on the inside (lingual) is the biggest question for getting good forceps grip. The height of the tooth is immaterial.
3. The roots are well away from the inferior alveolar nerve, and I wouldn't have any worries about that, even if it becomes a surgical extraction.
   
4. You always have to be a bit wary about the lingual nerve as it can be just below the gum on the inner side of the tooth. If he grasps the tissue poorly with forceps, or makes an incision or tears the tissue on the lingual side, then you'd be in trouble. Still unlikely though. I've had more issues with IAN than lingual.
5. Very bad idea to leave alone. Dogs don't sleep forever, and neither will this tooth. As it continues to decay, it will make it more difficult to remove.

 

[Zammo]

Hi there. Big thanks, I was hoping you would reply as I know you are a dentist. Actually I have not been on this forum before, but if you frequent other places you may have seen my x-ray there. My out of control anxiety is making me ask about different places

Can I follow up with some questions ?

I was a bit confused when the dentist said "no, they are right there next to it" when I made comment that I was happy the roots are away from the nerve, as like you say, it seems far away to me. My normal dentist also said they seem far away (he sent me to this oral surgeon though in case tooth broke up). Do you think this is just likely the oral surgeon being extra careful to say the nerves there still a concern ?

So even though I am pain free right now, I should still go ahead with this in your opinion ? The lingual nerve risks don't outweigh the risk of leaving the tooth in ? In your expert opinion, with my tooth from what you see in the photos (which I realise is not as good as seeing in person), how risky is this for me to have done without damage to the lingual nerve ?

I wish I didn't have that hole on the tongue side, as like you say, if he cuts bone there then it is right by the lingual nerve.

Finally, on the cheek side of the gum, in the crease of my mouth, so right at the very back where the wisdom tooth gum meets the crease of cheek, there is a slight red dot, very small, could this be an infection from the tooth leaking in to the mouth ? It is just below the wisdom tooth on the gum. As something caused my tooth to raise up twice needing the bite reduced. However antibiotics stopped any pain in the 3rd day of taking them.

Sorry for all the questions, you are a good man doing this advice for free, much appreciated. Given I am "going in" on Friday I only have 1 day to cancel if I feel it too risky, haha. I chickened out of having the root removed from another tooth that broke (you can still see the root in the x-ray) and this was 10 years ago, I was told to have it taken out as it would cause problems, but touch wood so far the root is still fine buried. Hence why I am always tempted to leave things, but I know one day I will be unlucky.