Removal of all four wisdom teeth at the same time has several advantages. It minimizes the number of surgeries and recoveries, anesthesia, and exposure to medications. In addition, patients experience the same level of discomfort, regardless of number of teeth being removed, and the recovery period remains unchanged.
However, there are circumstances in which staging may be preferred. One such circumstance is when the lower wisdom teeth are sitting close to a sensory nerve that lies within the lower jaw bone. Any nerve disturbance during extraction can lead to prolonged numbness of the lower lip and chin area. This risk increases after age 21 due to the complete formation of the roots; hence, it is best to remove wisdom teeth between the ages of 15 to 18 when the roots are immature and further away from this nerve bundle. In most cases, this is a temporary numbness which resolves in 8-12 weeks but, in rare situations, it may be more prolonged or permanent. An experienced oral surgeon with good skills can minimize this risk by using atraumatic extraction techniques.
If the roots seem close to the nerve canal on a Panorex x-ray, the oral surgeon should obtain a CBCT (cone beam CT scan) to better visualize each structure and assess their relationship. If both of the lower wisdom teeth are in intimate contact with the nerve, then it is best to extract only one of the lower wisdom teeth and delay the extraction of the other one until the patient’s lip and chin are assessed for normal sensory function. This way, the possibility of numbness on both sides can be avoided. Once normal sensation is verified on the initial extraction side, the oral surgeon can proceed with the extraction of the wisdom teeth on the other side.