Wisdom teeth, the final set of molars to emerge, often require removal due to impaction, pain, or other dental issues. While this is a routine surgical procedure, it carries potential complications. A specific concern is the possibility of nerve damage. This rare complication can lead to altered sensations in the mouth and face, making it important to understand its causes, symptoms, and potential outcomes.
The Proximity of Nerves
Nerve damage during wisdom tooth extraction is possible due to the close relationship between third molars and significant nerves in the jaw. The inferior alveolar nerve (IAN) runs through a bony canal in the lower jaw, providing sensation to the lower teeth, gums, lip, and chin. Lower wisdom teeth, especially impacted ones, can have roots very close to, or intertwined with, this nerve’s pathway. During extraction, the nerve can be stretched, compressed, or directly injured by instruments or the tooth itself.
The lingual nerve (LN), a branch of the trigeminal nerve, travels near the inner side of the lower jaw, providing sensation and partly taste to the tongue. This nerve is located in soft tissue, making it susceptible to injury during surgery, particularly when soft tissues around the tooth are manipulated. Advanced imaging, such as 3D CT scans, can help oral surgeons visualize the relationship between tooth roots and these nerves, assessing risk before the procedure.
Recognizing Nerve Damage
Nerve damage after wisdom tooth removal involves recognizing sensory changes that persist once local anesthesia wears off. If the inferior alveolar nerve is affected, it can cause numbness or tingling in the lower lip, chin, and teeth on the affected side. Patients might describe this as a “pins and needles” sensation or a persistent loss of feeling. These altered sensations can range in intensity and may affect daily activities like speaking or eating.
Damage to the lingual nerve causes numbness or tingling on one side of the tongue or in the floor of the mouth. Some individuals may also experience an altered sense of taste. While initial numbness is expected after surgery, if these symptoms continue for 24-48 hours after anesthesia wears off, it could indicate nerve involvement. Symptoms can vary in severity and may be temporary, gradually improving over time, or in rare cases, persistent.
Likelihood and Outlook
Nerve damage following wisdom tooth extraction is uncommon. Temporary nerve disturbances, such as tingling or numbness, are estimated to occur in 0.5% to 5% of cases. Permanent nerve damage is rarer, affecting less than 1% of patients. This low incidence highlights that most extractions proceed without such issues.
Several factors influence the risk of nerve injury. Tooth position, such as deeply impacted or horizontally angled teeth, poses a higher risk due to nerve proximity. Extraction complexity, including bone removal, and patient age (over 25, due to denser bone and developed root structures) also contribute.
If nerve damage occurs, many cases resolve spontaneously as the nerve heals. Minor injuries, like bruising or stretching, often improve within weeks to months. Moderate cases may take longer, potentially three to six months. Management often begins with observation and may include anti-inflammatories or nerve-specific pain relievers. In rare instances of severe, persistent damage, surgical intervention for nerve repair might be considered, typically within a specific timeframe for optimal outcomes.