Wisdom teeth removal is a common dental procedure. While generally safe, a potential concern is nerve damage. This complication, though uncommon, can lead to temporary sensory disturbances. Understanding this risk helps patients prepare for their procedure and recognize any unusual symptoms.
The Nerves at Risk
Two nerves are susceptible to injury during lower wisdom tooth extraction: the inferior alveolar nerve (IAN) and the lingual nerve. The inferior alveolar nerve travels within a canal inside the lower jawbone, providing sensation to the lower teeth, gums, lower lip, and chin. Its close proximity to the roots of the lower wisdom teeth makes it vulnerable during extraction. The lingual nerve runs closer to the inner surface of the lower jaw, providing sensation and taste to the tongue and the floor of the mouth. Both nerves are branches of the trigeminal nerve, responsible for facial sensations.
How Nerve Damage Occurs
Nerve damage during wisdom tooth removal can result from several mechanisms. Direct trauma can occur if surgical instruments inadvertently cut, crush, or stretch the nerve. Compression by surgical instruments, bone fragments, or swelling in surrounding tissues can also cause injury. Chemical injury, such as from local anesthetic solutions or inflammatory agents, is another potential cause of nerve irritation. The complexity of the tooth’s position, like deeply impacted or horizontally angled wisdom teeth, and their root structure can increase the risk of nerve injury.
Recognizing Nerve Damage
Symptoms of nerve damage become apparent immediately after the local anesthetic wears off. Common signs include persistent numbness or tingling in the lower lip, chin, or tongue. Patients might describe this as a “pins and needles” sensation or an area feeling “asleep.”
Altered sensation, known as dysesthesia, can manifest as burning or electric shock-like pain. If the lingual nerve is affected, there may also be a change or loss of taste on one side of the tongue. These sensory changes can impact daily activities, making eating, drinking, or speaking challenging.
Prognosis and Management
Most cases of nerve damage after wisdom tooth removal are temporary, with symptoms resolving spontaneously over weeks to several months. Minor injuries, like bruising or stretching of the nerve, often heal within one to six months. Persistent symptoms lasting beyond six to twelve months may suggest lasting nerve impairment.
Initial management involves observation and monitoring the patient’s sensation. Medications, such as anti-inflammatory drugs or nerve-specific pain relievers, may be prescribed to reduce swelling and manage discomfort. In rare instances of severe and persistent damage, a referral to a specialist for evaluation, diagnostic imaging, and potential surgical intervention like nerve repair, may be considered. Surgical repair is usually performed within a few months of the injury for the best outcomes.
Reducing the Risk
Dental professionals employ several strategies to minimize the risk of nerve damage during wisdom tooth removal. A thorough pre-operative assessment is important, often involving panoramic X-rays to visualize the wisdom teeth and nerves. In higher-risk cases, Cone Beam Computed Tomography (CBCT) provides a detailed 3D view of nerve pathways and their relationship to tooth roots, allowing for accurate surgical planning. Careful surgical planning and the use of precise, minimally invasive techniques are important. Selecting an experienced oral surgeon skilled in these procedures helps reduce complications.