A wisdom tooth extraction is a medical procedure that most of us will have to experience in our lifetimes. Wisdom tooth extraction is not something that should be feared, but preparing for it does require some understanding.
Wisdom teeth or third molars are the last teeth to erupt into the mouth. They do not serve any purpose and are considered as evolutionary remnants. This is why they are the most commonly extracted teeth in the mouth [1].
The fact that wisdom teeth erupt at the very back of the mouth, often in over-crowded conditions with a lack of space makes it clear why they are so often removed. These very same conditions also makes the wisdom teeth difficult to extract, however. In fact, a minor surgical procedure may have to be performed in a lot of cases.
Like all surgical procedures, small or big, there is the possibility of some complications if you have wisdom teeth extracted [2].
Infection after wisdom tooth removal is the most common complication, but also the complication that can most easily be prevented with proper aftercare and hygienic conditions. The most serious complication after surgery to have a third molar taken out, though, is nerve damage after wisdom tooth removal.
Nerve damage after wisdom tooth removal
Why does it happen?
Nerve damage is most common after the removal of a lower wisdom tooth. The position of the nerve running through the center of the lower jaw is anatomically very close to the lower wisdom teeth. Sometimes, the nerve can actually be traveling in between the roots of the lower third molar [3].
In such a case, in the process of removal of the wisdom tooth, some amount of damage can also occur to the nerve, due to the close physical proximity [4]. This damage is quite transitory for most of the affected people but in the worst case, it may be permanent.
How can nerve damage after wisdom tooth removal be prevented?
The best way to prevent nerve damage from occurring during a wisdom tooth extraction is to follow proper planning. This is not something that you as a patient can really do, but the dentist or dental surgeon should ideally order a CT scan of the area if a regular x-ray indicates the nerve may be close by [5].
The other method is to follow a conservative method of extraction without cutting too much of bone. Complicated cases should be referred to oral surgeons who have experience in dealing with such more complex situations [6].
Symptoms of nerve damage after wisdom tooth removal
The kind of symptoms you might experience will depend on the amount of damage that has taken place to the nerve. If the nerve has just been shocked or received an increased amount of pressure during the extraction then patients may feel a tingling sensation on the lip and tongue on the side of the extraction. The symptoms will last for a week or two and then subside [7].
If some more damage has occurred to the nerve without it being severed, then the tingling sensation a patient feels may last for a few months. Patients may also report numbness on the side of the jaw where the extraction took place. The numbness starts to diminish slowly over a period of time before returning back to normal [8].
The most severe symptoms are seen in cases where the entire nerve has been severed. The damage, in this case, is permanent and may never heal. Patients will feel numbness on the side of the extraction, difficulty in carrying out other functions such as talking, chewing, swallowing, and blowing air [9].
Treatment for nerve damage after wisdom tooth extraction
Nerve damage is notoriously slow to heal. This is why it is recommended that no surgical intervention be done for the first year after the nerve damage has occurred. Patients will be put on nutritional supplements that are believed to help promote nerve regeneration and a few mouth exercises will be advised as well. Unfortunately, this is pretty much the extent of the non-surgical treatment that can be provided.
The affected patient should be recalled for monitoring appointments at regular intervals and then evaluated. If there is no improvement in the symptoms then the patient may have to consider surgery as an option. In this procedure, the two ends of the severed nerve are joined back to each other in order to return the nerve to normal function [10].
As mentioned earlier, nerve healing is very slow and difficult to predict. The success of this surgical procedure to bring back complete nerve function is very low. However, in a large majority of the cases, some amount of nerve function should return, making the operation a worthwhile consideration for many patients.
For patients that have been affected by a complete loss of sensation and function, even a marginal improvement after surgery can be considered a success, as it can greatly improve their quality of life.
Conclusion
Nerve damage after wisdom tooth removal is one of the major complications that can occur. It is, however, something that happens very rarely. Even in the instances where it does happen, the most severe symptoms are seen only in a small percentage of affected people. If the proper planning for wisdom tooth extraction and the proper technique is followed, nerve damage is not something that patients should be worried about.
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