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One of the more serious post-operative complications after a wisdom tooth extraction is the presence of sustained numbness. Here are some of the reasons why it may have occurred and what can be done about it.

Wisdom tooth removal can be daunting for most people. The shape, size, and position of the tooth dictate the difficulty with which the extraction will be carried out but in general, wisdom tooth extractions are more difficult than other teeth [1].

Surgical wisdom tooth extractions, which is the most common kind of oral surgical procedure carried out around the world, also carried with it the risk of some post-operative complications. The most common complication is an infection after wisdom tooth removal but there are some other more serious ones as well [2].

In particular, numbness after wisdom tooth extraction is one that patient need to be aware of.

Reasons for numbness after wisdom tooth removal

Our wisdom teeth or the third molars as they may be referred to by dentists are usually buried deep inside the bone. This puts the tip of the roots of these teeth in close approximation to the inferior alveolar nerve that runs through the center of the lower jaw.

Numbness after getting a wisdom tooth extracted is much more common in the lower jaw than it is in the upper jaw because of the location of the tooth as well as the major nerves that run through the jaws [3].

Even wisdom teeth that have erupted into the mouth may be placed very close to the nerve running through the jaw. In such situations, the very act of force application on the wisdom tooth can result in transient damage to the underlying nerve.

Since a wisdom tooth may have to be removed by using a surgical method where some amount of bone has to be cut and the teeth sectioned into small pieces, damage can also occur during this process.

The collection of blood around the nerve after extraction and the formation of a hematoma can also increase the pressure being applied to the nerve and cause numbness for a short amount of time [4].

Rarely, the injection needle used to give local anesthesia can hit the nerve and cause some amount of damage to it. Since the average needle used in dentistry is thinner than the average width of the nerve, the damage is usually quite minimal and transient in nature [5].

In some instances, poor operator technique where an excessive amount of bone cutting was done can lead to the damage of the inferior alveolar nerve or the lingual nerve running through the lower jaw [6].

Symptoms associated with nerve damage during wisdom tooth removal

Patients that suffer from nerve damage during wisdom tooth removal complain of tingling, lack of sensation, and even difficulty in making normal muscle movements. The severity of the symptoms depends upon the extent of the injury [7].

The most common areas where the lack of sensation will be felt are the chin, the half of the tongue on the side of the extraction, lip, and cheek. If the numbness has occurred after an upper wisdom tooth extraction then the areas affected will be the upper lip, back of the throat, palate, and the upper cheek [8].

Patients may find that their taste sensation has been altered or that they are having trouble difficulty speaking, swallowing, whistling, and chewing. In rare cases, one half of the face may start to droop as well.

Treatment

Nerve damage is notoriously slow to heal and very difficult to treat. The recommended protocol for dentists says to wait for the healing to occur on its own for at least a year before attempting anything else.

Your dentist will wait for a few weeks to let any inflammation in the area die down and then set up an appointment to try and assess the severity of the symptoms.

The majority of the patients may only have received minor external damage to the nerve and so the numbness corrects itself in a matter of a few weeks. For those patients where the damage to the nerve was a little more severe, the complete return of the sensation on the side could take up to a few months [9].

In very rare cases, where the nerve has been severed completely or the damage is very severe, the sensation will not return at all.

Patients will be asked to take vitamin B12 supplements since that is believed to help improve the chances of nerve regeneration. If there has been little or no improvement after a year, then a surgical procedure to rejoin the nerve may be carried out [10].

The success of this procedure varies between 50-90% and in most cases, only a partial return of sensation is reported. For a patient that is severely affected, however, even a partial return of the nerve sensation is considered a win [11]

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