Wisdom Teeth Removal Complicatons - In Depth Look at Nerve Damage

Nerve damage is a possible complication of wisdom teeth removal. The mandibular nerve enters the back of the bone of the lower jaw. (See the Figure on the right). The mandibular nerve has many branches which consist of nerves implicated in taking out wisdom teeth. The most well known of these are the lingual nerve and the inferior alveolar nerve. It is apparent from the figure on the right that these nerves are clearly beneath the lower teeth and thus can be damaged when removing one of the lower wisdom teeth. The lingual nerve supplies sense of touch and taste to the right and left half of the anterior 2/3 of the tongue as well as the lingual gingiva. The inferior alveolar nerve supplies sensation to the lower teeth on the right or left half of the dental arch, as well as sense of touch to the right or left half of the chin and lower lip.

Nerve damage occurs when can a nerve is traumatized, crushed or completely cut. The numbness is called parasthesia. Because nerves heal slowly the mandibular nerve recovers in about three to six months. If after a year recovery hasn't occured the nerve damage is likely permanent. This happens to about 1 in 100 people after wisdom teeth removal.

The mandibular nerve is the largest of 3 branches of the trigeminal nerve. It is branch V3 as shown on the Figure to the left. If damage to this branch is to occur it can cause additional problems.All sensory information from the face is sent to the trigeminal nerve nucleus. The three parts of the trigeminal nucleus receive different types of sensory information. The spinal trigeminal nucleus receives pain/temperature fibers. The main trigeminal nucleus receives touch/position fibers. The mesencephalic nucleus receives proprioceptor and mechanoreceptor fibers from the jaws and teeth. Therefore damage to the mandibular nerve can cause pain, not regulate temperature properly, and feel numb.

This has the possibility of developing into trigeminal neuralgia. The attacks are said to feel like stabbing electric shocks or shooting pain that becomes intractable. Individual attacks affect one side of the face at a time, last several seconds or longer, and repeats up to hundreds of times throughout the day. Paresthesia symptoms include frequent drooling, biting of the lip or the inside of the cheek or the side of the tongue, and paralytic disfigurement or drooping of the lip. The sense of taste, the facility of speech, and the sensory pleasure of kissing are diminished. Constant tingling numbness is the most common feature. Those suffering from severe paresthesia may be driven to near hysteria by a loss of sensory functions that affects all aspects of their lives.

Other Nerves Known To be Damaged

Both the buccal nerve and mylohyoid nerve have been damaged in during wisdom teeth removal.. There is evidence that the use of lingual nerve retraction can increase the risk of mylohyoid nerve damage.

Additonal Considerations

It is possible that other neves could be damaged with wisdom teeth removal. Such as the auriculotemporal nerve and the occipital nerve. The occipital nerve is located in the neck and could be damaged if the patient is not placed properly in the dental chair when having their teeth taken out.

Headache Caused by Nerve Damage

The international headache society states that injury or entrapment of peripheral branches of the trigeminal nerve other than the nasocilliary and supraoribital nerves may give rise to pain referred to the area innervated by the branch affected. Examples are neuralgias of the infraorbital, lingual, alveolar, and mental nerves. Thus nerve damage to the lingual and alveolar nerves (among others) is a cause of headache.

References
1. Removing Wisdom Teeth. Clinical Evidence, the British Medical Journal. Written September 2006.
http://besttreatments.bmj.com/btuk/pdf/34088.pdf
2. American Association of Oral and Maxillofacial Surgeons. White Paper on Third Molar Data.
Written March 2007. http://www.aaoms.org/docs/third_molar_white_paper.pd
3. Become Healthy Now. http://www.becomehealthynow.com/popups/cut_nrvs_head.htm
4. St Joseph Atlanta. http://www.stjosephsatlanta.org/
5. Anesthesia UK. http://www.frca.co.uk/images/trigeminal_nerve.jpg
6. The International Headache Society. The International Classification of Headache Disorders, 2nd edition. Written 2004. http://216.25.100.131/ihscommon/guidelines/pdfs/ihc_II_main_no_print.pdf
7. American Association of Oral and Maxillofacial Surgeons. White Paper on Third Molar Data.
Written March 2007. http://www.aaoms.org/docs/third_molar_white_paper.pdf