Wisdom teeth related nerve injury
In all cases you MUST let your dentist know about changed nerve sensation the day after your treatment. It is important for you to understand what type of nerve injury that you have, as they are treated differently and with various degrees of urgency. In general the earlier nerves are repaired the better the outcome, however, some nerve injuries are best observed over a period of time.
If your surgeon suspects direct nerve injury during third molar surgery he/ she should immediately refer you to a specialist who may explore and repair your nerve injury urgently. However if direct nerve injury is not suspected;
If you experienced a severe / excruciating pain during removal of your wisdom tooth or severe pain during the dental injection the nerve injury may have happened at this time. Extreme pain after surgery may also be a sign of nerve damage. If your surgeon suspects direct nerve injury during third molar surgery he/ she should immediately refer you to a specialist who may explore and repair your nerve injury urgently.
After surgery where there is a risk of nerve injury during a procedure, your surgeon or their staff should routinely contact you post-surgery the next day. However, this is not yet routine practice for many surgeries. The next day after surgery, if you experience persistent numbness, change in sensation (as if your dental injection hasn’t worn off) then you MUST contact your surgeon so that they can arrange review immediately and arrange urgent treatment or monitor the recovery of your nerve injury.
You may benefit from taking early medical treatment;
- steroids (Prednisolone step down over 5 days (50/40/30/20/10ms)
- non-steroidal anti-inflammatories (Aspirin or Ibuprofen 400-600mg TDS) to reduce any nerve related inflammation
in addition vitamins B 12 complex (injections or oral) may assist minimising damage to your nerve but there is limited medical evidence to support these supplements.
(always check that your medical history does not prevent you taking these drugs.
If the lip and gums remain changed in sensation the next morning you MUST contact your treating dentist and discuss as to whether you have your any retained tooth roots removed within 24 hours.
Tongue nerve injury
Generally 88-90% of these injuries recover at 12weeks after surgery. Thus we tend to have a ‘sit and wait’ policy for these injuries.
If the nerve injury persists longer than 2 weeks it is important that you are referred to a specialist during the early post-operative period to ensure active surveillance of the nerve injury recovery and timely surgery for exploration and repair if indicated.
If repair surgery is required, when there is no recovery, it should be undertaken within 12 weeks to optimise outcome.
Lip nerve injury
The next day after surgery, if you experience persistent numbness, change in sensation (as if your dental injection hasn’t worn off) then you MUST contact your surgeon.
Generally these injuries should be explored and repaired, when indicated, early on in the post-surgical period) less than 2-4weeks) as there is no evidence to support the sit and wait policy applied to tongue nerve injuries.
If any tooth fragment remains or direct damage to the nerve canal is evident on the post-operative radiograph the surgeon may decide to re-operate and explore the nerve within 2 weeks after the wisdom tooth surgery.
However if recovery is taking place the specialist may decide to delay the second surgery and review the patient to monitor recovery. If surgery is delayed usually the best outcomes for repair surgery is within 3 months after the initial surgery.
If your injury is more than 14 days old removing the retained roots is unlikely to make much difference to your nerve injury but you can remain on your vitamin supplements and if you are experiencing discomfort and pain you can arrange a consultation with you doctor to discuss prescriptions of Nortriptyline and Pregabalin. Both these medications treat hyperactive or overly sensitive nerves that have been damaged, but they also have many side effects and are contraindicated for some patients