Nerve Damage After Tooth Extraction: Causes and Solutions

Tooth extraction can lead to nerve damage?

Hello Dr.
Huang, in October 2018, I had my upper left wisdom tooth extracted due to pain.
The procedure was painless, and the recovery period was also quite manageable.
Later, in November 2018, the dentist discovered that I had a wisdom tooth in the lower right as well and recommended that I have it extracted when I had the time.
During the extraction, I received anesthesia two or three times, and the dentist mentioned that it was difficult to extract because it was too close to the throat and quite large.
During the procedure, I felt a strong pulling sensation on the throat nerve, and there was significant bleeding in the mouth.

A week after the extraction, I returned for a follow-up appointment and reported to the dentist that the left side of my face, including the left side of my tongue, still felt numb.
The dentist advised me to rest and mentioned that the nerve would heal naturally.
However, to this day, while the numbness in my left cheek has decreased, there has been little change in my oral cavity.
Sometimes I experience a sweet or sour taste, and occasionally I feel some sensation when biting down with my upper and lower teeth (though it is not painful yet).
At times, it feels like my teeth are loose.

Currently, I have issues with deep bite and the left side of my jaw.
Could these problems be a result of the tooth extraction? Will there be any long-term effects? I have consulted both a dentist and a neurologist, but they were unable to provide a solution.
I would like to know if there are other methods to address this issue.
Which specialist should I see?

Miss Zhou, 30~39 year old female. Ask Date: 2020/06/11

Dr. Huang Tingfang reply Dentistry

Dear Ms.
Chou,
Hello! I recommend visiting a medical center to see an oral surgeon.
Take care! Wishing you all the best and smooth recovery!
Sincerely,
Dr.
Huang Ting-Fang, Dentistry

Reply Date: 2020/06/11

More Info

Nerve damage following a tooth extraction can be a concerning issue, especially when it involves the facial nerves or the nerves that innervate the tongue. In your case, it seems that the extraction of your wisdom teeth, particularly the one on the right side, may have resulted in some degree of nerve injury, leading to persistent numbness and altered sensations in the left side of your face and mouth.

Causes of Nerve Damage During Tooth Extraction
1. Anatomical Proximity: Wisdom teeth, especially those that are impacted, can be located very close to major nerves, such as the inferior alveolar nerve or the lingual nerve. During extraction, if the tooth is large or deeply embedded, the force required to remove it can inadvertently stretch or damage these nerves.

2. Surgical Technique: The technique used by the dentist or oral surgeon can also play a role. If excessive force is applied or if the extraction is particularly complicated, there is a higher risk of nerve injury.

3. Infection or Inflammation: Post-operative complications such as infection or inflammation can also contribute to nerve irritation or damage, leading to prolonged symptoms.

Symptoms of Nerve Damage
The symptoms you are experiencing, such as persistent numbness, altered taste sensations, and a feeling of pressure or movement in your teeth, are indicative of nerve involvement. The fact that you have a sweet or sour taste sensation could suggest that the nerve responsible for taste (the chorda tympani branch of the facial nerve) may have been affected.

Recovery and Management
1. Natural Healing: Nerves have a slow healing process, typically regenerating at a rate of about 1 mm per day. In many cases, if the nerve is not completely severed, it can heal over time. However, the duration of recovery can vary significantly from person to person.

2. Physical Therapy: Some patients benefit from physical therapy or neuromuscular therapy, which can help improve function and reduce discomfort. This may include exercises to stimulate the affected area.

3. Medications: If you are experiencing pain or discomfort, medications such as analgesics or anti-inflammatory drugs may be prescribed. In some cases, medications specifically for nerve pain, such as gabapentin or pregabalin, may be beneficial.

4. Nutritional Support: Adequate nutrition, including B vitamins, can support nerve health. Some practitioners recommend supplements, but it's essential to discuss this with your healthcare provider.

5. Follow-Up Care: Since you have already seen both dental and neurological specialists, it may be beneficial to continue follow-ups with an oral surgeon or a specialist in orofacial pain. They can provide a more targeted approach to your symptoms and may suggest further diagnostic imaging or nerve conduction studies if necessary.

When to Seek Further Help
If your symptoms do not improve or worsen over time, it is crucial to seek further evaluation. Persistent numbness, altered sensations, or pain that interferes with daily activities should be addressed promptly. You may also consider consulting a specialist in pain management or a neurologist who has experience with nerve injuries related to dental procedures.

Conclusion
In summary, nerve damage following tooth extraction can lead to a range of symptoms, and while some degree of recovery is expected, it can take time. Continued monitoring and a multidisciplinary approach to management may provide the best outcomes. If you have not already done so, consider seeking a second opinion or further evaluation from a specialist who focuses on nerve injuries related to dental procedures.

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