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Lingual Nerve Damage A Common Risk In Wisdom Teeth Removal | Port Orange Medical Malpractice Lawyer

Lingual Nerve Damage A Common Risk In Wisdom Teeth Removal

While performing dental procedures, dentists must exercise extreme care not to injure vital anatomical structures in the oral cavity, including nerves.

An extraction or dental implant nerve injury can have unpleasant and lifelong consequences for the patient. For example, the extraction of wisdom teeth (third molars) often gives rise to dental malpractice suits relating to an injury of the lingual nerve that has caused either temporary or permanent nerve damage and related symptoms such as a numb tongue or even more serious complications.

Administration of anesthesia causes blockage of the inferior alveolar nerve (supplying the teeth) and the nearby lingual nerve (supplying the tongue). This is why the numbing of the lower jaw during dental procedures causes patients to lose sensation in their teeth, lower lip and chin and part of their tongue.

Surgical procedures in the area of the lingual are the most common cause of nerve damage, resulting in temporary or permanent loss of sensation or pain in the distribution of the nerve.

Sometimes the inferior alveolar nerve is injured, and sometimes the lingual nerve. Both can be bothersome injuries, but in general the inferior alveolar nerve injuries (mouth tissue and lip numbness) are tolerated better than the lingual nerve injuries (tongue and inner gingival tissue).

Researchers with the Department of Oral and Maxillofacial Surgery at the University of California, San Francisco, conducted a survey to determine the reporting of the frequency of temporary and permanent nerve damage following wisdom teeth or third molar removal and to identify factors associated with injury rates.

A postal survey was sent to all members of the California Association of Oral and Maxillofacial Surgeons requesting information on known instances of inferior alveolar and lingual nerve damage that had occurred in their practices over a 12-month period and known instances of permanent damage over their entire careers.

Replies were obtained from 535 California Oral and Maxillofacial Surgeons (OMFS) representing 86% of all OMFS in California. Instances of injury to the inferior alveolar nerve in a 12-month period were reported by 94.5% of OMFS; 53% reported instances of lingual nerve injury in a 12-month period.

Instances of permanent nerve injury of the inferior alveolar nerve were reported by 78% of OMFS; 46% reported permanent lingual nerve injury occurring during their professional lifetime.

The overall estimated self-reported rate of injury was 4 per 1,000 lower third molar extractions for the inferior alveolar nerve and 1 per 1,000 extractions for the lingual nerve for all cases (temporary and permanent).

In most cases (80%) of inferior alveolar nerve injury the cause was known, but in a majority of cases of lingual nerve injury (57%) the cause was unknown. Self-reported rates of permanent injury were 1 per 2,500 lower third molar extractions for the inferior alveolar nerve and 1 per 10,000 lower third molar extractions for the lingual nerve. Injury rates were associated with provider experience (ie, extractions per year) and years in practice.

This survey included a high percentage of California OMFS. Injury to the inferior alveolar and lingual nerve was reported by most OMFS in California following lower third molar removal, and many reported cases of permanent nerve injury, frequently with unknown cause.

If your surgeon/dentist identified during the procedure that the nerve was severed, you should have been referred immediately for surgical repair. If it becomes evident after the anesthesia wears off that you have sustained nerve injury and it does not improve within 6-8 weeks, it may be appropriate to see a board certified surgeon, with expertise in nerve repair.

Surgical repairs done within the right time frame (10-12 weeks) can be expected to attain about 75% of normal sensation in about 70% of the cases. The longer delay until surgery, the lesser the percentage of success such that it is rarely recommended after 9 months. With partial numbness it can be hard to make the decision, which should probably be made within 4-5 months.

Both the inferior alveolar nerve and the lingual nerve can be repaired, including the portion of the inferior alveolar nerve that travels within the bone. The rates of recovery of the inferior alveolar nerve is better than those with the lingual nerve.

For more on surgical safety issues, see the library of articles by Daytona Beach medical malpractice attorney.

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