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Wisdom Teeth Nerve Damage

The Inferior Alveolar Nerve (IAN), sometimes called the Inferior Dental Nerve, supplies all feeling to the teeth on your lower jaw. This nerve branch is part of the Mandibular Nerve which is the largest of the three divisions of the Trigeminal Nerve or fifth cranial nerve. The Trigeminal Nerve is the one responsible for providing sensation to your teeth and other facial structures.

Anatomy of the IAN

The Inferior Alveolar Nerve is a part of the mandibular nerve that travels behind the lateral pterygoid muscle. It enters the mandibular foramen after giving a branch off to the mylohyoid nerve.

While in the mandibular canal, it brings lower molars and second premolar their sensory branches. This creates the inferior dental plexus and gives off small gingival and nerves to the teeth.

At about the 2nd premolars, the nerve branches out of the mental nerve through the mental foramen and supplies sensation to the chin and lower lip areas.

The IAN continues as the mandibular incisive nerve bringing nerve endings to the canines and incisors. Very rarely a bifid IAN can be present and can be detected by locating a doubled mandibular canal on a radiograph.

Symptoms of IAN damage

A plethora of sensations might indicate damage to the Inferior Alveolar Nerve including:

  • Numb lip, gums, or chin
  • Crawling sensations
  • Burning sensations
  • Tingling sensations
  • Feelings of tiny jolts of electricity
  • Hypersensitivity along the teeth, lips, gums, or chin

If you are experiencing any of these symptoms following a dental or facial surgical procedure, contact your doctor or dentist.

What causes Inferior Alveolar Nerve damage?

Injury to the Inferior Alveolar Nerve typically occurs because of complications in dental, oral, or maxillofacial surgeries; this includes Endodontic or Root Canal Procedures, Third Molar or Wisdom Teeth Removals, dental implant placements, or other facial surgeries.  Despite the very best care possible, you should be aware that nerve damage is always a risk of any surgical or dental procedure.

There are three main theories concerning nerve injuries: anesthetic toxicity, needle trauma, and intraneural hematoma.

Anesthetic Toxicity

A local nerve block is sometimes applied during a dental procedure and can sometimes cause a loss of sensation to the front two-thirds of the tongue (a lingual nerve block), the lower lip and chin (a mental nerve block), or the teeth (an inferior alveolar nerve block.)

Needle Trauma

Some people may feel an "electric shock" upon the insertion of a needle because the needle encountered the Inferior Alveolar Nerve. Often the contact does not result in nerve damage. However, it is possible for a needle to pierce and cause trauma to the nerve.  This is especially true when the patient’s mouth is being held open for a procedure.

Intraneural Hematoma

Intraneural Blood Vessels pierced by a needle result in a hematoma. Hemorrhage can cause reactive fibrosis and the formation of a scar putting pressure on nerve fibers.

Prevention of Inferior Alveolar Nerve damage

The only way to avoid Inferior Alveolar Nerve injuries is the accurate measurement of the available bone for implant support coronal to the IAN Canal.

Your dentist or doctor may use CT-based surgical stents or navigation systems to avoid nerve damage. These guards prevent overpenetration of the drill into bone. Many dentists working with implants prefer the use of transverse alveolar implant techniques to angle the implant laterally connecting to the cortical buccal bone to avoid damage.

Some professionals support using infiltration for local anesthesia instead of an IAN block which causes all sensation to disappear. This way the patient will feel pain if the drill comes near to the IAN canal - a significant indication to stop. 

Diagnosis of Inferior Alveolar Nerve damage

If nerve injuries are suspected, your doctor or dentist should be informed as soon as possible. Your professional should perform an examination at that time. Be sure to make a note of any altered sensations you have been feeling since the procedure and imparted those to your doctor or dentist in follow-up visits.  It is not uncommon for patients to complain of strange sensations even if the surgery was uneventful.  Just the same, it is best to make a note of any changes because nerve injuries occur for numerous reasons.

If your doctor or dentist agree that nerve damage may have occurred, they may use at radiograph to confirm their suspicions that the damage may have occurred due to drilling, local anesthesia, or an aggressive retraction of the buccal flap. 

Treatment of Inferior Alveolar Nerve damage

Did you get dental implants? If so, the abnormal sensations you are experiencing might not be from Inferior Alveolar Nerve damage. Instead, they could be indicative of an implant too tightly screwed into place. It is possible that a loosening of the implant will resolve the issue.

Eighty-five percent of the cases have shown that nerve damage from IAN block resolves within eight weeks of the injury. Those who have symptoms past eight weeks have had less positive results.

From the moment that you inform your dentist or doctor of your abnormal sensations, they should be carefully monitoring your symptoms. Anyone who does not show improvement within two weeks should, most likely, be given a referral to an orofacial pain specialist or oral surgeon for sensory testing.

Anti-inflammatory drugs have been effective in helping to treat unwanted sensations, but for those who have persistent symptoms, microsurgery may be necessary, ideally within three months.

Microsurgical repair of IAN damage has a very high rate of success with over 90% of patients reporting slight or significant improvement after. Less than ten percent report no improvement after a year.

Talk to your dentist or doctor for more information about Inferior Alveolar Nerve injuries.

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