Likelihood of Paresthesia after Lower Wisdom Tooth Extraction

Fish Bloke

My top two wisdom teeth were pulled by my dentist and, after a few years waiting, I've just had my consultation about getting the lower two removed. I'm on their waiting list and I opted to be called at short notice too. I do intend to go through with it. However, I am extremely nervous at the thought of permanent paresthesia.

I was wondering if any of the professionals here could give me an idea of how common this really is. I was given the statistics that 1 in 200-250 procedures result in damage to nerves controlling sensation in the lips or tongue. Is this really the case? Has anyone ever experienced this either as a patient or as a dentist or surgeon?

One of my major worries is that when I had the upper two teeth taken out, bone or tooth shards (I really can't remember which) were left in the socket. These worked their way out through the gum on their own eventually and caused no real issues. I obviously have no idea how these things work, but I'm worried that if the same thing were to happen with the lower teeth, the shards would somehow interfere with the delicate tissues and nerves down there.

I know of all of the sensible people reading this are probably laughing up their sleeves at me. You're right to, I know I probably have very little to worry about! I'd just like some honest opinions on the risk here.

res ipsa

Fish Bloke wrote: »

My top two wisdom teeth were pulled by my dentist and, after a few years waiting, I've just had my consultation about getting the lower two removed. I'm on their waiting list and I opted to be called at short notice too. I do intend to go through with it. However, I am extremely nervous at the thought of permanent paresthesia.

I was wondering if any of the professionals here could give me an idea of how common this really is. I was given the statistics that 1 in 200-250 procedures result in damage to nerves controlling sensation in the lips or tongue. Is this really the case? Has anyone ever experienced this either as a patient or as a dentist or surgeon?

One of my major worries is that when I had the upper two teeth taken out, bone or tooth shards (I really can't remember which) were left in the socket. These worked their way out through the gum on their own eventually and caused no real issues. I obviously have no idea how these things work, but I'm worried that if the same thing were to happen with the lower teeth, the shards would somehow interfere with the delicate tissues and nerves down there.

I know of all of the sensible people reading this are probably laughing up their sleeves at me. You're right to, I know I probably have very little to worry about! I'd just like some honest opinions on the risk here.

7% for the tongue.4% for the lip. These are figures for any damage including temporary altered sensation.

btkm8unsl0w5r4

res ipsa wrote: »

7% for the tongue.4% for the lip. These are figures for any damage including temporary altered sensation.

THey seem very high there res, thought it was more like 0.5% - 0.2% maybe Oral Surgeon will pop in a tell us. 7% would mean nearly 1 in ten :eek:

res ipsa

Ellie Gigantic Cocoon wrote: »

res ipsa wrote: »

7% for the tongue.4% for the lip. These are figures for any damage including temporary altered sensation.

THey seem very high there res, thought it was more like 0.5% - 0.2% maybe Oral Surgeon will pop in a tell us. 7% would mean nearly 1 in ten :eek:

Those figures are from john meechans book which is a pretty recent one. They don't refer to exclusively permanent nerve damage where I imagine the figures are much lower.

Oral Surgeon

Ellie Gigantic Cocoon wrote: »

THey seem very high there res, thought it was more like 0.5% - 0.2% maybe Oral Surgeon will pop in a tell us. 7% would mean nearly 1 in ten :eek:

i always quote the risk of permanent altered sensation which is in the region of 0.2 to 0.4% depending on what studies you read.

Different techniques, the difficulty of the extraction and some other factors may play a role in increasing (or decreasing) those risks for a particular patient...

The risk of tempory altered sensation is a very difficult one to assess and I think that the high percentages quoted for "temporary nerve damage" are ridiculous.
Imagine you have a broken leg and the surgeon operates, opens it up, pushes the muscles away, plates & screws etc, then stitches the skin and dresses it... You MAY have some nerve strain and stretching resulting in temporary altered sensation but more likley you just have a lot of local swelling and inflammation, on top of this you will be on some strong analgesics to dull this pain... Of course it will feel different for a while, is this temporary paresthesia? maybe by definition it is but it is not something that I would worry a patient about with high percentages....
Similarly for wisdom tooth removal, there is a lot going on for the few days after the procedure... swelling and healing tissue....

What you should assess is the risk of permanent altered sensation which when done correctly is low.

OS

res ipsa

Fish Bloke, if you want to avoid complications such as temporary and permanent nerve damage, as opposed to unavoidable side effects such as soreness, swelling and possibly trismus, see an oral surgeon who qualified as an oral surgeon about 10 years ago. This person will usually be somewhere around 40 years old
Recently qualified surgeons make a lot of mistakes as do old surgeons (see link)

http://www.dailymail.co.uk/health/article-2085012/Surgeons-reach-peak-performance-age-35-50.html?ITO=1490

Temporary Nerve Damage is not a trivial concern especially for some professions (musicians, singers etc) and is pretty unique to mandibular wisdom tooth extraction and not comparable to repair of a broken leg which is not an elective procedure and where the benefits of surgery on a broken leg clearly outweigh the risks of no surgery.

I enclose a paper on this for your perusal:
http://exodontia.info/files/Dental_Update_-_Nerve_Damage_and_Third_Molar_Removal.pdf

btkm8unsl0w5r4

Res, that's a controversial point that I don't entirely agree with. I should ban you for posting a link to dental update...the daily mail of dental journals

The reference they give for those figures is to Robinsons 1997 study which is pretty old and is a comparing two techniques with and without lingual flap retraction. (N for each group was less than 400) and only the lingual flap group saw these high figures, and the high figure was temporary 89% of cases. Drawing this sort of headline figure from this source is poor science. All under GA (increased risk nerve damage) all by a mix of skill level surgeons. Lingual flap reflection is avoided in most cases unless absolutely necessary (in this study it was carried out regardless of the ability to remove the tooth without it) It would be similar to me choosing an article with a low success rate for root canal fillings and claiming that a 52.6% of root treated teeth are not successful and infected . This is not true and flies in the face of clinical experience, modern techniques and experienced operators.

I think these fine details are best for the lounge as this is getting a bit technicial for here.

Oral Surgeon

res ipsa wrote: »

Fish Bloke, if you want to avoid complications such as temporary and permanent nerve damage, as opposed to unavoidable side effects such as soreness, swelling and possibly trismus, see an oral surgeon who qualified as an oral surgeon about 10 years ago. This person will usually be somewhere around 40 years old
Recently qualified surgeons make a lot of mistakes as do old surgeons

So if that article can be applied to oral surgeons, could it also be applied to dental surgeons, prosthodontists, endodontists, periodontists......

res ipsa wrote: »

Temporary Nerve Damage is not a trivial concern especially for some professions (musicians, singers etc) and is pretty unique to mandibular wisdom tooth extraction and not comparable to repair of a broken leg which is not an elective procedure and where the benefits of surgery on a broken leg clearly outweigh the risks of no surgery.

Temporary damage is not trivial but it is no reason to not undergo a procedure that is indicated for your long term health...
These temporary figures quoted, in many cases, include altered sensation for the first few hours and days post op- I don't know of any patients who are keen to go singing or playing the sax straight after wisdom tooth removal....
BTW I have seen patient with temporary lingual nerve damage from having a filling (from the LA). There are also reports in the lit of lingual nerve damage from intubation from GA alone (for a non oral operation).....


Removal of a wisdom tooth is often the only treatment available for certain patients to prevent further pain and infection (this is not elective in the same way as a facelift is elective). Indeed, a fractured leg can be treated with open reduction and internal fixation or closed with a cast depending on the case.....

res ipsa

Ellie Gigantic Cocoon wrote: »

Res, that's a controversial point that I don't entirely agree with. I should ban you for posting a link to dental update...the daily mail of dental journals

The reference they give for those figures is to Robinsons 1997 study which is pretty old and is a comparing two techniques with and without lingual flap retraction. (N for each group was less than 400) and only the lingual flap group saw these high figures, and the high figure was temporary 89% of cases. Drawing this sort of headline figure from this source is poor science. All under GA (increased risk nerve damage) all by a mix of skill level surgeons. Lingual flap reflection is avoided in most cases unless absolutely necessary (in this study it was carried out regardless of the ability to remove the tooth without it) It would be similar to me choosing an article with a low success rate for root canal fillings and claiming that a 52.6% of root treated teeth are not successful and infected . This is not true and flies in the face of clinical experience, modern techniques and experienced operators.

I think these fine details are best for the lounge as this is getting a bit technicial for here.

that's a fair point fitzie but if u don't agree with the second link that surely reinforces the first one: Id est that the proper technique should be performed by the proper person to provide the minimum chance of morbidity. I would be interested in ure views on the second link also covered in the Irish Indo health. Probably best in the lounge but do u think that dentists & specialist dentists have a peak performance that declines with age similar to say premiership footballers? Or are medical surgeons different due to the usually long stressful procedures they endure ? Being over 4 years out out of grad school I'm wondering whether I have arrived or will I look back in 5 years time & have a different slant on things ?
Always good to have contrarian viewpoints!

btkm8unsl0w5r4

Good discussion points here, lets open a lounge thread.

Fish Bloke

Thanks for the information everyone. At lot of the technical stuff is going over my head but I do appreciate your opinions on this.

On a separate note, would you be able to give me some idea of how this procedure might be done at Dublin Dental Hospital? Not the ins and outs, I'm just wondering if, considering the risks of this procedure, it is likely that a student would be performing it?

Oral Surgeon

Fish Bloke wrote: »

it is likely that a student would be performing it?

Luck of the draw;
You might have the consultant maxfax, a specialist oral surgeon, a postgrad in oral surgery, a dental house officer or more rarely a undergrad dental student....
It's not like its cheap in the DDH for a lower wisdom tooth, (e245 the last time I checked)....

Fish Bloke

It's not a money issue, I'm just consdering the experience of the person likely to perform the surgery. I would be scared if it was a student who had never done it before, and although I know everyone has to start somewhere, it would just make me worry that bit more about the risk of damage. I know there's a chance that even the most experienced surgeon could slip or inject the nerve or any number of things, it's just something playing on my mind.

btkm8unsl0w5r4

Pay to see a private oral surgeon, that way your sure.