Dental Nerve Injury
Trigeminal Neuropathic Pain
Inferior Alveolar Nerve Injury
Lingual Nerve Injury
Root Canal Overfill
Dental nerve injuries can be a devastating and traumatic experience for individuals who have been injured. These nerve injuries may be either temporary or permanent, and the symptoms experienced vary, depending on the nerve injured, and the extent of damage to that nerve. While there are many nerves which may be injured during dental procedures, the two most frequent injuries occur to the lingual nerve and the inferior alveolar nerve. For information regarding symptoms of lingual and inferior alveolar nerve injuries, and for a list of dental procedures which most commonly result in injury to those nerves, please use the links provided below.
Common symptoms following an inferior alveolar nerve injury include the following:
Numbness of the lip, chin, and gums
Tingling sensation in the lip, chin, and gums
Pain, Burning, or electric shock sensations in the lip, chin, and gums
Inferior Alveolar nerve injuries are most commonly caused by the following procedures:
Wisdom teeth removal
Placement of dental implants.
Overfilled or overinstrumentation of a tooth during a Root Canal Procedure
Filling of the root canal should end at the root tip apex. Overextended filling materials can penetrate the underlying main sensory nerve in the lower jaw or into the sinus in the upper jaw causing a chemical burn to sensitive nerve tissue. Persistent numbness and/or pain in the lip and chin is symptomatic of overfill of lower posterior teeth. If this occurs you should see a maxillofacial microsurgeon to evaluate for immediate decompression surgery to remove the overfill before the nerve becomes irreversibly injured. The Inferior Alveolar Nerve (IAN) or Mental Nerve can be damaged as a result of an overfilled or overinstrumentation of a tooth.
Implants drilled too deep can penetrate the underlying main sensory jaw nerve and cause permanent lip and chin numbness and/or pain. If severe pain and/or numbness persists 8 hours after implant placement surgery, you should contact your dentist.
Trigeminal neuralgia is a neuropathic disorder of the trigeminal nerve that causes episodes of intense pain in the eyes, lips, nose, scalp, forehead, and/or jaw. Trigeminal neuralgia is considered by many to be among the most painful of conditions.
To describe the pain sensation, people describe a trigger area on the face, so sensitive that touching or even air currents can trigger an episode of pain. It affects lifestyle as it can be triggered by common activities in a persons daily life, such as toothbrushing. Breezes, whether cold or warm, wintry weather or even light touching such as a kiss can set off an attack. Although trigeminal neuralgia is not fatal, successive recurrences may be incapacitating, and the fear of provoking an attack may make sufferers reluctant to engage in normal activities.
In some cases of atypical trigeminal neuralgia, the sufferer experiences a severe, relentless underlying pain similar to a migraine in addition to the stabbing pains. In other cases, the pain is stabbing and intense, but may feel like burning or prickling, rather than a shock. Sometimes, the pain is a combination of shock-like sensations, migraine-like pain, and burning or prickling pain. It can also feel as if a boring piercing pain is unrelenting.
This is a pain condition that happens after an injury to one or more branches of the trigeminal nerve. Trigeminal neuropathic pain is as a result of nerve injury following dental procedures (tooth extractions, root canals, etc), facial fractures, nerve injury from sinus surgery, etc. This condition is often diagnosed as trigeminal neuralgia. This pain is usually continuous and generally is of a burning quality. Many patients with TNP have documented loss of sensation on the face or forehead. It is important to make this distinction, since the surgical procedures that are effective in trigeminal neuralgia, are almost never helpful for TNP, and not uncommonly can make this condition worse.
Trigeminal neuralgia in Dental Malpractice Cases is usually caused during Root Canal Procedures resulting in an over extension of a file or an overfill beyond the apex of the root.
Treatments for trigeminal neuralgia include medication and five different procedures Microvascular decompression, radiofrequency rhizotomy, glycerol rhizotomy, balloon rhizotomy, and stereotactic radiosurgery. Atypical trigeminal neuralgia can also respond to the same treatments as classic trigeminal, though success rates are slightly lower. Medications used for trigeminal neuralgia are usually anti-seizure medicines, in particular Tegretol, Trileptal, Neurontin and Lyrica. If medication is not helping or patients are experiencing side effects from the medication, then a procedure can be considered. Surgery may be recommended, either to relieve the pressure on the nerve or to selectively damage it in such a way as to disrupt pain signals from getting through to the brain.
Common symptoms following a lingual nerve injury include the following:
Numbness in the tongue;
Loss of ability to taste
Tingling sensation in the tongue
Pain, Burning, or electric shock sensations in the tongue
Lingual nerve injuries are most commonly caused by the following procedure:
Wisdom teeth extractions
Every year, thousands of people have their wisdom teeth removed. Wisdom teeth are also referred to as third molars. The older a patient is at the time of removal the higher the risk of developing complications.
Permanent injuries can include jaw fractures, inferior alveolar nerve and lingual nerve injuries. Often jaw fractures also damage the inferior alveolar nerve.
A lingual nerve injury is a devastating event for the injured person. Some lingual nerve injuries will heal within a few days of the procedure, and some injuries are permanent. Lingual nerve injuries can occur during tooth extraction due to the dentist’s instruments. Once the lingual nerve is injured by being severed or nicked by a drill or other instrument, the patient will likely experience some degree of numbness, pain, tingling or lack of sensation in that area of their mouth. Even if the teeth are tilted, difficult to remove, infected, or the patient delayed removal, the dentist or oral surgeon must still take the same degree of care and seek to minimize the risks and damage to the patient during the removal.
If you are having pain or other problems with your wisdom teeth that requires their removal you should have the procedure performed by an oral surgeon to limit your risks.
If you sustain a lingual nerve or inferior alveolar nerve injury you should contact a neurosurgeon familiar with treating these injuries as soon as possible since the faster treatment begins the better the chance of recovery.