Risk of injury to lingual nerve.

[Idiopathic]

I have heard that 3rd molar extraction in older individuals runs a real risk of damage to the lingual nerve (20%). Is this true, and if so, is the damage often permanent? I am a 30-year-old 3rd year medical student with a painful cavity in an upper wisdom tooth. Are there any alternatives to having this tooth removed? Are the horror stories true?? Could I end up numb on that side of the face?

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[gryffindor]

I know med students took anatomy with us, so you must have learned that the lingual nerve runs in your mandible, not the maxilla. If you need an upper (maxillary) wisdom tooth out, I'm not aware that it is anywhere near your lingual nerve to possibly damage it, unless the oral surgeon/dentist is talking about taking out all your wisdom teeth in addition to the upper one with the cavity. There are other complications with taking out an upper tooth, like bleeding, hematoma, sinus exposure, but I don't think nerve damage is one of them.

 

[Midoc]

"Older individuals" probably refers to those people in whom the roots of the third molars are completely formed. When teeth erupt into the oral cavity the roots are almost always not completely formed and as a rule of the thumb they aren't usually completely formed for an additional three years. Yours are certainly completely formed. There should be no risk of damage to the lingual nerve with any extraction but there is a risk of damage to the inferior alveolar nerve with lower molars. The additional risk only occurs if the roots of your lower teeth are near, surrounding or have displaced the mandibular canal. If the inferior alveolar nerve was damaged then the likely outcome is temporary numbness of the lower lip on that side of your body. Cases of permanent numbness are rare and if it occured it would only be half or your lower lip, not half of your entire face.

Since it is an upper tooth that is decayed if you have only that tooth removed you are at no reasonable risk of damage to either your lingual or inferior alveolar nerves.

Your other options are likely a large restoration, crown, or root canal and a crown depending on how badly the tooth is decayed.

 

[no2thdk999]

I have heard that 3rd molar extraction in older individuals runs a real risk of damage to the lingual nerve (20%). Is this true, and if so, is the damage often permanent? I am a 30-year-old 3rd year medical student with a painful cavity in an upper wisdom tooth. Are there any alternatives to having this tooth removed? Are the horror stories true?? Could I end up numb on that side of the face?

There are risks to every dental procedure but parasthesia after extraction of a maxillary molar is extremely rare. There is a lot of collateral innervation in this area and it would be VERY rare to have any type of nerve damage. I never seen one and can't remember every even hearing of such.

As to options there are always other choices but with a painful maxillary 3rd molar I would 99.99% of the time recomend extraction. You could probably spend $2k+ for a questionable prognosis and likely future extraction or you could pay $200 (or less) and get rid of a tooth most people live without anyway.

As to age, after age 30 I need a reason to take out an asyptomatic fully impacted 3rd molar. We just don't heal as well and the r/o complications is higher. After age 35 I need a REALLY GOOD reason. I don't know of any research showing an increase in nerve damage due to age. However if I had nerve damage I would definitely rather see it in a 17 y.o. than a 45 y.o. because of the resiliency of youth.

Get the tooth extracted but offer to pay them an extra $20 if they'll give you 10 minutes of diet counseling and explicit oral hygiene instructions so it doesn't happen in the future.

JMHO
Rob

 

[River13]

There should be no risk of damage to the lingual nerve with any extraction but there is a risk of damage to the inferior alveolar nerve with lower molars.

Anytime a flap is developed in the posterior mandible there is risk of lingual nerve damage. Extending the incision bucally on the most distal tooth and developing a full-thickness mucoperiosteal flap lessens this risk, but I've seen several examples in OS lectures where the lingual nerve flips right behind the most distal tooth, in close proximity to where that incision would be placed. Sorry if that's too nit picky . If the procedure is done properly its a low risk but a risk nonetheless.

 

[Idiopathic]

Thanks for all the responses. I appreciate the feedback. The tooth is definitely coming out (ASAP).

 

[Midoc]

Ya got me there, I have not yet finished my first OS course. In fact, the next lecture is in about 7 hours so I better get to bed.