Long Term Effects of Trigeminal Nerve Injuries from Dental Care

A study was published in the Journal of Oral and Maxillofacial Surgery titled “Long-Term Outcome of Trigeminal Nerve Injuries Related to Dental Treatment” by M. Anthony Pogrel, Ryan Jergensen, Eric Burgon, and Daniel Hulme. (vol. 69, pages 2284-2288, 2011) that looked at long-term effects of those who suffer from permanent nerve injury from dental treatment particularly involving the third molars or wisdom teeth.

A total of 145 patients with 95 female and 50 male patients were involved in the study who had suffered a trigeminal nerve injury affecting either the inferior alveolar nerve or lingual nerve and in 8 cases both nerves. Nineteen patients (13.1 %) reported that their employment was affected, while 21  patients (14.5%)  reported problems with their relationship, 53  patients (36. 6%) reported depression, 55  patients (38%) reported problems speaking and pronouncing words correctly, 63  patients (43.5%) reported problems eating, and 1 patient reported a significant change in his appearance. Twelve patients (8.2%) were reported to have gone on to make a late full recovery.

Some of the coping mechanisms the patients used include getting used to it (64), prayer and mediation (7), ice and heat packs (3), pressure on teeth (3), exercise and yoga (3), antidepressants (2), chewing gum (2), relation and acupuncture (2), and other methods included keeping a journal, alcohol, massage, and herbal medicines.

The authors state:

“In this study, the encouraging news is that in general terms, patients did tend to improve with time, with over 8% going on to full recovery, although it is unclear in some cases whether this recovery was a true neurological improvement or the development of coping mechanisms.”

It is not clear from the results if the improvement in symptoms in a few of these patients was due to and an actual improvement or just the better ability to cope. I agree that I think this is hard to say.

The authors also mention the ability for surgical exploration which did not occur in all these patients but is a possibility within 9 months after injury to the trigeminal nerve following a wisdom tooth extraction

  • Patients with a witnessed transection
  • Patients who are still totally anesthetic at 8 weeks postinjury, with no signs of recovery
  • Patients with severe dysesthesia at 8 weeks postinjury, who are showing no improvement
  • Patients at 4 months postinjury, who have less than 30% return of function (or do not have protective reflexes), or have severe dysesthesia

For the patients in the study who did have surgery some were helped but none fully recovered.

Consequently many of these patients suffered from a permanent decrease in their quality of life.

3 thoughts on “Long Term Effects of Trigeminal Nerve Injuries from Dental Care”

  1. I had my wisdom teeth removed 3 years ago. It has left me with chronic nerve pain specifically in the mouth area and the left side of where the jaws join (lower) and can be at the right side if the pain gets severe. I’m taking 1200 mg of gabapentin daily plus Tylenol which doesn’t do much. And 1-2 times a month I take dilaudid mg to give me some rest from the pain ( which never ever goes away unless I take this, and which I had to change doctors 2 times and beg my last one to give me. The reason I knew that it worked is that I used my husband’s rx that he had filled for a surgical procedure and the 27 that he had left lasted me 1 1/2 years). Problem is and aside that I never get really any relief from this pain, I also have trouble with pain from constipation and gas. I just want to know if there is any other way to treat this. I’m so tired of it all. Please let me know if you have any ideas.

  2. I just hit the two year mark of The worst day of my life. When I woke up from the procedure that removed my two lower wisdom teeth, I could immediately tell something was wrong. The staff, my husband, and my friends assured me that it was a normal part of the recovery process to believe this and that it was normal to have numbness and parasthesia in my chin and lips. Four days later when the numbers was still present, I knew in my heart that something really was wrong. Although I was a healthy 27 year-old woman, my recovery was slow and painstaking. Despite my cautionary efforts, I had painful nerve exposure on both sides of the extraction sites. Four weeks after the procedure I woke up nauseas and hot–my face was swelled up like a chipmunk on steroids. My mom rushed me to my oral surgeon and they immediately tore open my stitches and suctioned out the infection, which had somehow gotten out of control overnight. This was rare, according to the Dr.–to have an infection so late in recovery. At this point I also explained that my chin and lips were still numb, that I was struggling to talk and eat and teach my classes of high school students. He looked concerned and did a cone scan to reveal that my nerve was intact and all looked good. He assured me that it would just take time. A week later I did start to get feeling back. But oh how I wish I could have just kept the numbness! The pain the enveloped my face was brutal. Pins and needles turned into what I can only describe as a migraine in my face. The lightest touch would feel like an electric shock. When I got a new puppy and he inevitable tried to lick my face, I would almost pass out from the pain. I did pass out once, when I tried to eat a dorito. The sharp chip made contact with my nerve sensitive gum and I was out. A few weeks later, it was my wedding day. I called my future husband to ask a question I never thought I would–I asked him not to kiss me on the alter. Instead I asked him to kiss my forehead or my nose. I was heartbroken on my wedding day. But I tried to remain hopeful. Although I couldn’t brush my teeth or kiss my husband on our honeymoon–I remained hopeful that I would recover. But then as the days turned to weeks and the sensations in my face became more intense it was hard to stay positive. I became depressed. I wanted no intimacy with my new husband and I stopped singing and performing with my band–all the things that brought me joy: my dogs, my music, my teaching, eating–they were starting to disappear. Then something even more strange started happening. Although the nerve pain was isolated to the right side of my chin and lower lip–it started to spread–yes spread to the other side of my face slowly. This was almost unheard of in the oral medicine department at the University of Washington so we decided I needed to see a neurologist. I got an MRI and started taking various medicines that made me sick or lethargic. I became an Empty shell. The stress and depression got worse when I found out my medical provider didn’t cover any of my treatments as it was a “complication from a procedure outside of coverage”. I am still making payments for that damn MRI. It was “normal” by the way. But I’m not normal. I will never be the same. After trying five different seizure and neurological medicines I started seeing an acupuncturist. Although the pain and numbness is still there, she is helping me learn to cope through stress reduction. I started singing in the shower again. My dogs are trained to kiss my ear instead. My husband and I have learned the power of positivity. I struggle with this everyday but I’ve realized that it is not going away and I must remain positive and must find the joy in the mundane otherwise the numbness and pain will take over my entire mind, body, and spirit. I cannot let that happen.

  3. Thank-you for sharing what U are going through and I now know that there is somebody out there that is going through a similar thing as me. I only have had 2 months of the discomfort and it is driving me crazy!! I have been cut ,burnt broken bones and have been through cancer treatments and this has been the absolute worst. Have U ever considered looking at legal measurers re the dentist that did the extraction? I am thinking about it but will give it a month or two before a make a any move yet!! Tks so Much Dennis

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