Surgical repair of
lip and tongue numbness
The trigeminal nerve is the sensory nerve of the face. This nerve is divided into several branches through which we feel the face, eyes, scalp, mouth and tongue.
During dental treatment, the trigeminal nerve can be damaged for a variety of reasons - ranging from local anesthesia injections to various treatments such as root canals, implants, extractions and other surgical interventions. These injuries will typically lead to loss of sensation in the lower lip and / or tongue. Less commonly, these injuries that can cause severe pain, weak pain, tingling or feelings of heat / cold.
While sensory disturbances in the face can cause a great deal of suffering, the good news is that most injuries will heal spontaneously and everyday life will return to normal. In those few patients where the nerve does not heal spontaneously the negative impact on quality of life can cause great distress in eating, drinking, speaking and in daily behavior.
How can nerve damage be avoided during dental treatment? Currently - there is no way the dentist can know the exact location of the nerve that gives the sensation to the tongue (lingual nerve) because the anatomy varies from person to person.
Moreover, there is no imaging available that can demonstrate the trajectory of this nerve. As a result, for example in the injection of local anesthesia, it is not possible to determine in advance where to insert the injection needle so that on the one hand the local anesthetic fluid is delivered effectively (close to the nerve) and on the other the needle itself does not penetrate and damage the nerve itself.
Finally, even the tip of a suture needle may inadvertently penetrate the nerve sheath or hug it while suturing the gums and resulting in sensory disorders.
In contrast, the mandibular nerve that gives the sensation to the lower lip and teeth can be demonstrated on X-rays , because it passes inside the jaw through a canal called the mandibular canal (similar to an electrical wire that passes through a tube in a wall).
Although the nerve itself is not seen on imaging, the canal within which it is located can be demonstrated by X-rays and thus its location can be assessed in advance.
The most dominant variable for successful surgical outcomes is the period of time that passes from the moment of injury to the time of the repair.
What to do if there is no sensation in the tongue / lower lip after dental treatment?
If twenty-four hours after a root canal treatment, dental implants, wisdom tooth extraction or any other dental treatment the anesthetic sensation does not fully wear off in the lower lip and / or the tongue - there is a risk of nerve damage and you should be examined as soon as possible by a skilled Oral and Maxillofacial surgeon.
During the examination, the doctor will assess the reason of the disturbance, and what the chances are of spontaneous recovery. Only in cases where it is decided that the nerve has been irreversibly damaged will surgical intervention be recommended.
The importance of early testing stems from the fact that the most important variable for treatment success is the period of time that passes from the moment of injury to the moment of repair. The shorter this time, the higher the chance that the sensation will return after the repair.
A rarer neurological disorder that can be caused after dental treatment is characterized by severe pain in the injection or treatment area. If after a few weeks of dental treatment a strong feeling of very focused pain begins, triggered by touching a specific point in the the mouth, you may be suffering from a "traumatic neuroma" and it is important to be examined by a Oral and Maxillofacial Surgeon.