Expert: Mark Bornfeld DDS - 2/21/2009

Question
I had a really bad toothache on a tooth that already had root canal surgery done on it four years ago.  Two days after the pain I had a swallon face and numbness in my chin.  I had the tooth extracted and most of the swellon went away.  I still have a numb chin.  I've had the numb chin for more than 5 weeks.  The oral surgeon did a panoramic x-ray and didn't see any tumors or growths.  He wants me to come back in one month.  Is there any other test that I should do?  I thought the numb chin was isolated to the toothache but it scares me to think it might be someting more series like cancer.

Answer
Dear Tom,

The fact that the onset of the numbness coincided with the acute infection makes it almost 100% certain that the numbness was due to compression of the sensory nerve by the infection, and not some more significant malignancy or neurological disease. However, the persistence of the numbness is not typical, and I suspect that the extraction of the tooth may have superimposed additional injury to the nerve (I'm going to guess that we're talking about a lower premolar, which is most likely to result in this type of persistent numbness due to its proximity to the sensory nerve.)

There is no need to employ additional diagnostic tests, because the sequence of events clearly indicates a physical injury to the nerve rather than some undisclosed pathological process. What cannot be predicted, though, is the speed and completeness of recovery of sensory nerve function. The healing of nerve fibers is frustratingly slow, and you may not know whether your sensation will return completely to normal until as much as six months have passed. However, you can relax if your concern is cancer-- it clearly is not.

In the unlikely event that full nerve function does not return, you should know that most patients so affected usually accommodate to the sensory deficit, and eventually come to be unaware of it. As such, it is seldom a significant quality of life issue.

Good luck!

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY