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Dentistry/Chin & lip numbness & pain after wisdom teeth removal

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QUESTION: I have been in a lot of pain since I had my wisdom teeth extracted.  The lower right jaw seemed like it was opened to the max and has not been normal since the surgery.  I was told that the tooth sat directly on the nerve but he didn't sever the nerve and everything went well.   That was February of 2010.  I went back for several follow ups but it has never gotten better.  I was referred to a neurologist which cost me a boatload in test and some medications that knocked me out!!! Still no help.  I tried an acupuncturist which gave me a little relief but couldn't afford to keep going weekly.  Any suggestion?  I feel like I walk around looking mad all the time but its because I am literally in pain.
My husband says he can tell by the look on my face how bad the pain gets.  I also was fitted for a bite guard to wear at night because they thought I was grinding down hard on my teath at night.

ANSWER: Cindy - Without examining you it is a little difficult for me to determine where the pain actually comes from.  If you would, could you describe the pain, where it shows up and what restrictions or changes it produces (such as difficulty opening the mouth, headaches, etc.) and get back to me with those symptoms and where it occurs and maybe I can better define what might be occurring.

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QUESTION: The pain is pretty much in my chin and lip...only on that lower quarter of my mouth...it is like an electric shock when even my shirt collar hits my chin.  It feels like there is constant pressure on my teeth.  I would think with the wisdom tooth out they would move in that direction but instead it feels like everything is moving towards the front.  Cold air on my face is really bad however cold on the inside actually feels good. It is just the opposite with hot.  I get headaches from the constant pressure.  Sometimes it centers on certain teeth yet I've had them checked and they said there is nothing wrong with them.

Answer
Cindy -  it is obvious that much of the electric shock in the chin, along with pressure on the teeth, is due to a neuritis (nerve inflammation).  That can occur from the removal of wisdom teeth, with the mandibular nerve lying below the roots of the wisdom teeth.  If the neurological medication you've been prescribed does not stop the pain, the appropriate treatment to stop the pain would be to give you permanent numbness of the mandibular nerve.  This permanent numbness can be rendered via surgery, but easier and just as effective is an alcohol injection into the mandibular nerve canal.  I know that permanent numbness doesn't sound good or desirable, but it will stop the pain.  You should speak with a board certified oral and maxillofacial surgeon or neurologist skilled in this alcohol injection technique to destroy the nerve and given you permanent numbness.  I know that numbness does not sound very good, but it is much more comfortable that pain.

What should be done first is to just give you a novocaine injection to see if numbing that nerve quiets the pain.  If it does, the alcohol injection will definitely work.  If you have more questions, feel free to contact me again.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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