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Oral Surgery/traumatic wisdom tooth extraction

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Question
Dear Dr. Teig,
I had my lower left wisdom tooth extracted in October 2012.  The consulting surgeon that I saw in September recommended all four teeth to be extracted under sedation.  I decided to do one at a time, beginning with the impacted tooth which the surgeon deemed would be a complicated surgery, and at the time of scheduling the appointment asked the receptionist if sedation was still required and she told me local should be fine.  
Then when I showed up for my surgery  3 weeks later, a different oral surgeon was there to perform the procedure.  Although he looked at my pan xray and looked inside my mouth, he did not not look at my chart or have any discussion with me.
He proceeded to extracted the tooth in what I consider a very rushed and traumatic manner. After making the incisions and removing some bone, he told me I would feel some pressure.  What I felt was this extreme and abrupt downward thrust on my lower jaw, and as he did this I felt the entire left side of my lower jaw go lower (my upper jaw was being held in place by the bite block).  I want to reiterate that I felt my jaw being hyper-extended.  I immediately grabbed him to stop, which he did not do and then his assistant held my hands down while he continued to exert excessive for on my jaw until the tooth came out.

Later that day, when I tried to drink I noticed that my entire left joint was unstable while the right side was getting stuck or being restrained.  6 months post extraction, I am still in severe pain.  There is a deep ache in front of my ear, my tongue is partially numb, my chin is burning, I'm getting wierd sensations across the left side of my face, I can only open my mouth two centimeters and if I want to open it further, I have to crank it open.   There's multiple clicks when opening and closing my mouth, and the right side is locking.  Every tooth along the lower left side is sensitive, I have daily earaches, neck and shoulder pain, and dizziness. What I am experiencing is tormenting.

Starting day 1 from the extraction there has been a very tender spot under my jaw bone.  Now there is a hard lump there.
I also had an MRI of my tmj done and the oral radiologist that read the report said that he sees changes to a lot of the tissues around my tmj suggestive of trauma, something he usually sees in motor vehicle accidents!!  In thirty one years, I have never sustained an injury to my face, neck or jaw and have never had any pain, numbness or altered sensations.

Is it possible that the surgeon tore some muscles, ligaments and tendons in my face and now that they're healing with scar tissue, it's putting pressure on the nerves?
Also, do you think having the procedure done under sedation would have made a difference.

Thank you so much
Natasha

Answer
Natasha - I have to tell you that it definitely sounds like the surgeon who did the extractions was not skillful and he traumatized and damaged the jaw joint.  That is not good since healing of that joint, on its own, is very difficult since it is constantly used.  It sounds like ligaments in the joint were disrupted or torn and secondarily it has produce a change in your bite and the jaw muscles have responded with repeated spasms. The spasms alone can disrupt normal biting, but internal damage to the jaw joint, as indicated by the radiologist, is not good.  This problem is like a snowball rolling down a hill and as you chew and open your mouth, you are repeatedly irritating the joint.  

If done under sedation it might have been better, if the doctor was just reacting to your discomfort, rushing.  

Where do you go from here?  Get the opinion from another surgeon to evaluate you.  That is the best approach.  You might need surgery or some type of active treatment to help the healing.  I wish you well and hope you feel better soon.

Oral Surgery

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon 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 practicing for over 20 years. Assistant Clincal Professor at 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 Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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