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Oral Surgery/Lingual Nerve Symptoms

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QUESTION: My wife had a temporary crown removed and recemented on her right upper second molar.  No anesthesia was used.  The whole procedure was very brief...in the office about 15 minutes.  It was very painful when the temporary cap was being pulled off.  The next day she developed pain along the right side of her tongue.  It has lasted 6 weeks now.  Also, if it is important, she had all of her wisdom teeth extracted 40 years ago.

1)Do you think the lingual nerve was damaged by this procedure?

2)Have you ever heard of work on the upper molars causing lingual nerve injury?

ANSWER: Chris -  I have to tell you this is a little strange.  The lingual nerve, the nerve that provides sensations to the tongue is no where near the upper right second molar.  To damage the lingual nerve with this treatment is quite difficult.  If she had an injection to numb the area, it is possible that some of the local anesthetic solution dripped internally by gravity and may have numbed that nerve, but just from a drip it would wear off quickly.  

Where was the pain when the cap was removed.  Was it in the area of the tooth or was it on the lower jaw?

This is the strangest.  Did the dentist have her bite on something to keep her mouth open during treatment?

This is a difficult question to answer.  If you can respond to my two questions, it might help me arrive at a cause.  If you could answer my questions, it might help arrive at a possible cause.

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QUESTION: Hi Doctor Teig.  Thank you for your prompt reply.  In answer to your questions.  The pain during the procedure was felt in the upper second molar which was having the temporary crown recemented.  The dentist pulled the crown off with a hemostat, pulling hard.  No implements were used to keep her mouth open but she did bite down on a roll of cotton for about a minute while the adhesive was setting after the crown was replaced.

ANSWER: Chris -  as unusual as it is, the nerve to the tongue splits of a nerve that provides sensation to the lips, chin, upper jaw, and other facial regions.  The split of the tongue branch occurs in a different area from the nerve that provides sensation to where the upper second molar is.  There is a very small chance that the dentist, when he gave you the injection might have allowed some of the local anesthetic fluid to affect the other branch of the nerve.  This is very strange and I have never heard of this, but I guess it is possible.  

The same nerve that provides sensation to the upper jaw, where the tooth was, exits the skull behind the tooth and at the back end of the upper jaw.  That nerve has branches to other areas like the tongue.  Is that what happened?  I just don't know.  This is so unusual so I cannot tell you if that is what actually happened.  

As long as the numbness of the tongue wears off, there should be no residual problems.  If any numbness continues, then there is a possibility that the nerve sustained an injury from the injection or another reason.  If you still have numbness I suggest that you have a neurologist examine you.  I hope it's all gone.


---------- FOLLOW-UP ----------

QUESTION: Hi Again Doctor Teig.  Just to be clear, there was no injection and no anesthesia of any kind.  The dentist just pulled the temporary cap off with a hemostat and recemented it back.  This was the upper right second molar.  Does any of this make sense?

Answer
Chris -  I wish I could answer the question, but without any stimulation directly to the area, I just don't know.  If the numbness is still present, you should see a neurologist to evaluate the nervous system in that area.  I wish you well - I wish I could give you more information.

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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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