The trigeminal nerve comprises three divisions of nerve, which provide sensations to the face, mucous membranes, and other head tissues.
Injury to any of these divisions of nerve causes an array of symptoms, which not only hampers normal activity but may also lead to social and mental health problems.
So, it's important to take immediate interventions if a dentist or a patient suspect any dental nerve injuries.
Local anesthetic solution or obturation materials reaching the nerve tissue during endodontic therapy are examples of chemical insults that may cause trigeminal nerve injuries during dental treatment.
Surgeons performing osteotomy procedures to fix upper or lower jaw deformities.
Insertion of implants into the nerve canal could cause nerve damage.
During third molar surgery.
The fracture of the body and para symphysis of the mandible could cause injury to the mental and mandibular nerve.
Symptoms, Complications and Management
Cause 1
Local Anesthesia
Symptoms
Pain and changes in sensation.
Functional difficulties related to nerve damage.
Complications
Trismus
Paralaysis of the facial nerve
Hematoma
Management
First-line therapy for nerve injury from dental local anesthetic is pain management by painkillers.
For nerve healing and function, dentists prescribe vitamin B12 supplements.
Cause 2
Over-Instrumentation and Overfilling During Root Canal Treatment
Symptoms
There can be an abnormal sensation, altered sensation, tooth sensitivity, or loss of sensation related to nerve injury.
Complications
Iatrogenic injury such as accidental extrusion of sodium hypochlorite beyond the root apex can cause paresthesia and ecchymosis of the soft tissue mucosa. However, this gradually recovers with proper medical treatment.
Management
At the first sign of a traumatic inferior alveolar nerve injury, steroid medication is necessary.
Removing the foreign material and decompressing the nerve as soon as possible reduces the possibility of permanent nerve damage.
In severe nerve injury, further treatment may involve a nerve graft.
Cause 3
Maxillofacial Surgery for Correcting Maxillomandibular Deformities
Symptoms
Neurologic injuries associated with orthognathic surgery mainly affect the infraorbital, inferior alveolar, incisive, and mental nerves.
This kind of nerve injury causes paralysis of the facial nerve and permanent hypoesthesia.
Complications
Neuropathic pain
High risk of permanent hypoesthesia in old patients.
Management
Cryotherapy
A local anesthetic is used to numb the region before freezing it.
This is done with a local anesthetic cream or injection.
After applying a metal probe with liquid nitrogen, the temperature may rise.
It's possible to do this several times.
Take pain medications if the area still hurts 1.5–2 hours after the treatment.
External Neurolysis
If the nerve fiber is normal but is bound to the encompassing tissues by scar tissue, oral and maxillofacial surgeons perform external neurolysis.
Medications
Certains class of medications such as vitamin-B12, antiepileptics, analgesics, and steroids are helpful in relieving the symptoms.
Nerve Grafting
When direct nerve restoration isn't workable owing to a long distance, dentists refer the patient for inter-positional nerve transplant, to an oral and maxillofacial surgeon.
Cause 4
Jaw Fractures
Symptoms
Fractures of the bony canal can cause temporary or permanent anesthesia of the lip, teeth, and gingiva.
A lingual nerve injury might cause temporary or permanent anesthesia of the ipsilateral tongue and gingiva.
Complications
Neurosensory disturbance within the path of mental nerve is seen due to the close proximity of the inferior alveolar nerve, in case of mandibular fractures.
Visual disturbances and altered sensation along the path of facial nerve is seen in case of maxillary fractures.
Management
Early fracture reduction and fixation may help nerve recovery margins.
Cause 5
Third Molar Extraction
Symptoms
Inferior alveolar and lingual nerve injuries can cause:
Patients with paresthesia in the distribution of the IAN(inferior alveolar nerve).
Patients with complete anesthesia post-operatively.
Complications
Mild paresthesia or permanent loss of sensation may occur in case of IAN injuries during third molar removal.
Distoangular impactions poses a high risk of lingual nerve injury because of the close proximity of the lingual nerve fibers and lingual plate distal to mandibular third molar. Complete recovery usually occurs after several weeks to months. However, in case of permanent loss of taste sensation, surgery is essential to promote recovery of the lingual nerve.
Management
The abnormal sensations fade with time.
Some diminish in days or weeks.
Others see a decline within months.
Nerve injury during third molar removal is rare, and non-recovery is extremely rarer.
Cause 6
Implant Placement
Symptoms
Mild paresthesia to complete anesthesia
Pain
Complications
Complications arise due to placement of implant in the region of inferior alveolar nerve. The lower lip, gum, teeth, chin, and tongue become numb, tingly, and painful after nerve injury.
Management
Treatments for implant-induced nerve injury include near-infrared therapy, stellate ganglion block, vitamin-B12 medication, and surgery.
Frequently Asked Questions
How do dentists treat nerve damage?
Dentists treat nerve injuries in different ways. First, they inspect detectable nerve injuries by thorough examination and then they proceed towards the treatment.
What does nerve damage feel like in a tooth?
In the early stages of tooth nerve damage, you will experience sharp, continuous pain. Hot or cold foods may provoke pain. You may also wake up at night because of the excruciating pain arising from the tooth.
In the later stages, the tooth's nerve undergoes necrosis. You will experience a dull pain at this stage, which goes through a remission process.
Is dental nerve damage permanent?
Dental nerve damage can either be temporary or permanent. However, this all depends on the severity of the nerve injury.
How do dentists treat nerve damage?
There are many ways of treating nerve damage. This all depends on the type and location of the nerve injury. For example, dental caries involving the tooth's nerve require root canal treatment. In contrast, nerve injury because of third molar extraction requires patience and medications to relieve numbness and pain resulting from nerve injury.
What does nerve damage feel like in a tooth?
Tooth nerve discomfort can be as severe as a piercing or stabbing ache or mild as a dull ache. Certain foods and drinks can trigger pain because of the exposed tooth nerve.
What are the benefits of dental nerve damage treatment?
Removal of infected nerve tissue from a tooth does not affect the tooth's integrity. Your tooth will be functional as soon as the problem in the tooth resolves.
How can I know if I have a damaged tooth?
If you feel any food particles penetrating the inner portion of the biting surfaces of teeth or if you experience any pain during chewing, this sign indicates damaged tooth structure.
Conclusion
Taking strong preventative measures and a prompt treatment strategy are the most effective ways to lessen the likelihood of nerve injuries and the possibility of permanent disability.
A complete medical history, comprehensive clinical assessment, and an auxiliary radiographic evaluation are all essential for diagnosing nerve damage.
Anti-inflammatory medicine prescriptions as a kind of early intervention might be helpful.
