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Medical Forum / General / Dentistry / August 2005Numb after wisdom teeth removal
Hi All - I had my wisdom teeth removed about 5 weeks ago and the left-hand side of my bottom lip is still numb. I've been in steady contact with my oral surgeon, etc., but I was just wondering if anybody else has experienced this and when I can expect for the feeling to return. If the feeling does not return, are there any surgical options I should know about? It still is quite painful, which leads me to believe that perhaps it will eventually resolve itself, but I am starting to really worry about all of this. Please let me know if you have any advice or experiences to share. Any and all stories are welcome and appreciated. Thanks for reading. 90% of such cases tend to resolve in less than 6 months. Your surgeon should be monitoring your progress.  Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > Hi All - > [quoted text clipped - 8 lines] > experiences to share. Any and all stories are welcome and appreciated. > Thanks for reading. Actuallaly its 6 months to 1 year. If it doesn't resolve there are no surgical options you will eventually get used to it and every once in a while realize the lip is still numb. When I had my wisdom teeth taken out I had the exact same problem so what you are experiencing is pretty common risk of the procedure. > 90% of such cases tend to resolve in less than 6 months. Your surgeon > should be monitoring your progress. [quoted text clipped - 23 lines] > > experiences to share. Any and all stories are welcome and appreciated. > > Thanks for reading. >Actuallaly its 6 months to 1 year. >If it doesn't resolve there are no surgical options you will eventually >get used to it and every once in a while realize the lip is still numb. >When I had my wisdom teeth taken out I had the exact same problem so >what you are experiencing is pretty common risk of the procedure. You should add that the person may get used to it or they may not. I find it really annoying that surgeons.. okay not always dental surgeons.. assume that when they mess you up you'll get used to it. I had an op to take tissue from inside the lower lip for grafting elsewhere and was told that it would all be healed in a few months. It hasn't. I have a large numb area which I can't get used to no matter how much I try. It gets sore for one thing. Why is it that we are just brushed aside and told that we will get used to it.... You are right some people may not get used to it. It could take up to six months for the area to get back to normal. Sometimes numbness is permanent. There is also a local anesthetic called Articaine or Septicaine that is more likely to cause nerve damage if used. It should not be used to block a whole segment of a nerve. But any local anesthetic can cause numbness. Ask your dentist to map the area where you are numb, to track the progress of the numbness. i.e. if the area is mapped a month later and it is found that the area of numbness is getting smaller, then there is progress. Basically the dentist pin-pricks a lot of points in the area around the numbness and asks where you feel the pinprick and where not, and then he can get a feel for the boundary of the numbness. Then he draws a diagram of the area in your chart to document it. State-of-the-art technique, like the space shuttle. Disclaimer: this is not intended to be professional dental advice. advice may be wrong. not responsible for damage, death, injury used from following advice. Have fun. Studies show Articaine to have NO higher incidence of parasthesia than mepivicaine . Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > It could take up to six months for the area to get back to normal. > Sometimes numbness is permanent. There is also a local anesthetic [quoted text clipped - 13 lines] > advice may be wrong. not responsible for damage, death, injury used > from following advice. Have fun. > Studies show Articaine to have NO higher incidence of parasthesia than > mepivicaine . I'm not so sure anymore. I've had two cases of residual paresthesia after using articaine...and zero with lidocaine. Both resolved fully within 3 weeks; however, they made me quite uneasy. The latest CRA newsletter reports a much higher incidence of residual paresthesia from articaine when used for a mandibular block. I've stopped using it for IANB's and use it solely for infiltrations now. Check out he lastest CRA newsletter for more info on this. Articaine has been documented to cause parasthesia but it was always temporary and in areas such as the palate and in all of these case a lot of it was used. It is one of the best local anesthetics around in my opinion dispite the questionable reviews. Check out JAGD, Nov/Dec 2003 p498-501. I can email a copy of it to you if you like. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >> Studies show Articaine to have NO higher incidence of parasthesia than [quoted text clipped - 7 lines] > use it solely for infiltrations now. Check out he lastest CRA newsletter > for more info on this. > Check out JAGD, Nov/Dec 2003 p498-501. > > I can email a copy of it to you if you like. I read that article. However, the CRA report that I mentioned is the most current info out. I realize it's not peer-reviewed, and the statistics are purely anecdotal, but I'm going with their suggestion of avoiding IANB's with articaine. Having personally seen two paresthesias in a 12 month period following an IANB with articaine is enough to convince me that there might actually be some substance to the CRA report. I'll be avoiding IANB's with articaine until I read some new research on it. I do not use CRA as a reference for anything. I don't feel they have any credibility beyond the fact that the report is mailed to a lot of offices. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >> Check out JAGD, Nov/Dec 2003 p498-501. [quoted text clipped - 10 lines] > I'll be avoiding IANB's with articaine until I read some new research on > it. >> Check out JAGD, Nov/Dec 2003 p498-501. >> [quoted text clipped - 8 lines] > >I'll be avoiding IANB's with articaine until I read some new research on it. Have been using articane for IANB for over two years now with no paresthesia. Could be tecnic sensitive. Usually give a Gow-Gates. YMMV -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>> Check out JAGD, Nov/Dec 2003 p498-501. >>> [quoted text clipped - 14 lines] > Have been using articane for IANB for over two years now with no > paresthesia. Me too...until it happened to me. >Could be tecnic sensitive. Both cases required more than 1 carpule for the block. Usually I use 1 carp for the IANB and 1 carp shared between the long buccal and a buccal and/or lingual infiltration. Both cases required a 2nd carpule for the IANB. Perhaps I hit the nerve bundle on reinsertion and the patient couldn't tell (ie--no "electric shock") because they already had soft tissue anesthesia back there. If they report an electric shock feeling on first insertion for the IANB, I remove and redirect. > Usually give a Gow-Gates. >Both cases required a 2nd carpule for the IANB. >Perhaps I hit the nerve bundle on reinsertion and the patient couldn't tell >(ie--no "electric shock") because they already had soft tissue anesthesia >back there. Very possible, and paresthesia would result with any anesthetic IMO. > If they report an electric shock feeling on first insertion for >the IANB, I remove and redirect. Same here. For ext or rct I follow up with marcaine. Otherwise, it's ligamentary injection or X-tip with mepivi 3% plain for restorative. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com I find, if the patient needs a second carpule, I use lidocaine with 1:100,000 epi. The combination works very well. Plus, the second carpule only gets about 1/3 into the normal IANB location. 1/3 up behind the maxilla, and 1/3 towards the TMJ. Since doing it this way, I have yet to have a patient still sensitive. The X-Tip kit sits on the shelf. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >>>> Check out JAGD, Nov/Dec 2003 p498-501. [quoted text clipped - 30 lines] > >> Usually give a Gow-Gates. >I find, if the patient needs a second carpule, I use lidocaine with >1:100,000 epi. The combination works very well. Plus, the second carpule >only gets about 1/3 into the normal IANB location. 1/3 up behind the >maxilla, and 1/3 towards the TMJ. Doh! I meant to say mandibular nerve block. >>I find, if the patient needs a second carpule, I use lidocaine with >>1:100,000 epi. The combination works very well. Plus, the second carpule >>only gets about 1/3 into the normal IANB location. 1/3 up behind the >>maxilla, and 1/3 towards the TMJ. > > Doh! I meant to say mandibular nerve block. Hold on. I corrected myself too soon. IANB=inferior alveolar nerve block=mandibular nerve block. You had me confused, Steve. What you're describing is a superior alveolar block...not an IANB. If you fail with the IANB, try placing a little anesthetic back behind where you would normally put a SANB. The mandibular nerve often branches off back there. You get the lingual and mandibular on those patients who are wired a tiny bit differently. Trust me it works almost 100% of the time. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >>>I find, if the patient needs a second carpule, I use lidocaine with [quoted text clipped - 7 lines] > block=mandibular nerve block. You had me confused, Steve. What you're > describing is a superior alveolar block...not an IANB. Stabidents are fast, simple, and very effective. If you have trouble finding the hole, use X-Tips. JME, Fawks > If you fail with the IANB, try placing a little anesthetic back behind where > you would normally put a SANB. The mandibular nerve often branches off back > there. You get the lingual and mandibular on those patients who are wired a > tiny bit differently. Trust me it works almost 100% of the time. The only times a parasthesia occurred in my office after IANB, I was using Mepivicaine. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >>> Check out JAGD, Nov/Dec 2003 p498-501. [quoted text clipped - 24 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com And I've shared my anecdote also. I've had two cases of temporary parasthesia with less than 100 IANB's using 4% Citanest Forte. None with any other anesthetic in 26 years of practice, but I've also never used Articaine (4% solution). Most experts agree that there is an increased risk of parasthesia with 4% anesthetic solutions for IANB's. Whether that added risk is significant in clinical practice remains as a topic for debate. Many dentists have not taken any hands on training with local anesthetics since graduation from dental school. They choose anesthetics and techniques that a friend, some speaker, or article touts as 'better' in order to solve their problems getting patients numb. They might be amazed at what would happen if they spent a day listening to a real expert in local anesthesia and then practiced those techniques on each other under this person's supervision. Poke & hope/grab & jab anesthesia attempts would lessen dramatically. Their patients could experience less pain during injections and have more effective results. Like the Pink Floyd song lyrics....comfortably numb (great for your reputation as a dentist). :-) Fawks PS: None of this is directed at Dr. M. or any other smd poster. > The only times a parasthesia occurred in my office after IANB, I was using > Mepivicaine. |
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