Dr. Hall,
I am 32 years old and in July of this year I began having complications with my upper right wisdom tooth. The top and bottom (all four) wisdom teeth had always been impacted however the upper right had began to break through the gum and was pushing on all the teeth on that side causing swelling and pain. I consulted with an oral surgeon and decided upon his advice to have all four removed. I had the surgery the following day.

Surgery went as planned and recovery appeared to be on schedule. I had the knots on both jaws and I did notice that the right side was more painful and a pressure and numbness when I bit down. I believed it was part of healing. Three months later(October) I woke up to the entire right side of my face being swollen. I called the oral surgeon and saw him immediately. It appeared that I had an infection so he opened the area back up and cleaned it out. I was back to square one recovering from the extraction.

Again, recovery went well and at the follow up appointments I appeared to be healing well. Three weeks later I began feeling the numbness and pressure again, which I now knew was not normal. I went to the surgeon and he took a cat scan among other films. I again was told that he believed it to be an infection and that it needed to be cleaned out again. That was in November. I again healed well and again had the numbness and tingling return three weeks into recovery.

I was then referred to a nerve specialist. I was told this week by the nerve specialist that I have buccal nerve damage and that there is not much I can do about it. My question … How common is this? Is this negligence by my surgeon? Long term can the damage improve? Thank you so much and I have enjoyed all of the informative information your site!
-Tina from Texas

Tina,
You are having some unusual complications from your wisdom tooth surgery. I’m not going to be able to tell you anything specific about your case, because it sounds like nobody is too sure, but I can tell you some general principles that could help.

There can be, in rare situations after wisdom tooth surgery, a resistant pocket of infection that takes an extended period of antibiotics and time to heal. It sounds like this may have happened in your case, because the follow-up treatment by the oral surgeon each time seemed to help. But it’s unusual that your problems would return three weeks into recovery. Were you taking antibiotics all this time? Did you stop taking them? That’s a possibility that I would investigate, that you may have stopped taking them because the prescription ran out and the oral surgeon should have given you a longer prescription.

If the neurologist is correct that you have buccal nerve damage, it is difficult for me to attribute this to negligence by your surgeon, mostly because it appears that the damage wasn’t caused directly by the surgery. The buccal nerve in some patients can run close to the lower wisdom tooth, and it could be severed if the surgeon makes too wide a cut. But this isn’t what happened in your case, because of two reasons. If you have any feeling at all, such as tingling, the nerve wasn’t severed. And second, the numbness and tingling is occuring three weeks into recovery, so it is an indirect result of other things that are going on, not the surgery.

As far as how long this will last, nerves do recover, though it is slow. If you have tingling, the nerve is only damaged and not destroyed, so it should recover in time, though it can take up to a year.

Has anyone considered the possibility that maybe the area should be just left alone, without further surgical intervention, and just keep taking antibiotics for a month or two?

And, as a parenthetical note, this is a great illustration of the desirability of prophylactic removal of the wisdom teeth when you are young. I am confident that, had you had these wisdom teeth removed when you were 18, this would not have happened. The likelihood and severity of complications increase dramatically with increasing age, because the bone gets more dense and the roots of the teeth enlarge with time. I saw this time after time in my practice. Read my post of just one week ago where I addressed the issue of prophylactic removal of wisdom teeth.

Dr. Hall

Read Tina’s reply, where she says that it sounds like we are right: Reply to buccal nerve damage.