Abstract
Objective To investigate relationships between pathology, eruption status, age, anaesthetic modality and nerve damage during lower third molar surgery.
Design Single centre prospective study.
Setting Oral surgery out-patient clinics.
Subjects 367 patients unselected for age, gender or social class, scheduled for lower third molar removal. At 1 week, any evidence of iatrogenic nerve damage was recorded. Patients with altered lingual and/or labial sensation were followed up for 6 months.
Results 718 lower third molars were removed from 250 males and 117 females. 96 removals (13.4%) were associated with altered lingual, labial or buccal sensation. There were no significant associations between nerve damage and eruption status, age and pre-operative pathology. There was a highly significant difference in the incidence of nerve damage between LA removal (3%) and GA removal (18%) (chi-squared = 17.18; f = 2; P < 0.01) but no significant associations between surgical difficulty and nerve damage within each of the two groups.
Conclusions Lingual and inferior alveolar nerve damage was five times more frequent when lower third molars were removed under general anaesthesia rather than local anaesthesia. This could not be explained in terms of surgical difficulty, pre-operative pathology, age or anatomical position.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Blackburn C W . A method of assessment in cases of lingual nerve injury. Br J Oral Maxillofac Surg 1990; 28: 238–245.
Blackburn C W, Bramley P A . Lingual nerve damage associated with the removal of lower third molars. Br Dent J 1989; 167: 103–107.
MacGregor A . The impacted lower wisdom tooth. pp 62–63. Oxford: Oxford University press, 1985.
Blackburn C W . Experiences in lingual nerve repair. Br J Oral Maxillofac Surg 1992; 30: 72–77.
Rood J P . Permanent damage to inferior alveolar and lingual nerves during the removal of impacted mandibular third molars. Comparison of two methods of bone removal. Br Dent J 1992; 172: 108–110.
Mercier P, Precious D . Risks and benefits of removal of impacted third molars. A critical review of the literature. Int J Oral Maxillofac Surg 1992; 21: 17–27.
Lysell L, Rohlin M . A study of indications used for removal of the mandibular third molar. J Oral Maxillofac Surg 1988; 17: 161–164.
Guralnick G, Laskin D . NIH consensus development conference for the removal of third molars. J Oral Surg 1980; 38: 235–236.
Stanley H R, Alattar M, Colett W K, et al. Pathological sequelae of 'neglected' impacted third molars. Oral Pathol 17: 113–117.
Song F, Landes D P, Glenny A, Sheldon T A . Prophylactic removal of impacted third molars: an assessment of published reviews. Br Dent J 1997; 182: 339–346.
Knutsson K, Brehmer B, Lysell L, Rohlin M . General dental practitioners evaluation of the need for extraction of asymptomatic mandibular third molars. Comm Dent Oral Epidemiol 1992; 20: 347–350.
Brickley M R, Kay E J, Shepherd J P . A decision analysis of lower third molar surgery. Med Decision Making 1995; 15: 143–151.
Armstrong R A, Brickley M R, Shepherd J P, Kay E J . Healthy decision making: a new approach in health promotion using health state utilities. Community Dent Health 1995; 12: 8–11.
Antczak-Bouckoms A, Tulloch J . Towards improving third molar decisions. Dentomaxillofac Radiol 1994; 23: 67–68.
Knutsson K, Brehmer B, Lysell L, Rohlin M . Asymptomatic mandibular third molars: oral surgeon's judgement of the need for extraction. Oral Maxillofac Surg 1992; 50: 329–333.
Absi E G, Shepherd J P . A comparison of morbidity following the removal of lower third molars by the lingual split and surgical bur methods. Int J Oral Maxillofac Surg 1993; 22: 149–153.
Robinson P, Smith K G . Lingual nerve damage during lower third molar removal: a comparison of two surgical methods. Br Dent J 1996; 180: 456–461.
Mason D A . Lingual nerve damage following lower third molar surgery. Int J Oral Maxillofac Surg 1988; 17: 290–294.
Office of Population Censuses and Surveys. Standard occupational classification. pp 1–54. London: HMSO, 1991.
Winter G B . Impacted mandibular third molars. St Louis: American Medical Book Co, 1926.
Bruce R A, Frederickson G C, Small G S . Age of patients and morbidity associated with mandibular third molar surgery. JADA 1980; 101: 240–245.
Hopkins R . Third molars may cause severe problems in middle age (letter). Br Med J 1994; 309: 1301.
Author information
Authors and Affiliations
Additional information
Refereed Paper
Rights and permissions
About this article
Cite this article
Brann, C., Brickley, M. & Shepherd, J. Factors influencing nerve damage during lower third molar surgery. Br Dent J 186, 514–516 (1999). https://doi.org/10.1038/sj.bdj.4800155
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.bdj.4800155
This article is cited by
-
Electrical stimulation to clinically identify position of the lingual nerve: results of 50 subjects with reliability and correlation with MRI
Oral and Maxillofacial Surgery (2022)
-
Nerve Injury After Surgical Excision of Mandibular Third Molars Under Local Anesthesia: An Audit
Journal of Maxillofacial and Oral Surgery (2019)
-
Impacted Mandibular Third Molars: A Retrospective Study of 1198 Cases to Assess Indications for Surgical Removal, and Correlation with Age, Sex and Type of Impaction—A Single Institutional Experience
Journal of Maxillofacial and Oral Surgery (2017)
-
The effect of modified surgical flap design for removal of lower third molars on lingual nerve injury
Clinical Oral Investigations (2017)
-
Influence of tooth sectioning technique and various risk factors in reducing the IAN injury following surgical removal of an impacted mandibular third molar
Oral and Maxillofacial Surgery (2016)
