Management of Third Molar-Related Nerve Injuries: Observe or Treat?

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12 Scopus citations


The determination of whether to observe or treat a nerve injury following third molar surgery depends on several factors: (1) knowledge of the natural course and incidence of sensory recovery following nerve injury; (2) the history of the nerve injury; (3) the physical findings; (4) the results of diagnostic procedures to determine the type (degree) of nerve injury; (5) the characteristics of the neuropathic pain, if present; and (6) the potential benefits and risks of treatment (i.e., surgery), if indicated. A witnessed injury is best treated immediately, but no later than within 4 weeks. Observation for up to 3 months is indicated when there is a history of an unwitnessed nerve injury, the descriptive word choices and functional deficits suggest only hypoesthesia, the physical findings are negative (i.e., no dystrophic changes, evidence of self-induced injury, neuropathic pain, or triggers), and the clinical neurosensory examination shows only mild sensory impairment, because more than half of IAN and LN injuries recover before 3 months. The presence of a LN deficit after 3 months has a greater chance of being associated with a severe nerve injury, and therefore the probability of recovery is less than with an IAN deficit after 3 months. Nerve injuries persisting up to and beyond 3 months, or those associated with pain, should be evaluated for the type of injury and the character and source of the pain, if present. Treatment is indicated when after 3 months there is still moderate or severe sensory impairment or there is neuropathic pain. However, further observation may still be indicated when the risk of the treatment outweighs the benefits.

Original languageEnglish (US)
Pages (from-to)79-84
Number of pages6
JournalAlpha Omegan
Issue number2
StatePublished - Jun 1 2009

ASJC Scopus subject areas

  • Dentistry(all)


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