Clinical Audit on the Prevalence of

Paresthesia After Surgical Removal

of Impacted Third Molar

By Dr Nirmal Kumar
 Presentation Outline
• Aims and Objectives
• Introduction
• Materials and Methodology
• Results
• Discussion
• Conclusion
 Aims & Objective
• General
1. A clinical audit on the prevalence of paraesthesia post surgical
removal of impacted wisdom tooth under local anaesthesia and
general anaesthesia in Ambulatory Care Centre and General
Operation Theatre, HSB in patients attending to Oral Maxillofacial
Department from 2010 to 2013

• Specific
1. To find out the prevalence of paraesthesia after third molar
surgery
2. To find out the treatment provided to these patients by the
dental officers in Oral Maxillofacial Department, Hospital
Sultanah Bahiyah, Alor Setar.
3. To find out the relationship between the proximity of the
mandibular canal to the root of the wisdom tooth and the
prevalence of paraesthesia.
 Introduction
• Third molar or more commonly known as
wisdom tooth removal is one of the most
common surgical procedures done by
dental practitioner during his/her service.
• indications
 recurrent
pericoronitis

prophylactic
cellulitis
removal

periodontally
compromised Indications abscess

unrestorable
osteomyelitis
caries

Cysts &
tumors
• Complications
– Alveolitis
– Infection
– Neurosensory deficit
• The major complications related to
mandibular third molar removal is the post-
operative neurosensory deficit.
• This complication may affect the inferior
dental nerve or more commonly the lingual
branch of the mandibular division of the
trigeminal nerve.
• Most studies have shown that paraesthesia
following mandibular third molar removal is
most likely temporary and will resolve within
the first 6 months.
• If no improvement is seen after 2 years of
follow-up, the altered sensation may be a sign
of permanent neurosensory deficit, a
complete loss sensory function and neurogenic
symptoms.
 Materials and Methodology
• Retrospective study
• A sample of 266 data of patients who underwent surgical removal
of impacted wisdom tooth under local anaesthesia or general
anaesthesia in Oral Maxillofacial Clinic from the period of October
2010 to September 2013 were taken from their respective folders
to obtain information on the
– demographic, the
– type of impaction,
– the proximity of tooth to the mandibular canal
– the shape of the roots,
– the technique of tooth removal,
– treatment choices for paraesthesia and
– prevalence of paraesthesia post-surgery.
– Out of the 266 cases, 199 were in compliance
• Sample that contains incomplete
record has been excluded from
sampling.
 Results
• The study was conducted over the period of 4
months with the number of subjects which
was 199 patients. The distribution data
collected is as shown below.
DISTRIBUTION OF PATIENTS SEEKING SURGICAL REMOVAL OF
THIRD MOLAR IN OMFS DEPARTMENT FROM OCTOBER 2010 –
SEPTEMBER 2013 BASED ON GENDER

MALE
45.2%
FEMAL
E
54.8%
DISTRIBUTION OF PATIENTS BASED ON AGE GROUP

140

120

100

80

60

40

20

0
0 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89
PREVALENCE OF PARASTHESIA AFTER SURGICAL REMOVAL OF
THIRD MOLAR IN OMFS DEPARTMENT, HOSPITAL SULTANAH
BAHIYAH
5.5% 4%

No paraesthesia

Paraesthesia

Inferior Dental
Nerve
Parasthesia

Lingual Nerve
Paraesthesia
90.5%
TYPES OF TREATMENT PROVIDED BY OMF
DEPARTMENT FOR PARAESTHESIA

11%

Self-healing Medications

90%
 RELATIONSHIP BETWEEN THE PROXIMITY OF THE MANDIBULAR
CANAL TO THE ROOT OF THE WISDOM TOOTH AND
PREVALENCE OF INFERIOR DENTAL NERVE PARAESTHESIA

• Type A : The roots of the third molar cut off the radiolucency of the
canal, and the apex of the roots are visible under the canal.
• Type B : The roots of the third molar are in the radiolucency of the canal
and have not cut off the lower cortical layer of the mandibular canal.
• Type C : The roots of the third molar are adjacent to the canal, and the
superior border of the canal is visible.
RELATIONSHIP BETWEEN THE PROXIMITY OF THE MANDIBULAR
CANAL TO THE ROOT OF THE WISDOM TOOTH AND
PREVALENCE OF INFERIOR DENTAL NERVE PARAESTHESIA
6

0
Type A Type B Type C
 Assessment of Paresthesia
• Light touch
• Pin prick
• Two point Discrimination
• Taste Simulation
Discussion
 Surgeon
Patientexperience
age
Depth of
impaction
Surgical
approach
used
Risk Factors
Presence of
overlying
ramus bone
Operatin
g time Lingual flap
elevation
• In this study, the incidence of paraesthesia of
the inferior alveolar nerve was 5.5%, whereas
the rate reported in the literature varies
between 0.4% and 8.4%.
• total incidence of inferior alveolar nerve and
lingual nerve injury following impacted lower
third molar removal was reported to be 13.4%
by Lopes et al.
• Our study showed the total to be 9.5%
 Treatment for Paraesthesia
1) Self healing
2) Medication :
– Neurobion
– Vitamin B complex
3) anticonvulsants, antidepressants, opiates,
antiarrhythmic, or topical anaesthetics
4) low-power laser therapy
5) Surgical
 Conclusion
• Mandibular third molar extraction is a very commonly carried out
procedure in day to day dental practice and is undoubtedly
associated with few risks especially neural injuries and therefore, a
thorough evaluation of the risks and benefits from surgery is of
utmost importance, both for patient benefit and safety from litigation
for the dentist.
• to utilize the available evidence to allow the best treatment
outcomes, it would be wise to take up cases in which extraction is
justified and based on clear cut indications, and also where the
benefits outweigh the risks involved in the procedure.
• a mandatory post-operative assessment should be made at timely
intervals, to diagnose the complications that arise at an earlier stage
and enable quick recovery by initiating timely treatment.
THANK YOU