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INCIDENCE OF MANDIBULAR NERVES
DAMAGE FOLLOWING OF THE LOWER
WISDOM TOOTH REMOVAL IN USIM
CLINIC
Supervisor: Dr John Chong Keat Hon
Group members:
Nurfarhana Mohd Yusop
1080042
Siti Nur Farhanah Mohd Desa 1080055
RESEARCH BACKGROUND
Third molar or wisdom tooth is the most common
tooth to be impacted1.
 Impacted wisdom tooth has been associated with
pathological changes to the tooth and its
supporting structure2.
 The problematic impacted wisdom tooth can be
managed either conservatively or alternatively
removed by surgical extraction3.

The complications following surgical removal of lower
wisdom teeth may vary from alveolar osteitis,
infections, haemorrhage, nerve injury and mandibular
fracture4.
 In this study, we aim to obtain data on the incidence of
nerve injury following surgical removal of lower
wisdom tooth and the related contributing factors
namely anatomical and operative variables5, 6.

OBJECTIVES
General objective: To determine the incidence
of nerve injury following surgical removal of
impacted mandibular third molars in USIM
dental clinic.
 Specific objectives:
 To assess the incidence of nerve injury of the
lingual and inferior alveolar nerves
(temporary/permanent) following surgical
removal of lower wisdom teeth.
 To assess the operators’ experience in relation
to nerve injury during surgical removal of
wisdom teeth.
 To assess the relationship between wisdom
teeth’s anatomical position and the nerve
injury during surgical removal.

METHODOLOGY
Study design: retrospective study involving
patients that had undergone surgical removal of
lower wisdom teeth in USIM dental clinic from
June 2011 until December 2012, n=37
 Research tools and data collection procedure:

Patient’s folders
 Orthopantomogram radiographs (OPG)

Patient’s folder: to determine the patient’s gender, the
operator whom conducted the surgery and the
presence of nerve injury following surgical removal of
lower wisdom tooth
 OPG: to determine the classification of impacted
wisdom tooth and its relationship to inferior alveolar
nerve (IAN)

Winter’s classification
 Pell and Gregory classification
 Risks of IAN injury
 Pederson scale


Statistical analysis: Data were analyzed by using
Statistical Package for Social Sciences (SPSS)
version 20.0.
RESULTS
DISCUSSION
From the collected data, it was shown that there
is no nerve injury recorded following surgical
removal of the lower wisdom teeth during the
retrospective study from June 2011 to December
2012.
 One of the limitations in this study is that the
sample that we obtained from June 2011 until
December 2012 in USIM dental clinic was small
which is merely 37 samples.

Even though the number of patients who are
indicated for surgical removal of wisdom tooth
are increasing, some of the patients’
appointments cannot be arranged as they had
already undergone the treatment elsewhere.
 Poor record keeping by the operator is also one of
the limitations as there is incomplete information
recorded in the patients’ folders.
 There were also some patients that are unable to
be recalled for review following surgery thus
there is no information gained regarding the
nerve injury.

Our recommendation is to have a bigger sample
size for the future research.
 Poor recording should be rectified and folder
checking should be more vigilant.
 Operators should record the presence or absence
of the signs and symptoms of nerve injuries.
 The importance of keeping a good record for
future references and medico-legal purposes
should be emphasized.

Regarding to the insufficient data keeping of the
operators, we suggested a questionnaire is to be
attached with consent form for assessment of
lingual and inferior alveolar nerve.
 The questionnaire that we suggested is the
modification of neurosensory questionnaire11.
 It will be used to interview the patient one week
after the surgical procedure either during recall
visit or by phone call.
 If altered sensation presence in any parts of the
mouth, the questionnaire will be repeated after a
month.

QUESTIONNAIRE11

Do you feel a tingling sensation/numbness on the tongue?
- YES

Can you differentiate the temperature of food and beverages
on each side?
- YES

- NO
Do you feel a tingling/numbness on the chin (on the side of
the surgery?
- YES

- NO
Do you feel a tingling sensation/numbness on the lower lips
(on the side of surgery)?
- YES

- NO
Have you experienced any altered taste sensation?
- YES

- NO
- NO
Do you feel a tingling/numbness on the gum (on the side of
the surgery)?
- YES
- NO
CONCLUSION
Based on the collected data, there is no incidence
of nerve injury following surgical removal of
wisdom tooth in USIM dental clinic from June
2011 to December 2012.
 The small sample in this survey made the
assessment of the three operators’ experiences on
surgical removal of lower wisdom teeth become
unnoticeable.
 In this retrospective study, there is no differences
between the anatomical position of the lower
wisdom teeth to the incidence of nerve injury.

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Impacted tooth [Internet]. [updated 2012 May 4; cited 2012 June 8]. Available from:
http://www.nlm.nih.gov/medlineplus/ency/article/001057.htm
Interventions for treating asymptomatic impacted wisdom teeth in adolescents and adults [Internet].
2008 Oct 8. [updated 2005 Feb 6; cited 2012 June 8]. Available from:
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