Wisdom teeth removal is a common procedure, and a temporary loss of sensation, known as paresthesia, is an expected part of the immediate recovery experience. The initial numbness is caused by local anesthetic agents used to ensure the surgical area is pain-free during the extraction. How long this numbness lasts depends on whether the sensation loss is from the anesthetic wearing off or from a complication involving nearby nerve structures.
Immediate Numbness: The Anesthesia Timeline
The initial numbness immediately after the procedure is solely a result of the local anesthetic injection, which temporarily blocks nerve signals. The duration is predictable and depends on the specific type and concentration of the anesthetic agent used, as many surgeons use long-acting nerve blocks to manage post-operative pain. For most patients, the effects of the local anesthesia will completely wear off within 4 to 12 hours following the surgery. This temporary loss of feeling is normal and expected, covering the lips, chin, and sometimes the tongue. As the anesthetic is metabolized, you will begin to feel a tingling or “pins and needles” sensation, signaling that normal feeling is returning.
Persistent Numbness: Understanding Nerve Irritation and Damage
When numbness persists beyond the expected 24-hour mark, it suggests the involvement of a major nerve located near the extraction site. The two nerves most commonly affected during the removal of lower wisdom teeth are the Inferior Alveolar Nerve (IAN) and the Lingual Nerve (LN). The IAN runs through the lower jawbone and provides sensation to the lower lip, chin, and gums. The Lingual Nerve controls sensation and taste for the front two-thirds of the tongue and is vulnerable due to its proximity to the inner side of the jaw.
Nerve issues are categorized by severity. Temporary irritation, often called neuropraxia, involves bruising or stretching of the nerve sheath and is the most common form of injury, resolving as swelling subsides. More serious nerve damage, known as axonotmesis, involves a significant disruption or partial severing of the nerve fibers. Fortunately, persistent nerve injury is rare, occurring in under 1% of all extractions. For the vast majority of temporary irritations, sensation spontaneously returns, with approximately 95% of cases resolving completely within the first four to six weeks.
Long-Term Recovery and Medical Intervention
If numbness remains beyond 24 to 48 hours without any sign of improvement, contact the oral surgeon for an assessment. If sensation is still altered one week after the procedure, a formal evaluation is necessary to track the nerve’s status and establish a baseline for recovery. The surgeon will perform sensory testing and may order diagnostic imaging, such as a Cone Beam Computed Tomography (CBCT) scan, to determine if bone fragments are compressing the nerve. Early intervention often involves a conservative approach, including prescribing anti-inflammatory medications to reduce swelling and alleviate compression.
The use of B vitamins or nerve-specific medications, such as Gabapentin, may also be recommended to support nerve health and manage discomfort. If there is no notable improvement after several months, the patient may be referred to a specialist for further evaluation, including electrophysiological testing. In cases where a severe injury is confirmed and no recovery has occurred after six to nine months, a microsurgical nerve repair procedure may be considered. Even in severe cases, a significant degree of sensation often returns, though the full recovery process can take six months to a full year as the nerve fibers slowly regenerate.