As an Atlanta dental malpractice attorney, I receive calls every day from dental patients who have been injured due to dental procedures. Almost all of the dental nerve injuries that are actionable dental malpractice claims involved the trigeminal nerves of the face, mouth, neck and jaw.
The trigeminal nerve is the largest of the cranial nerves and has three major divisions: the opthalmic nerve (V1), the maxillary nerve (V2), and the mandibular nerve or inferior alveolar nerve (hereafter referred to as the “mandibular nerve” for simplicity and consistency) (V3). A nerve outside of the central nervous system is called a peripheral nerve. The mandibular nerve is a peripheral nerve which is the largest of the trigeminal nerves and is the most common branch injured following dental implant surgery. While the mandibular nerve is technically outside of the central nervous system, most of my clients report debilitating pain in parts of their face and head served by the mandibular nerve. This nerve carries sensory information from the lower lip, chin, lower teeth, gums, the lower jaw, and, at times, can extend up and into the ear on the side of the face affected by a dental implant injury, for example.
The mandibular nerve also contains motor fibers for supply of the muscles for eating (mastication), muscles of the ear and muscles of the soft palate. However, these motor branches and many of the sensory fibers to the external ear are rarely injured during implant surgery because these motor fibers are separated from the V3 branch of the trigeminal nerve prior to its exit from the foramen ovale of the skull and many of the sensory fibers enter the nerve above the lingula of the ramus. A V3 injury in dental implant surgery usually occurs after the nerve enters the lingula of the mandibular ramus and anywhere along its pathway in the jaw and/or its exit from the mental foramen in the chin area of the jaw.
The structural makeup of the mandibular nerve consists of connective tissue and neural components. The smallest functional unit is the nerve fiber. These nerve fibers can be either myelinated or unmyelinated. Myelinated nerve fibers are the most common and consist of a single axon that is encased individually by a single Schwann nerve cell. The individual nerve fibers and Schwann cells are surrounded by a protective endoneurial connective tissue layer (endoneurium), which is made up of a basal lamina, collagen fibers and endoneurial capillaries.
In turn, the individual nerve fibers are situated in multiple groups termed fascicles. Surrounding the bundles of fascicles is a thin, dense, multilayered connective tissue sheath called the epineurium. The epineurium maintains intrafascicular pressure and acts as a diffusion barrier in the protection of the individual fibers. If any of these extra neural tissues are injured, impaired neural transmission of the individual nerve fibers may result in a sensory disturbance. The neurosensory impairment is dependent on the extent of damage to the individual tissue type.
A main concern related to injury of the mandibular nerve is the altered sensory functions such as numbness, pain or altered sensation following dental implant procedures or root canal therapy on the lower teeth. Loss of sensation of the cheek or lower lip often lead to secondary traumatic injury to the soft tissues during chewing and mastication and may affect the ability to drink. This is similar to a dental patient who suffers and injury while eating prior to the local anesthetic wearing off. Unfortunately for the injured patient, this numbness sometimes never wears off and, in the most debilitating dental malpractice injuries, is coupled with severe pain in the chin, jaw and up into the ear. Injury to the lingual nerve almost alters taste (such as chocolate tasting like chalk or sweets foods tasting salty) and, sometimes completely and permanently ruining the injured person’s ability to taste.
Attorney Robert J. Fleming has been handling wrongful death cases, automobile accident cases, personal injury cases, dental malpractice and medical malpractice lawsuits for individuals and families who have been harmed, injured or died as a result of the carelessness or negligence of another for more than 20 years in and around Atlanta, Georgia and its surrounding areas, including Alpharetta, Austell, Avondale Estates, Chamblee, College Park, Conyers, Duluth, Decatur, Doraville, Hapeville, Johns Creek, Jonesboro, Lawrenceville, Norcross, Peachtree City, Riverdale, Roswell, Sandy Springs, Stone Mountain, and Smyrna. If you have been seriously injured and would like quality legal representation, contact Robert J. Fleming directly on (404) 525-5150 or contact us online.