June 4, 2018
by Yasser Alali, DDS MSc (candidate); Harshdeep Mangat, BSc, MD, DMD, MSc; Marco F. Caminiti, BSc, DDS, Med, FRCD(C)
The Lingual nerve (LN) is a branch of the mandibular division of the trigeminal nerve (V3) that is responsible for general somatic afferent (sensory) innervation. It supplies the mucous membranes of the mandibular lingual gingiva, floor of the mouth and the ipsilateral two-thirds of the tongue. 1 It also carries specialized taste fibers and parasympathetic innervation to salivary glands. While it should be an infrequently encountered nerve during routine and basic oral and maxillofacial surgical procedures encountered in daily dental practices, its vulnernable position poses a risk of iatrogenic injury. The purpose of this paper is to enlighten readers with regard to the anatomy of this nerve in light of potential risks, which unfortunately are not uncommon. Unfortunately, current treatment options yield minimal success in the improvement or restoration of function of the lingual nerve following injury.
The aim for this paper is to:
I. Review and detail the anatomy of the lingual nerve;
II. Explain the methods of injury that have been reported and
III. Describe methods to mitigate against injury and help alleviate symptoms of nerve damage
After exiting the skull base via the foramen ovale, the mandibular division of the trigeminal nerve divides in the infratemporal fossa into the auriculotemporal, inferior alveolar and lingual nerves (LN). 3 The LN also carries nerve fibers that are not part of the trigeminal sensory system. The Chorda Tympani (CT), which is a branch of the cranial nerve VII (facial nerve), transmits taste sensation to the anterior two thirds of the tongue via preganglionic parasympathetic fibres to the submandibular and sublingual salivary glands. 1,2
The LN arises from the posterior division of the trigeminal nerve. 3 The CT joins the LN lower in the infratemporal fossa, approximately one centimeter below the bifurcation of the lingual and inferior alveolar nerves, after it exits the base of the skull via the pterygotympanic fissure. 3 Therefore, beyond this point, the LN contains: 1. autonomic fibers destined for the submandibular ganglion, 2. fibers for taste derived from the facial nerve; and, 3. general trigeminal sensory fibers to the anterior two third of the tongue 3 (Fig. 1). It then travels in anterior direction just medial to the inferior alveolar nerve and the lateral pterygoid muscle. 2 Once the LN enters the pterygomandibular space, its traverses between the lateral aspect of the medial pterygoid muscle and medial aspect of the mandibular ramus 1,2 (Fig. 2).
The course of the third division of cranial nerve five and the associated peripheral branches. Trigeminal nerve – mandibular branch (V3); Chorda tympani (CT); Inferior alveolar nerve (IAn); Lingual nerve (Li); Mental nerve (Me).
Innervation pattern of the lingual nerve with accessory peripheral branches and the demonstration of the rich neuronal supply in and around the area of the mandibular dentition. Chorda tympani (Ct); Inferior alveolar nerve (IAn); Lingual nerve (Li); Mental nerve (Me); Submandibular Ganglion (Gang); Nerve to Mylohyoid (My).
At the third molar area, the mylohyoid muscle is inferior to the LN. At the posterior attachment of the mylohyoid muscle to the mandible, the LN makes an anteromedial turn and travels superficial to the mylohyoid muscle. The location of the LN with respect to the height of the crestal alveolar bone varies, as reported in different studies examining the distance between the third molar and mandibular ramus in addition to the configuration of the alveolar ridge 4 (Fig. 3). These studies illustrate that the LN is potentially susceptible to injury during a variety of procedures including administration of local anesthesia, third molar extraction, preprosthetic surgery, to more extensive procedures like orthognathic surgery 4 (Fig. 4). The location of the LN is reported to be at the level of the alveolar crest or higher in 17.6% of cases. 5 In the retromolar region, the distance from the lingual alveolar crest to the LN is averaged at 4.45 mm and ranges between 3.01 mm to 2.28 mm in the third molar area. 5,6 As the LN courses along in the region of the mandibular second molar, the submandibular ganglion can be found suspended inferiorly by preganglionic parasympathetic fibres secretory fibres from the LN. 1 The LN then starts to move anteromedially, beneath the submandibular duct. The nerve then enters the ventral mucosa of the tongue anterior. 1
A: Prior to dissection. B: After removal of the mucosa. C: Exposure of the lingual nerve (arrowhead). Note the lingual nerve passes lateral to the medial pterygoid muscle and below the superior pharyngeal constrictor muscle. SPCM; superior pharyngeal constrictor muscle, MPM; medial pterygoid muscle.The Clinical View for Dissection of the Lingual Nerve With Application to Minimizing Iatrogenic Injury J. Iwanga Clinical Anatomy 30:467–469 (2017).
Course of the lingual nerve (arrowhead) in different tongue positions after removal of the superior pharyngeal constrictor muscle. A: Neutral position. B: Protruding, left-deviated and elevated position. C: Lower position. *tooth #47
The Clinical View for Dissection of the Lingual Nerve With Application to Minimizing Iatrogenic Injury J. Iwanga Clinical Anatomy 30:467–469 (2017).
Multiple studies have investigated the branching patterns of the LN from the inferior alveolar nerve (IAN). 4,7 The bifurcation of the LN and IAN bifurcation most often occurs between the otic ganglion and the sigmoid notch. Furthermore, less common branching patterns of the LN from IAN can occur in the upper half of the ramus, above the lingula or demonstrating a plexiform branching pattern – in order of incidence respectively. With respect to the relationship of the mandibular third molar to the LN – studies have failed to identify any statistical relationship between the presence or absence of the mandibular third molar and LN position. Furthermore, no significant relationship between distance from the LN to the lingual alveolar crest and the degree of mandibular crest resorption has been reported within the literature. 8
Clinicians must remember that the nerve has complex sensory and secretomotor function. Therefore, any damage to the LN can result in altered salivary secretion on the affected side and loss of taste to the anterior two-thirds of the tongue in addition to temporary or permanent general sensory changes to the anterior two-thirds of the tongue and floor of mouth. These can manifest as anesthesia, paresthesia, dysesthesia or hypoesthesia. 9-11 This loss of sensory function can cause speech changes, pain, burning sensation, drooling, and tongue biting 12,13 (Table 2).
The potential for injury to the LN varies based on the type of procedure. In certain settings such as head and neck oncology, injury sustained by the LN is often unavoidable. However, more alarming is the fact that the majority of iatrogenic LN injuries are the result of elective non-oncologic procedures. 14 The cause of LN injuries include: administration of local anesthetic 15, removal of mandibular third molars 12, the surgical insertion of dental implants 16, and inadvertent instrumentation during mandibular osteotomies. 17 The incidence of LN injury during extraction of mandibular third molar varies, with the majority of studies reporting an incidence of 0.6% to 2.0%. 8,9,17 Fortunately, permanent injury to the LN from third molar surgery appears to be less common and has ranged from 0.04% to 0.6%. 12 The incidence of LN injury after performing a sagittal split ramus osteotomy ranges from 9% to 19.4%. 12
Several factors influence LN injury following extraction of mandibular third molar surgery. Although some studies have shown that the avoidance of the “lingual flap technique” in addition to preserving the lingual plate of the mandible can reduce the incidence of temporary lingual nerve injury. 14,18,19 A systematic review has shown no difference in permanent LN injury rates whether a lingual retractor was used or not. 13 There is no relation between the incidence of LN injury and the angulation of the mandibular third molar and LN injury. 20
The increased age of patients, degree of difficulty of the position of the third molars and surgeon experience have been shown to be the only significant predictors in determining risk of permanent LN injury as reported in a prospective study by Jerjes. 21
1st week after third molar removal. It shows a unilateral lingual atrophy of the fungiform papillae of right hemitongue accompanied by signs of recent bites.
Martos-Fernández M, de-Pablo-Garcia-Cuenca A, Bescós-Atín MS. Lingual nerve injury after third molar removal: Unilateral atrophy of fungiform papillae. J Clin Exp Dent. 2014.
6th month post-removal. A decrease in fungiform atrophied area was observed despite the persistence of bites signs.
Martos-Fernández M, de-Pablo-Garcia-Cuenca A, Bescós-Atín MS. Lingual nerve injury after third molar removal: Unilateral atrophy of fungiform papillae. J Clin Exp Dent. 2014.
Exposure of distal and proximal LN stumps. Bagheri et al. Microsurgical Repair of Lingual Nerve Injuries. J Oral Maxillofac Surg 2010.
Lingual Nerve And Local Anesthesia
The incidence of LN and IAN injuries caused by local anesthetic block injections ranged between 1:26,762 to 1:800,000. 10 Epidemiologically, several reports have highlighted the association between LN injury and high concentration local anesthetics like prilocaine 4% and articaine 4%. The mechanism of injury often related to physical damage caused by the needle causing subsequent hemorrhage, inflammation and scarring resulting in demyelination. 10 Trauma to LN injury from needle injection would result in damage the nerve bundle and consequently neurotmesis because the average diameter of the most commonly used needle is 25 gauge is approximately 0.45 mm and the average diameter of the lingual nerve is 1.86 mm. 22 Chemical injury will occur if local anesthetics is deposited in the intrafascicular space or inside the nerve which will results in demyelination, axonal degeneration, and inflammation of the endoneural fibers. 22
Lingual Flap And Nerve Protection
Its strongly recommended to avoid lingual flap detachment as much as possible to decrease the incidence of lingual nerve damage. Using lingual flap to protect the LN should be restricted to cases with high risk of nerve injury. 22
Lingual Nerve In Lower Third Molar Region
One of the important prevention strategies to avoid iatrogenic LN injury is obtaining a thorough knowledge of lingual nerve anatomy and topography. The inclination of the alveolar lingual plate in addition to the prominence of the alveolar process influence the lingual nerve position at the lower third molar region. 22
Edentulousness and mandibular atrophy with a loss of muscle mass causes the LN to rest in a superficial position compared to dentated individuals. LN will be more cranial in position if there is a short distance between mandibular ascending ramus and the lower third molar. 22,23 Therefore, marked mandibular atrophy could be an important risk predictor for lingual nerve injury during surgery in the area with any lingual flap manipulation.
The lingual split technique in addition to lingual flap retraction is associated with an increased risk of temporary nerve damage compared with the buccal approach plus and the simple buccal approach. 24
Although tooth sectioning does not increase the incidence of LN damage, it could be a possible risk factor for LN injury during extraction of lower third molar. The nerve may be directly cut by the rotary instrument during tooth sectioning. Therefore, sectioning two thirds of the lower third molar followed by using straight elevator to complete the separation would prevent the risk of LN injury. Furthermore, LN damage is also associated with removal of periradicular bone at the distolingual or lingual sites. 10,22
Although there is little data reporting on damage to the LN due to suturing, it is evident that the LN could be damaged by direct trauma from the needle if it is inserted too apically. 22 The nerve can also be compressed if included within the flap of the tissue adapted by the suturing. Over exuberant and excess tissue bites for suturing must be avoided and the use of compressive/occlusive maneuvers for surgical hemostasis must take into account the position of the nerve. Interestingly if the nerve and associated blood supply has been damaged during surgery, the first sign is significant bleeding which is difficult to control. Methods to stop the bleeding (suturing, hemostat, cautery) can worsen the status of an already damaged nerve.
Protocol for LN Injuries (Adapted from Robinson et al. (2004))
Witnessed or open injuries mandate documentation and urgent immediate referral to an OMFS with experience in microneurosurgical repair for early intervention. The patients should be also given anti-inflammatory medications following acute nerve injury including steroids, NSAIDs, or both .
This would include ibuprofen 800 mg TID for 14 days or Solumedrol Dose Pack (usually a six-day course). An unwitnessed LN injury will be noted at a postoperative follow-up or by patient complaints or calls to the office. This would mandate a baseline history and neurosensory examination to establish the appropriate management and is essential. The injury should be classified as being either dysesthesia, paresthesia, hypoesthesia, or anesthesia. The pain and decreased sensation could be quantified on a visual analog scale of 1 to 10 and mapped quickly on a representation of the tongue and floor of mouth in any clinical chart. In cases where patients complain of intermittent pain, the clinician should be able to determine whether the pain is stimulated or spontaneous. Patients with long standing injury usually present with constant pain which may be the result of a lack of afferent input from the periphery and also due to the formation of a neuroma (traumatic neuroma). The decreased level of sensation could be quantified on a level of 1 to 10 and compared with the contralateral side. 25 Interference with daily living activates and alteration of taste sensation (paraguesia) should be documented. 12,25
Clinical Neurosensory Testing is a standardized maneuver utilized to objectively assess the degree of sensory impairment, monitor recovery, and determine if microneurosurgery is required. 26,27 Clinical Neurosensory Testing should be performed at three levels A, B and C to assess mechanoceptive and nociceptive awareness of the affected area. The non-affected side should be tested first to determine the patient’s normal responses. 26,27 The areas that are reported abnormal by the patient should be mapped and the final outline will represent the area of alternated sensation. 26,27 At level A, large myelinated A-alpha and A-beta assessed by using fibers brushstroke directional discrimination with constant rate and pressure by using hair brush or fine sable could be used and the patient should be asked to identify the direction of movement (i.e., to the right or to the left). In level B A-beta fiber assessed by using Boley gauge with blunt tips to evaluate two-point discrimination. The reference distance should be determined in the normal area based on the closest distance in which the patient could recognize the two points then the affected area is tested. Level C assessed could be evaluated by using or 27-gauge needle or dental explorer tip to assess C fibers and A-delta. Finally, there is insignificant correlation between altered taste sensation has little with the degree of LN injury. 26,27
The lingual nerve and other divisions of the trigeminal nerve are variably positioned within the hard and soft tissue of the mandibular molars. Clinician’s must be cognizant of this vast neural network that exists and that improper soft tissue manipulation can lead to devastating nerve injury. Surgery, unintentional laceration, crush injury, penetrating trauma, stretch injury, chemical insults can all contribute to damage to the LN. The management of LN damage depends upon the mechanism of injury, the duration of the nerve injury and the patient’s symptoms.
Unfortunately, trigeminal nerve injury for dentoalveolar surgery has major medicolegal implications due to the problematic consequence.11 Resultant lawsuits are usually based on inadequate informed consent, poor planning and assessment, poor surgical technique and improper management of LN injury postoperatively.10 Clinicians need to be aware that the Lingual Nerve specifically is difficult to repair and although the field of microneurosurgical intervention has shown advancements, the best method to avoid these injuries is prevention, which begins as always with a solid knowledge of anatomy. OH
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About the Authors
Yasser Alali, Resident, Division of Oral & Maxillofacial Surgery, University of Toronto, Toronto, Canada
Marco F. Caminiti, Program Director, Division of Oral & Maxillofacial Surgery, University of Toronto, Toronto, Canada
Corresponding author: Marco.Caminiti@dentistry.utoronto.ca
Harshdeep Mangat, Resident, Division of Oral & Maxillofacial Surgery, University of Toronto, Toronto, Canada
Although it hasn’t been formally identified I believe my lingual nerve has been damaged leaving me with parasthesia, altered taste and pain on the left side of my mouth following root canal treatment ultimately followed by tooth extraction of the lower left 5 th molar. The symptoms are sometimes unbearable but despite many investigations at Leeds Dental Hospital, no one has reached a conclusion and I have received no treatment. Is there anything that can be done?
What are your symptoms? Is your tongue mechanically and symmetricaly functioning?
Or has it been paralyzed? The tongue has 2 lingual nerves (one on each side) if one branch becomes damaged- the tongue will deviate sideways to the stronger branch.
It can be damaged mechanicaly, chemicaly (improper anasthesia techniques or too much anastethic). The lingual nerve is responsible in most part for the mechanical movement of the tongue. You also have the mandibular nerve which innervates the teeth and the jaw therein.
My son has had a MRN for tongue pain. His right lingual nerve shows to be inflamed. He’s 20 (17 at onset) and is in dire need of resolve and reason why his nerve is inflamed. He is in severe pain that is causing severe mental anguish. The Maxiollfacial Dr he sees is very well known and says “he has never seen anything like this”
Why is his nerve inflamed? He needs help! He’s a college student and is thinking he will need to drop pre-Med school due to this debilitating pain.
Any help? We will send records any where for opinions and praying for a fix for him! He doesnt want his life to be a future of opiates and
SSRI’s cause he is fixing to have to hit that road as he can’t take it much longer.
No known reason for his pain. Altered taste and it’s a high rate of pain 98% of the time.
Hello my LN was damaged during a wisdom tooth surgery and I have now lost the feeling in half of my tongue. It’s been 4 months now. It there any hope of regaining sensation at this point?
i am 39 from Greece.I have the same symptoms ,which are described from Julia.its now a year and a month ,my pain has been reduced enough ,but i have still metallic taste basically in chocolate ,coca cola.
i had a wisdom tooth surgery down-right wisdom extraction.This was the biggest mistake in my whole life.I should not have ever my wisdom tooth extracted . The experts say that rehab can last till 2 years ,byt i do not believe anymore this at all
Root canal: It has been 4 years and 4 months of parathesia, altered taste and pain. Did I say pain? Try 24/7. Caused when Endodontist was talking about his fun weekend at a football game. Walked in and immediately injected anesthesia. I felt like my tongue was instantly electrically zapped. POP. Total loss of movement. Anesthesia works quickly but not like that. After seeking help by several sources, I was told this was rare and if it didn’t come back within the year, it would likely be permanent. That is consistent with what I have read and been told. I’ve learned this is not so rare. Affects ability to articulate words. So who can help to manage the pain and make the sensation tolerable? The tongue actively pushes on teeth, and more. Not good. The only thing that calms the nerve is using dental wax and “I” came up with it. The nerve condition is intolerable! The wax separates the tongue from the teeth somehow calming the burning sensation. I could say more…awful, awful. Doctors, really, there must be something. Dentist causes the condition with carelessness in this case. Signed papers so no recourse. A lawsuit does not resolve the issue. But someone must be able offer some kind of relief.
Ra, I am in the same boat! Even the wax idea. Terribly painful and debilitating.
I’m from Toronto, but no longer live there. Boy do I regret that now! Can get no help in the more rural region i live in, and would consider flying back…flying anywhere…for help.
“We need such eye-opening posts. Unfortunately, I didn’t know this before the surgery and my nerve condition is pretty bad too. Thank you for highlighting the details here. Most of us are not well-versed with such details.”
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I had a root canal done almost 3 years ago, suffered excruciating pain for 4 months, gabapentin helped a lot but I had really bad vertigo from taking it… I am on cymbalta permanently it really helps with the pain, but the numbness and loss of taste will be there forever . The right side of my tongue was affected. I never knew that a shot of novacain could do this!
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Lots of factors in this equation, but maybe someone can see through to those that matter and offer a solution.: Routine checkup. No present problem with sensitive teeth or bite. Given peroxide and Listerine Sensitive mouth wash rinse. Unusual for me, but my gums bled lots while hygienist scaled. Hygienist was rough and hooked me deep in the gum a few times – twice on bottom right and once right between top front incisors on right side (I still get pain here multiple times per day, like a fizzy burning ache that comes and goes but comes on most when I hang my head down. X-rays show no problem.) Anyway, at that 1st visit, dentist suggested a 2nd molar filling near gum line at back of tooth against tongue – one on right and one on left. He noticed some filling on back of right incisor had come lose (long story about a past bite adjustment gone wrong and a brutal quick shaving fix from another dentist that left me with speech annoyances, which he, my current dentist had tried to fix.) So with his good work coming undone, he tried to fix it again, but built it up to thick and too high, and filled the freedom of movement groove up with bond and postured my right lower jaw back too much. My mouth blistered that night and my tongue felt uncomfortable in my mouth, like my teeth were poking it. Saliva flow felt funny too. I wondered if I burnt the inside of my mouth. About a couple weeks later I returned for the recommended fillings and expressed concern about the thick filling. He tried shaving and filling again the back of the top right incisor as some more filling where I was hooked had slivered away. Afterward, incisor filling was again, too much and too sharp, left top back filling was good. Right back too tooth had dull ache. Right side of tongue had deep dull ache too. That night, swelling and blisters in mouth occurred again (peroxide and mouth wash rinse I wondered), and sense of lots of salivation (dentist said I must be milking my saliva glands), then saliva flow slowed and became less mucus filled . With this tongue felt irritated, like I’d been licking sandpaper and tasted like I was sucking on pocket change. Tongue kept pushing against teeth and would relax when I ate. Could not tell if sense of hot was coming from the teeth and gums or the tongue. Scallop tongue became a problem – biting tongue too. Felt pull deep in tongue. Lots of tongue biting and some cheek biting at back right side. Told dentist I think I lost a piece of tooth off the tooth he filled, because it did not have the same bite sensation and hurts on and off. I had signs of biting myself with that tooth (big red blood blister where cheek meets gum.) He said it looks like I only lost a small bit of filling and said he did not need to fill it. Red bite marks on tongue kept turning into what resembled geographic tongue, all on right side. Dentist blamed a rough point on back tooth, filed it down and said the red raw at the front right of tongue must be from me teeth poking with my tongue. Altered speech. Altered bite sensation and now growing TMJ problems in right jaw, including occasional shooting pains, many times per day creepy crawly rolling neuralgia, ear ache and most recently pain running beside teeth and gum deep on right roof of mouth. Dentist said it looks a little red there, but is not concerned. He sees no dental problem, but will send me to a Prosthodontist ( 6 month wait list) and a maxofacial specialist ( 3 year wait list). Even so, dentist still thinks my problem must be like that another patient of his who is obsessed with an imperfect bite. He was trying to carefully hint at mental health being an issue. The onset of my “problem” is almost 4 months old – the day of my 6 month cleaning and check up, Feb 19th, 2022, and still ongoing. I reached put to my family doctor who says this is a dentist problem. I went to emergency one night with brutal neuralgia an ear ache and after having experienced shooting pains up the side of my nose into my eye. After looking in my ear and mouth and seeing little concern, the Dr. told me to take over the counter anti inflammatories and pain killers and to see my dentist, because oral health treatment in emergency is pricey and would likely be done by residents who are not as experienced as my dentist. I said, even tongue issues are not covered in Emergency. He said not yours. Yours is a dental matter. All oral health is dental. After lots of missed work, tears, night and early morning sweats and anger, I reached out for help from a psychiatrist who has prescribed Cymbalta. She said I really need to get the dental piece figured out and Cymbalta will help me with nerve pain and anxiety until I do. I was working full time as a grade 1 and 2 teacher. I love my job dearly and used to love reading, talking and singing with the kids, but it is too hard now. Even though I can not afford it, I have cut my time down to half and only show read alouds now on YouTube instead of reading my favourite stories. I talk minimally, and under the mask I often hide the fact that I am not singing with the kids. This is all to prevent injury. Otherwise, I bite tongue too much, risk throwing my jaw out of joint or suffer too much tongue fatigue. My husband is at home with stage four cancer. He had to shut down his business at the start of COVID. Am I stressed? Maybe, probably, but I thought I was managing really well though. I have my friends a great class if if children, supportive parents. I was running everyday. I felt good, until after that routine dental cleaning, checkup and incisor filling; and then worse after the molar fillings. I resent my dentist insinuating my problem is mental health. However, I am open minded, though not sure he is. I sense he is being over guarded. Cymbalta has made me tired, really tired. It has helped numb the TMJ pain some. All the tongue biting, geographic looking burns, scallop tongue etc. keep happening. As well I still get a deep sense of tongue pulling from the back, and as I mentioned most new, an uncomfortable feeling of pressure running along the right side roof of my mouth. The burning mouth and metal taste comes and goes depending on how bit up my tongue is and other factors I can not figure. I would like to think everything will be sorted out before school starts again in the fall and wonder what I can do to make this better and get my normal tongue and jaw function back. Physio tried to help, but until the dental piece is sorted out, only wants to massage my neck and offer mild stretching. I had seen Physio at the onset of troubles too, and wondered if aggressive jaw manipulation (stretching), could have caused or exasperated the problem.?! The Physio says no. I could really use advice and guidance. Thank you for taking time to read this. I just want to be a good mother, wife and teacher again without constantly injuring myself.
Note to self: mistyped 2022 for 2021. Oops.
Also, my homiopathic Dr. tested me and believes I am reacting as if dealing with a toxin and asked me what I drink. All I drink is water?! I do recall when the dental hygienist moved the curing light to cure my back right filling my dentist said, “you don’t have to cure,” so she pulled back. He let her cure the back left filling. Could this have made the difference in sensation and irritation against and on my tongue and had something to do with my reaction. If it did, wouldn’t it have leached out all toxins and become biocompatible by now?
About the tongue, most recently I came to realize that if I pull my tongue back and fit it into the natural groove in the roof of my mouth and gently push , it helps to thwart some of the deep tongue pulling I was experiencing, as if the challenging sense of tongue pulling was actually a pinched or injured nerve that is given more room when I lift my tongue. I really hope the burning tongue syndrome stops. It makes talking so dry and painful.
I was told by my dentist that I have to see a specialist regarding my 2nd molar. It’s extra long and it’s criss crossing over my main nerve on the lower part of the left side of my jaw. I am scared what the specialist will do. It takes 2 if not 3 × more numbing shots for me to not feel any pain. In the left side. The right side I can with the first shot. I have a 11 month old and I need to get better to take care of her without pain. What will I be looking forward to when I see the specialist??
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