The first time I had this surgery, I was terrified of nerve damage- either from the infection itself, or from injury to the nerve during the operation. There is nothing like feeling post surgical pain and trying to guess if it’s temporary healing pain, permanent nerve damage, or lingering infection. So I’m kind of surprised how serene I feel right now despite having some pretty severe (albeit probably temporary) nerve damage. Right now my right lower lip, chin, cheek, and gum feel like they’ve been novacained up. The lip in particular feels like someone applied liquid nitrogen to it.
I’m serene first and foremost because if I’d been given an omniscient choice, I still would have done the surgery. This freaky numbness is way better than the pain. Two, as post surgery nerve damage goes, “diminished sense of pain” is a pretty good one. Three, it’s almost certainly temporary. My dentist couldn’t tell me how long it would take to return to normal- I get the sense that it’s a long tail distribution- but he seemed very sure I would. Ideally I would like the icy feeling in my lip to go away now, and then for my gum numbness to recede just slightly slower than the pain.
My dentist has a tendency to give slightly more metaphorical/dumbed down explanations* than I would like, and I haven’t had the cope to press him on it. His explanation for this was that my nerve and the infection had made friends, and without the infection my nerve was sort of lost and confused, like a person reeling from being friend-dumped. That sounds unlikely to me to be literally true, so I’m going to investigate.
Clue number 1: the physical placement of numbness is exactly that followed by the novacaine injection I had for the surgery, minus my tongue. This appears to match the coverage area of the inferior alveovar nerve, although that does not cover the check. In fact, wikipedia says that a common dental infection site hits exactly that nerve plus the lingual (tongue) nerve. So IAN numbness without lingual nerve numbness would explain what I’m seeing except for the cheek. The cheek is covered by the buccal nerve. The buccal nerve joines with the IAN nerve fairly quickly , but if a single problem was blocking them both there are a number of other sites that should be involved (including the tongue). There’s a number of possible explanations- I misinterpreted gum numbness as cheek numbness, I have nonstandard anatomy that connects my IAV to my lower cheek, the physical stress of surgery. But the cheek numbness is fading much faster than the other numbness, so I’m prepared to just ignore it.
Clue 2: this feels exactly like novacaine numbness**. The –caines work by blocking the sodium channel, which prevents the sensory nerve from firing. It’s like being a spy without a way to report to the mother country- you might know a lot, but you have no way to tell anyone. Humans acclimate to extended doses of novacaine (or other drugs) by altering their chemistry. For example, cocaine causes your brain to release large amounts of dopamine. Over time, your brain compensates by reducing the number of dopamine receptors. It seems plausible to me that toxins produced by the bacteria could have altered the environment the nerve was in enough to cause it to adapt back. Hypothetically, if they raised the sodium concentration high enough, my reporting nerves may have upped the sodium concentration required to get them to care. This would explain exactly the symptoms I’m seeing, and provides a convenient mechanism for the problem to fix itself- the nerve will notice nothing is going on and adapt to its new environment just like it did the old one. And it is consistent with my dentist’s cartoon description of the issue.
Holy shit, I didn’t start checking blogs and playing 2048 until that last paragraph. Until then I was only writing or researching. This is amazing.
Of course this is pretty speculative. I’m not at all confident in the specifics of my explanation. But honestly regardless of explanation the most helpful thing I can do is give myself an excuse to not freak out, and I’ve done that, so mission accomplished.
*When I asked about pre-op antibiotics he said “no, because when you use antibiotics the bacteria have babies, and those babies are immune.” Most common antibiotics either work by retarding cell replication, or are effective only against actively dividing organisms. My guesses for what he mean are: “no, I don’t want to create resistant bacteria your immune system can’t reach. Let’s hold that in reserve” (although I didn’t end up with antibiotics during or after either), or possibly “no, those will kill the actively dividing bacteria but leave colonies of dormant ones that are harder to find on their own.” or if I want to get really speculative “antibiotics do nothing but create resistance if your immune system can’t reach the infection, and your infection is in an area with poor circulation.” Any of these would be preferable to my dentist believing in Lamarkian evolution.
**Note: novacaine left common use in the US years ago, more effective and less risky equivalents exist. But while they vary in exact side effect profile and action time, every one I’ve had creates this exact feeling, and they have similar if not identical mechanisms of action, so I’ll go with the name I learned as a child.