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Clinical investigation of gustatory and neurosensory alterations following mandibular third molar surgery: an observational prospective study

  • Assis Filipe Medeiros Albuquerque
  • Eduardo Costa Studart Soares
  • Paulo Goberlânio de Barros Silva
  • Barbara Betty de Lima
  • Francisco Samuel Rodrigues Carvalho
  • Thyciana Rodrigues Ribeiro
  • Davi de Sá Cavalcante
  • Fábio Wildson Gurgel CostaEmail author
Original Article
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Abstract

Objective

This study aimed to prospectively observe gustatory and neurosensory alterations following surgical removal of mandibular third molars.

Material and methods

A prospective clinical study was conducted with patients who required mandibular third molar extraction, recruited from the Division of Oral and Maxillofacial Surgery at the Federal University of Ceará (Brazil). Age, sex, and radiographic signs were recorded. The outcome variables were the presence or absence of gustatory and neurosensory alterations. The patients were observed preoperatively and at 7, 30, 90, and 180 days postoperatively by using gustatory and neurosensory tests.

Results

The response to sweet (p = 0.509) and sour (p = 0.078) stimulus did not alter significantly over time. The salty threshold significantly increased from the preoperative to 7- and 30-day postoperative periods, returning to baseline values at 90 days postoperatively (p = 0.038). The bitter threshold increased significantly from the preoperative to 7-day postoperative period, returning to baseline values at 30 days after surgery (p < 0.001). Regarding neurosensory evaluation, there was an altered response to stimulus at 7 days postoperatively in specific studied areas, returning to baseline values 30 days after surgery (p < 0.05).

Conclusion

The present study shows that mandibular third molar removal was associated with slight sensory disturbances related to mechanical, tactile, and gustatory perception. Regarding the recovery period, all patients returned to normal function without intervention, over a period ranging from 30 to 90 days.

Clinical relevance

This study highlighted the importance of a sensory evaluation following removal of third molars, notably regarding mechanical perception and gustatory threshold assessment.

Keywords

Neurosensory testing Peripheral nerve injuries Third molars Wisdom tooth 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Ethics Committee of the Walter Cantídio University Hospital (WCUH) No. 983. 983.130130 and was held in accordance with the Helsinki statements.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Shepherd JP, Brickley M (1994) Surgical removal of third molars. BMJ 309(6955):620–621CrossRefGoogle Scholar
  2. 2.
    Bagheri SC, Meyer RA, Khan HA, Kuhmichel A, Steed MB (2010) Retrospective review of microsurgical repair of 222 lingual nerve injuries. J Oral Maxillofac Surg 68(4):715–723.  https://doi.org/10.1016/j.joms.2009.09.111 CrossRefGoogle Scholar
  3. 3.
    Blondeau F, Daniel NG (2007) Extraction of impacted mandibular third molars: postoperative complications and their risk factors. J Can Dent Assoc 73(4):325Google Scholar
  4. 4.
    Charan Babu HS, Reddy PB, Pattathan RK, Desai R, Shubha AB (2013) Factors influencing lingual nerve paraesthesia following third molar surgery: a prospective clinical study. J Maxillofac Oral Surg 12(2):168–172.  https://doi.org/10.1007/s12663-012-0391-5 Google Scholar
  5. 5.
    Renton T, Thexton A, Hankins M, McGurk M (2003) Quantitative thermosensory testing of the lingual and inferior alveolar nerves in health and after iatrogenic injury. Br J Oral Maxillofac Surg 41(1):36–42CrossRefGoogle Scholar
  6. 6.
    Farole A, Jamal BT (2008) A bioabsorbable collagen nerve cuff (NeuraGen) for repair of lingual and inferior alveolar nerve injuries: a case series. J Oral Maxillofac Surg 66(10):2058–2062.  https://doi.org/10.1016/j.joms.2008.06.017 CrossRefGoogle Scholar
  7. 7.
    Tay AB, Zuniga JR (2007) Clinical characteristics of trigeminal nerve injury referrals to a university centre. Int J Oral Maxillofac Surg 36(10):922–927.  https://doi.org/10.1016/j.ijom.2007.03.012 CrossRefGoogle Scholar
  8. 8.
    Miloro M, Repasky M (2000) Low-level laser effect on neurosensory recovery after sagittal ramus osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 89(1):12–18CrossRefGoogle Scholar
  9. 9.
    Phillips C, Essick G, Zuniga J, Tucker M, Blakey G 3rd (2006) Qualitative descriptors used by patients following orthognathic surgery to portray altered sensation. J Oral Maxillofac Surg 64(12):1751–1760.  https://doi.org/10.1016/j.joms.2005.11.100 CrossRefGoogle Scholar
  10. 10.
    Essick GK, Phillips C, Turvey TA, Tucker M (2007) Facial altered sensation and sensory impairment after orthognathic surgery. Int J Oral Maxillofac Surg 36(7):577–582.  https://doi.org/10.1016/j.ijom.2007.02.006 CrossRefGoogle Scholar
  11. 11.
    Westermark A, Englesson L, Bongenhielm U (1999) Neurosensory function after sagittal split osteotomy of the mandible: a comparison between subjective evaluation and objective assessment. Int J Adult Orthodon Orthognath Surg 14(4):268–275Google Scholar
  12. 12.
    Harvey WS, Phillips CL, Essick GK (2001) Neurosensory impairment and patient perception of recovery following orthognathic surgery [abstract]. J Dent Res 80(1_suppl):178Google Scholar
  13. 13.
    Israel HA, Ward JD, Horrell B, Scrivani SJ (2003) Oral and maxillofacial surgery in patients with chronic orofacial pain. J Oral Maxillofac Surg 61(6):662–667.  https://doi.org/10.1053/joms.2003.50133 CrossRefGoogle Scholar
  14. 14.
    Phillips C, Essick G, Blakey G 3rd, Tucker M (2007) Relationship between patients’ perceptions of postsurgical sequelae and altered sensations after bilateral sagittal split osteotomy. J Oral Maxillofac Surg 65(4):597–607.  https://doi.org/10.1016/j.joms.2005.12.078 CrossRefGoogle Scholar
  15. 15.
    Zhou P, Chen Y, Zhang J, Wang K, Svensson P (2018) Quantitative sensory testing for assessment of somatosensory function in human oral mucosa: a review. Acta Odontol Scand 76(1):13–20.  https://doi.org/10.1080/00016357.2017.1375554 CrossRefGoogle Scholar
  16. 16.
    de Melo Albert DG, Gomes AC, do Egito Vasconcelos BC, de Oliveira e Silva ED, Holanda GZ (2006) Comparison of orthopantomographs and conventional tomography images for assessing the relationship between impacted lower third molars and the mandibular canal. J Oral Maxillofac Surg 64(7):1030–1037.  https://doi.org/10.1016/j.joms.2006.03.020 CrossRefGoogle Scholar
  17. 17.
    Dal Pont G (1961) Retromolar osteotomy for the correction of prognathism. J Oral Surg Anesth Hosp Dent Serv 19:42–47Google Scholar
  18. 18.
    Savi A, Manfredi M, Pizzi S, Vescovi P, Ferrari S (2007) Inferior alveolar nerve injury related to surgery for an erupted third molar. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103(2):e7–e9.  https://doi.org/10.1016/j.tripleo.2006.09.002 CrossRefGoogle Scholar
  19. 19.
    Shafer DM, Frank ME, Gent JF, Fischer ME (1999) Gustatory function after third molar extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 87(4):419–428CrossRefGoogle Scholar
  20. 20.
    Sittitavornwong S, Babston M, Denson D, Zehren S, Friend J (2017) Clinical anatomy of the lingual nerve: a review. J Oral Maxillofac Surg 75(5):926 e921–926 e929.  https://doi.org/10.1016/j.joms.2017.01.009 CrossRefGoogle Scholar
  21. 21.
    Ridaura-Ruiz L, Figueiredo R, Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C (2012) Sensibility and taste alterations after impacted lower third molar extractions. A prospective cohort study. Med Oral Patol Oral Cir Bucal 17(5):e759–e764CrossRefGoogle Scholar
  22. 22.
    Pell GJ, Gregory BT (1933) Impacted mandibular third molars: classification and modified techniques for removal. Dent Digest 39:330–338Google Scholar
  23. 23.
    Winter GB (1926) Principles of exodontia as applied to the impacted mandibular third molar; a complete treatise on the operative technic with clinical diagnoses and radiographic interpretations. American Medical Book Company, St. LouisGoogle Scholar
  24. 24.
    Costa FWG, Fontenele EHL, Bezerra TP, Ribeiro TR, Carneiro BGDS, Soares ECS (2013) Correlation between radiographic signs of third molar proximity with inferior alveolar nerve and postoperative occurrence of neurosensory disorders: a prospective, double-blind study. Acta Cir Bras 28:221–227CrossRefGoogle Scholar
  25. 25.
    Monnazzi MS, Real-Gabrielli MF, Passeri LA, Gabrielli MA (2012) Cutaneous sensibility impairment after mandibular sagittal split osteotomy: a prospective clinical study of the spontaneous recovery. J Oral Maxillofac Surg 70(3):696–702.  https://doi.org/10.1016/j.joms.2011.02.071 CrossRefGoogle Scholar
  26. 26.
    Bartoshuk L (1989) Clinical evaluation of the sense of taste. Ear Nose Throat J 68(4):331–337Google Scholar
  27. 27.
    Davidson TM, Murphy C (1997) Rapid clinical evaluation of anosmia. The alcohol sniff test. Arch Otolaryngol Head Neck Surg 123(6):591–594CrossRefGoogle Scholar
  28. 28.
    Kamath S, Booth P, Lad TE, Kohrs MB, McGuire WP (1983) Taste thresholds of patients with cancer of the esophagus. Cancer 52(2):386–389CrossRefGoogle Scholar
  29. 29.
    Perros P, MacFarlane TW, Counsell C, Frier BM (1996) Altered taste sensation in newly-diagnosed niddm. Diabetes Care 19(7):768–770CrossRefGoogle Scholar
  30. 30.
    Yildirim P, Gunduz OH (2015) What is the role of Semmes-Weinstein monofilament testing in the diagnosis of electrophysiologically graded carpal tunnel syndrome? J Phys Ther Sci 27(12):3749–3753.  https://doi.org/10.1589/jpts.27.3749 CrossRefGoogle Scholar
  31. 31.
    Costa FW, Soares EC, Esses DF, Silva PG, Bezerra TP, Scarparo HC, Ribeiro TR, Fonteles CS (2015) A split-mouth, randomized, triple-blind, placebo-controlled study to analyze the pre-emptive effect of etoricoxib 120 mg on inflammatory events following removal of unerupted mandibular third molars. Int J Oral Maxillofac Surg 44(9):1166–1174.  https://doi.org/10.1016/j.ijom.2015.06.012 CrossRefGoogle Scholar
  32. 32.
    Albuquerque AFM, Fonteles CSR, do Val DR, Chaves HV, Bezerra MM, Pereira KMA, de Barros Silva PG, de Lima BB, Soares ECS, Ribeiro TR, Costa FWG (2017) Effect of pre-emptive analgesia on clinical parameters and tissue levels of TNF-alpha and IL-1beta in third molar surgery: a triple-blind, randomized, placebo-controlled study. Int J Oral Maxillofac Surg 46(12):1615–1625.  https://doi.org/10.1016/j.ijom.2017.05.007 CrossRefGoogle Scholar
  33. 33.
    Robinson PP, Loescher AR, Yates JM, Smith KG (2004) Current management of damage to the inferior alveolar and lingual nerves as a result of removal of third molars. Br J Oral Maxillofac Surg 42(4):285–292.  https://doi.org/10.1016/j.bjoms.2004.02.024 CrossRefGoogle Scholar
  34. 34.
    Akal UK, Kucukyavuz Z, Nalcaci R, Yilmaz T (2004) Evaluation of gustatory function after third molar removal. Int J Oral Maxillofac Surg 33(6):564–568.  https://doi.org/10.1016/j.ijom.2003.12.001 CrossRefGoogle Scholar
  35. 35.
    Lehman CD, Bartoshuk LM, Catalanotto FC, Kveton JF, Lowlicht RA (1995) Effect of anesthesia of the chorda tympani nerve on taste perception in humans. Physiol Behav 57(5):943–951CrossRefGoogle Scholar
  36. 36.
    Pogrel MA, Renaut A, Schmidt B, Ammar A (1995) The relationship of the lingual nerve to the mandibular third molar region: an anatomic study. J Oral Maxillofac Surg 53(10):1178–1181CrossRefGoogle Scholar
  37. 37.
    McManus LJ, Dawes PJ, Stringer MD (2011) Clinical anatomy of the chorda tympani: a systematic review. J Laryngol Otol 125(11):1101–1108.  https://doi.org/10.1017/S0022215111001873 CrossRefGoogle Scholar
  38. 38.
    Halpern BP, Nelson LM (1965) Bulbar gustatory responses to anterior and to posterior tongue stimulation in the rat. Am J Phys 209:105–110.  https://doi.org/10.1152/ajplegacy.1965.209.1.105 Google Scholar
  39. 39.
    Bartoshuk LM, Gent J, Catalanotto FA, Goodspeed RB (1983) Clinical evaluation of taste. Am J Otolaryngol 4(4):257–260CrossRefGoogle Scholar
  40. 40.
    Anand R, Shankar DP, Manodh P, Devadoss P, Aparna M, Neelakandan RS (2018) Short-term evaluation of gustatory changes after surgical removal of mandibular third molar-a prospective randomized control trial. J Oral Maxillofac Surg 76(2):258–266.  https://doi.org/10.1016/j.joms.2017.06.028 CrossRefGoogle Scholar
  41. 41.
    van der Glas HW, van der Rijt EE, van der Bilt A, Koole R, Vriens JP (2007) Testing of iatrogenic lingual nerve injury using a novel psychophysical method and oral reflexes. Int J Oral Maxillofac Surg 36(6):545–549.  https://doi.org/10.1016/j.ijom.2006.12.009 CrossRefGoogle Scholar
  42. 42.
    Poort LJ, van Neck JW, van der Wal KG (2009) Sensory testing of inferior alveolar nerve injuries: a review of methods used in prospective studies. J Oral Maxillofac Surg 67(2):292–300.  https://doi.org/10.1016/j.joms.2008.06.076 CrossRefGoogle Scholar
  43. 43.
    Robinson PP, Smith KG, Johnson FP, Coppins DA (1992) Equipment and methods for simple sensory testing. Br J Oral Maxillofac Surg 30(6):387–389CrossRefGoogle Scholar
  44. 44.
    de Beukelaer JG, Smeele LE, van Ginkel FC (1998) Is short-term neurosensory testing after removal of mandibular third molars efficacious? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 85(4):366–370CrossRefGoogle Scholar
  45. 45.
    Ghali GE, Epker BN (1989) Clinical neurosensory testing: practical applications. J Oral Maxillofac Surg 47(10):1074–1078CrossRefGoogle Scholar
  46. 46.
    Zuniga JR, Meyer RA, Gregg JM, Miloro M, Davis LF (1998) The accuracy of clinical neurosensory testinf for nerve injury diagnosis. J Oral Maxillofac Surg 56(1):2–8CrossRefGoogle Scholar
  47. 47.
    Roychoudhury S, Nagori SA, Roychoudhury A (2015) Neurosensory disturbance after bilateral sagittal split osteotomy: a retrospective study. J Oral Biol Craniofac Res 5(2):65–68.  https://doi.org/10.1016/j.jobcr.2015.04.006 CrossRefGoogle Scholar
  48. 48.
    Siviero M, Teixeira MJ, de Siqueira JT, Siqueira SR (2010) Somesthetic, gustatory, olfactory function and salivary flow in patients with neuropathic trigeminal pain. Oral Dis 16(5):482–487.  https://doi.org/10.1111/j.1601-0825.2010.01660.x CrossRefGoogle Scholar
  49. 49.
    Nørholt SE, Aagaard E, Svensson P, Sindet-Pedersen S (1998) Evaluation of trismus, bite force, and pressure algometry after third molar surgery: a placebo-controlled study of ibuprofen. J Oral Maxillofac Surg 56(4):420–427CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Assis Filipe Medeiros Albuquerque
    • 1
  • Eduardo Costa Studart Soares
    • 2
    • 3
  • Paulo Goberlânio de Barros Silva
    • 4
  • Barbara Betty de Lima
    • 5
  • Francisco Samuel Rodrigues Carvalho
    • 2
  • Thyciana Rodrigues Ribeiro
    • 6
  • Davi de Sá Cavalcante
    • 7
  • Fábio Wildson Gurgel Costa
    • 8
    • 9
    Email author
  1. 1.Division of Oral and Maxillofacial SurgeryUNIFORFortalezaBrazil
  2. 2.Division of Oral and Maxillofacial Surgery, School of DentistryFederal University of CearáFortalezaBrazil
  3. 3.Division of Oral and Maxillofacial Surgery, Walter Cantídio University HospitalFederal University of CearáFortalezaBrazil
  4. 4.Division of Oral PathologyUNICHRISTUSFortalezaBrazil
  5. 5.Division of Oral and Maxillofacial Surgery, Walter Cantídio University HospitalFederal University of CearáFortalezaBrazil
  6. 6.Division of Clinical Dentistry, Postgraduate Program in Dentistry, School of DentistryFederal University of CearáFortalezaBrazil
  7. 7.Division of Oral Radiology, School of DentistryFederal University of CearáFortalezaBrazil
  8. 8.Division of Oral and Maxillofacial Surgery, Postgraduate Program in Dentistry, School of DentistryFederal University of CearáFortalezaBrazil
  9. 9.Department of Dental Clinic, School of DentistryFederal University of CearáFortalezaBrazil

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