Wisdom tooth extraction is a common dental procedure, but it can sometimes lead to unexpected complications, including jaw pain, surgical errors, and rare conditions such as concrescence and myositis ossificans. These complications may result in prolonged discomfort, additional surgeries, and difficulties in jaw movement.
Concrescence and Accidental Extraction of Adjacent Teeth
During wisdom tooth extraction, an adjacent tooth may also be removed, particularly if concrescence is present. Concrescence is a rare condition in which two adjacent teeth are fused together by their cementum, the outer layer of the tooth root. This condition is most commonly found in upper wisdom teeth (third molars) and second molars.
Detecting concrescence can be extremely difficult, as standard dental X-rays may not always reveal the abnormal fusion. Even with multiple radiographs taken from different angles, the condition can remain hidden. If concrescence is suspected but not confirmed through X-rays, cone-beam computed tomography (CBCT) should be used for a more precise diagnosis.
If an extraction is performed on a concrescent wisdom tooth, complications such as maxillary sinus exposure or fractures may occur. In many cases, the dentist may not realize that concrescence is present until midway through the extraction, at which point removing the adjacent molar becomes necessary due to the strong cemental attachment. This unexpected removal can contribute to wisdom tooth-related jaw pain and prolonged healing.
Myositis Ossificans: A Rare but Serious Complication
Myositis ossificans is a condition where bone forms within muscle or soft tissue, leading to stiffness, pain, and difficulty in jaw movement. This can happen after a traumatic extraction or when a root fragment is accidentally displaced into the surrounding muscle.
One case involved a 17-year-old male who developed persistent pain along the anterior border of his left jaw (mandibular ramus) after wisdom tooth extraction. Over 18 weeks, his pain worsened, and his jaw movement became increasingly restricted. A CBCT scan revealed a bony mass in the buccinator muscle, which was surgically removed. Following the procedure, the patient regained full jaw movement and no longer experienced pain.
Another case involved an 18-year-old female who underwent extraction of all four wisdom teeth under general anesthesia. One week later, she returned to the surgeon, complaining of muscle pain and difficulty opening her mouth. The cause of her condition remained unclear for several weeks until a CT scan showed calcification in the medial pterygoid and temporalis muscles, confirming a diagnosis of myositis ossificans.
Due to the severity of her condition, she required three additional surgeries and long-term follow-up for over five years. Doctors planned to provide her with a prosthetic jaw joint once her condition remained stable for an extended period.
Wisdom Tooth Extraction and Jaw Pain
Many patients experience jaw pain after wisdom tooth extraction, but in some cases, it may indicate underlying complications such as:
- Nerve injury leading to prolonged numbness or tingling.
- Muscle trauma from prolonged mouth opening during surgery.
- Retained bone or tooth fragments causing irritation and inflammation.
- Concrescence-related complications requiring additional tooth removal.
- Myositis ossificans, leading to jaw stiffness and difficulty opening the mouth.
If jaw pain persists for an extended period after a wisdom tooth extraction, it is crucial to undergo further evaluation, including advanced imaging techniques like CBCT or MRI, to diagnose any potential complications.
