7 October 2009

I thank the authors for sharing their own experience with regards to tooth section technique and pain upon the elevation in third molar removal. Their experience with the latter confirms what I have noticed throughout my years of practice, something that I found not mentioned in any standard textbook on minor oral surgery.

I thank the authors too for postulating that the pain felt during the elevation of the third molar was a result of the compression of the neurovascular plexus around the vessels that originate from different nerve branches. However, I beg to disagree as the only other nerve branches around the vessels are the sympathetic plexus.

I have one other observation that was not mentioned in my earlier communication; that is, in cases of patients experiencing pain upon the elevation of the third molar, I normally see part of the exposed nerve bundle once the apical portion of the root was removed. In my early days of noticing this structure, I used to probe it gently with a periodontal probe to confirm my diagnosis (of an exposed nerve). Such a gentle probing did not cause paresthesia but inflicted a ‘painful’ stimulation to the patient. I have stopped doing this now as I have learnt by experience that I am dealing with an exposed nerve anytime I treated a patient who also complaint of pain upon tooth elevation. It is this experience with the exposed part of the nerve that led me to postulate that the pain is caused by the release of sodium and potassium from their channels. I compare this to the mental nerve pain upon friction with a denture, as in cases of severe atrophy of the mandible. I welcome any other suggestions that may explain why patients feel pain upon the elevation of a wisdom tooth.

Thank you.

Sincerely yours,