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The lingual nerve is usually where you expect it.

Until it isn’t.

Most of the time, the lingual nerve sits below the alveolar crest on the lingual side of the mandible. But anatomical variations do exist, and in lower third molar surgery, those variations can matter a lot.

Studies have reported the lingual nerve at or above the alveolar crest in 4.6% to 21% of cases, and within the retromolar pad region in 0.15% to 1.5% of cases.

That’s why, during lower third molar surgery, a buccal incision approach without unnecessary lingual flap reflection is often preferred.

Less manipulation of the lingual tissues.
Lower risk of lingual nerve injury.
Fewer surprises when removing impacted wisdom teeth.

Because in third molar surgery, the nerve you don’t respect is usually the one that humbles you.

The Third Molar Masterclass replay comes down today.

Learn How to Flap, When to Section and When to Stop

Comment “Replay” and we’ll send it to you.

The ADA has officially released its updated Sedation & Anesthesia Guidelines, the first major revision in nearly a decade.

One of the biggest takeaways?

Minimal sedation is not simply defined by the route of administration. Dose, drug combinations, patient response, and physiologic effect all matter.

The updated document also reinforces expectations for:
— Monitoring and emergency preparedness
— Documentation and recovery protocols
— Fasting recommendations
— Emergency drills and team readiness
— Managing patients who unintentionally enter deeper sedation levels

Another important clarification is the role of the Maximum Recommended Dose (MRD) for unmonitored home use, and how exceeding it during a single appointment moves enteral sedation into moderate sedation guidelines.

⚠️ This post is only a simplified educational summary of selected updates and should not replace formal sedation training or review of the complete ADA document.

Sedation remains one of the highest-risk areas in dentistry, and providers should always follow current state regulations, licensure requirements, and appropriate training standards.

🔗 Full ADA guideline document:
Versaci, M. B. (2026, April 20). Ada releases updated sedation and Anesthesia Guidelines. Mary Beth Versaci. https://adanews.ada.org/ada-news/2026/april/ada-releases-updated-sedation-and-anesthesia-guidelines/

Image Credits:
Narcisa Olteanu (Canva), Herzstaub (Getty Images), ChaNaWit (Getty Images)