• Journal of The Korean Dental Society of Anesthesiology
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• v.9 no.2
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• pp.108-115
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• 2009

Trauma to any nerve may lead to persistent paresthesia. Trauma to the nerve sheath can be produced by the needle. The patient frequently reports the sensation of an electric shock throughout the distribution of the nerve involved. It is difficult for the type of needle used in dental practice to actually sever a nerve trunk or even its fibers. Trauma to the nerve produced by contact with the needle is all that is needed to produce paresthesia. Hemorrhage into or around the neural sheath is another cause. Bleeding increases pressure on the nerve, leading to paresthesia. Injection of local anesthetic solutions contaminated by alcohol or sterilizing solution near a nerve produces irritation; the resulting edema increases pressure in the region of the nerve, leading to paresthesia. Persistent paresthesia can lead to injury to adjacent tissues. Biting or thermal or chemical insult can occur without a patient's awareness, until the process has progressed to a serious degree. Most paresthesias resolve in approximately 8 weeks without treatment. In most situations paresthesia is only minimal, with the patient retaining most sensory function to the affected area. In these cases there is only a very slight possibility of self injury. But, the patient complaints the discomfort symptoms of paresthesia, such as causalgia, neuralgiaform pain and anesthesia dolorosa. Most paresthesias involve the lingual nerve, with the inferior alveolar nerve a close second. This is the report of a case, that had the persistent paresthesia care on left lingual & buccal shelf regions after the lingual and long buccal nerve block anesthesia.

• Journal of The Korean Dental Society of Anesthesiology
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• v.10 no.2
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• pp.172-177
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• 2010

Background: Damages of trigeminal nerve, particularly inferior alveolar nerve and lingual nerve, could occur following dental procedures. In some cases, nerve damage may happen as a complication of the local anesthetic injection itself and not of the surgical procedure. Methods: From September 2006 to August 2010, 5 cases of inferior alveolar nerve and lingual nerve damages, which were assumed to happen solely due to local anesthesia, were reviewed. All cases were referred to Division of Oral and Maxillofacial Surgery, Department of Dentistry, Hanyang University Medical Center for legal authentication in the process of criminal procedure. Results: In all five cases, patients complained of altered sensation occurred in the distribution of the inferior alveolar or lingual nerve following block anesthesia. The local anesthetics were 2% lidocaine with 1 : 100,000 epinephrine and the amount of local anesthetics, which were used during injection, were varied. Most of patients experienced the electric stimulation during injection. Recovery was poor and professional supportive care was mostly absent. Conclusions: Dental practitioners should consider that the surgical procedure caused the trigeminal nerve damage, however, dental local anesthesia for inferior alveolar nerve and lingual nerve could be one of the causes for damages. The various mechanisms for nerve damages by local anesthesia are thoroughly discussed.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.4
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• pp.315-321
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• 2022

Although rare, hypodermic needle fractures can occur in the maxillofacial region. In cases of fracture, urgent intervention is required to prevent further complications. We present the case of a 37-year-old female patient with a fractured needle in the left sublingual fossa during a lingual nerve block 6 months before referral. The fragment of a 30-gauge needle was located using cone-beam computed tomography and retrieved under local anesthesia with blunt dissection. The patient recovered uneventfully, except for predictable postoperative inflammatory complications, which resolved within 2 weeks. Precautions should be implemented to prevent needle fractures, which are usually preventable. However, if the retrieval is unsuccessful, the patient should be referred to a well-equipped surgical unit without delay.

• Restorative Dentistry and Endodontics
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• v.22 no.1
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• pp.278-290
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• 1997

The purposes of this study were to evaluate and compare the pulpal anesthesia induced by an inferior alveolar nerve block and that by Gow-Gates technique, and to investigate the relationship between pulpal anesthesia and intraoral soft tissue responses. After one side of mandibule was anesthetized with inferior alveolar nerve block or Gow-Gates technique using 2 % lidocaine with 1 : 100,000 epinephrine in 19 volunteers of ages between 24 and 29 (16 males and 3 females, average age 25.9 yrs.), electric pulp tests were done on the canine teeth of the anesthetized side and contralateral one before, at 1 min, continued at every 5 minutes until 60 min, and every 10 minutes until 100 min after completion of local anesthetic injection. Degree of pulpal anesthesia was classified as anesthetic failure, possible anesthesia and complete anesthesia by the criteria based on the thresholds to electric pulp test of contralateral canine and the currents of the electric pulp tester. Subjective signs on the lower lip and tongue were checked and prick-pin tests were done on the buccal gingiva of the first molar, buccal and lingual gingiva of the canine tooth at 5, 10 and 20 min after the completion of anesthetic injection. Thresholds to electric pulp test, degree of pulpal anesthesia and relationship between the pulpal anesthesia and soft tissue responses were analyzed with SPSS, paired t-test, Wilcoxon matched-pairs signed-ranks test and correlation analysis. The results were as follows : No significant differences were found in the peak thresholds to electric pulp test, in the induction time to it and in the depth of pulpal anesthesia between inferior alveolar nerve block and Gow-Gates technique (p>0.05). There was no significant relationship between pulpal anesthesia and soft tissue responses in both inferior nerve block and Gow-Gates technique.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.3
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• pp.217-226
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• 2022

Background: Intraosseous anesthesia is the process by which an anesthetic solution, after penetration of the cortical bone, is directly injected into the spongiosa of the alveolar bone supporting the tooth. This study aimed to compare the effectiveness of the traditional inferior alveolar nerve block (IANB) and computerized intraosseous anesthesia in the surgical extraction of impacted lower third molars, compare their side effects systemically by monitoring heart rate, and assess patients' a posteriori preference of one technique over the other. Methods: Thirty-nine patients with bilaterally impacted third molars participated in this study. Each patient in the sample was both a case and control, where the conventional technique was randomly assigned to one side (group 1) and the alternative method to the contralateral side (group 2). Results: The traditional technique was faster in execution than anesthesia delivered via electronic syringe, which took 3 min to be administered. However, it was necessary to wait for an average of 6 ± 4 min from the execution to achieve the onset of IANB, while the latency of intraosseous anesthesia was zero. Vincent's sign and lingual nerve anesthesia occurred in 100% of cases in group 1. In group 2, Vincent's sign was recorded in 13% of cases and lingual anesthesia in four cases. The average duration of the perceived anesthetic effect was 192 ± 68 min in group 1 and 127 ± 75 min in group 2 (P < 0.001). The difference between the heart rate of group 1 and group 2 was statistically significant. During infiltration in group 1, heartbeat frequency increased by 5 ± 13 beats per minute, while in group 2, it increased by 22 ± 10 beats per minute (P < 0.001). No postoperative complications were reported for either technique. Patients showed a preference of 67% for the alternative technique and 20% for the traditional, and 13% of patients were indifferent. Conclusion: The results identified intraosseous anesthesia as a valid alternative to conventional anesthesia in impacted lower third molar extraction.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.1
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• pp.9-17
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• 2020

Background: This study aimed to compare the pain levels during anesthesia and the efficacy of the QuickSleeper intraosseous (IO) injection system and conventional inferior alveolar nerve block (IANB) in impacted mandibular third molar surgery. Methods: This prospective randomized clinical trial included 30 patients (16 women, 14 men) with bilateral symmetrical impacted mandibular third molars. Thirty subjects randomly received either the IO injection or conventional IANB at two successive appointments. A split-mouth design was used in which each patient underwent treatment of a tooth with one of the techniques and treatment of the homologous contralateral tooth with the other technique. The subjects received 1.8 mL of 2% articaine. Subjects' demographic data, pain levels during anesthesia induction, tooth extractions, and mouth opening on postoperative first, third, and seventh days were recorded. Pain assessment ratings were recorded using the 100-mm visual analog scale. The latency and duration of the anesthetic effect, complications, and operation duration were also analyzed in this study. The duration of anesthetic effect was considered using an electric pulp test and by probing the soft tissue with an explorer. Results: Thirty patients aged between 18 and 47 years (mean age, 25 years) were included in this study. The IO injection was significantly less painful with lesser soft tissue numbness and quicker onset of anesthesia and lingual mucosa anesthesia with single needle penetration than conventional IANB. Moreover, 19 out of 30 patients (63%) preferred transcortical anesthesia. Mouth opening on postoperative first day was significantly better with intraosseous injection than with conventional IANB (P = 0.013). Conclusion: The IO anesthetic system is a good alternative to IANB for extraction of the third molar with less pain during anesthesia induction and sufficient depth of anesthesia for the surgical procedure.

• Journal of Oral Medicine and Pain
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• v.31 no.1
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• pp.59-67
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• 2006

There exist patients complaining speech problem due to dysesthesia or anesthesia following dental surgical procedure accompanied by local anesthesia in clinical setting. However, it is not clear whether sensory problems in orofacial region may have an influence on motor speech abilities. The purpose of this study was to investigate whether transitory sensory impairment of mandibular nerve by local anesthesia may influence on the motor speech abilities and thus to evaluate possibility of distorted motor speech abilities due to dysesthesia of mandibular nerve. The subjects in this study consisted of 7 men and 3 women, whose right inferior alveolar nerve, lingual nerve and long buccal nerve was anesthetized by 1.8 mL lidocaine containing 1:100,000 epinephrine. All the subjects were instructed to self estimate degree of anesthesia on the affected region and speech discomfort with VAS before anesthesia, 30 seconds, 30, 60, 90, 120 and 150 minutes after anesthesia. In order to evaluate speech problems objectively, the words and sentences suggested to be read for testing speech speed, diadochokinetic rate, intonation, tremor and articulation were recorded according to the time and evaluated using a Computerized Speech $Lab^{(R)}$. Articulation was evaluated by a speech language clinician. The results of this study indicated that subjective discomfort of speech and depth of anesthesia was increased with time until 60 minutes after anesthesia and then decreased. Degree of subjective speech discomfort was correlated with depth of anesthesia self estimated by each subject. On the while, there was no significant difference in objective assessment item including speech speed, diadochokinetic rate, intonation and tremor. There was no change in articulation related with anesthesia. Based on the results of this study, it is not thought that sensory impairment of unilateral mandibular nerve deteriorates motor speech abilities in spite of individual's complaint of speech discomfort.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.4
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• pp.179-186
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• 2020

This systematic review aims to determine if a single buccal infiltration (without palatal infiltration in the maxilla and Inferior Alveolar Nerve Block in the mandible) with 4% articaine can induce adequate analgesia for the extraction of primary molars (Maxillary and Mandibular) in children. PubMed, Ovid SP, and Embase were searched for studies published between January 1990 and March 2020 with the relevant MeSH terms. Titles and abstracts were screened preliminarily, followed by the full-texts of the included studies. Five articles were included for this systematic review. The outcome investigated was "Procedural pain during the extraction of primary molars after injection with single buccal infiltration of 4% articaine in comparison to single buccal infiltration, double infiltration (buccal and palatal/lingual), and inferior alveolar nerve block with 2% lignocaine." Of the five studies that evaluated subjective pain during extraction, two reported no significant difference between the articaine and lignocaine groups, and the remaining three reported lower subjective pain during extraction in the articaine group. Only two studies evaluated objective pain scores during extraction, and both studies reported lower pain scores in the articaine group. There is insufficient evidence to justify the statement that a single buccal infiltration of 4% articaine alone is sufficient for the extraction of primary molars. Further evidence is required to justify the claim that palatal infiltrations and IANB can be replaced with the use of 4% articaine single buccal infiltration for the extraction of primary molars in children.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.4
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• pp.283-309
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• 2021

Achieving profound anesthesia in mandibular molars with irreversible pulpitis is a tedious task. This review aimed at evaluating the success of buccal/lingual infiltrations administered with a primary inferior alveolar nerve block (IANB) injection or as a supplemental injection after the failure of the primary injection in symptomatic and asymptomatic patients with irreversible pulpitis in human mandibular molars. The review question was "What will be the success of primary and supplemental infiltration injection in the endodontic treatment of patients with irreversible pulpitis in human mandibular molars?" We searched electronic databases, including Pubmed, Scopus, and Ebsco host and we did a comprehensive manual search. The review protocol was framed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. We included clinical studies that evaluated and compared the anesthetic outcomes of primary IANB with primary and/or supplementary infiltration injections. Standard evaluation of the included studies was performed and suitable data and inferences were assessed. Twenty-six studies were included, of which 13 were selected for the meta-analysis. In the forest plot representation of the studies evaluating infiltrations, the combined risk ratio (RR) was 1.88 (95% CI: 1.49, 2.37), in favor of the secondary infiltrations with a statistical heterogeneity of 77%. The forest plot analysis for studies comparing primary IANB + infiltration versus primary IANB alone showed a low heterogeneity (0%). The included studies had similar RRs and the combined RR was 1.84 (95% CI: 1.44, 2.34). These findings suggest that supplemental infiltrations given along with a primary IANB provide a better success rate. L'Abbe plots were generated to measure the statistical heterogeneity among the studies. Trial sequential analysis suggested that the number of patients included in the analysis was adequate. Based on the qualitative and quantitative analyses, we concluded that the infiltration technique, either as a primary injection or as a supplementary injection, given after the failure of primary IANB, increases the overall anesthetic efficacy.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.6
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• pp.566-574
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• 2006

Purpose : This study was performed to provide an anatomical information of the mandibular ramus for the successful inferior alveolar nerve block. Three dimensional images were reconstructed from the computerized tomography (CT) and the anatomical evaluation of the mandibular ramus was done. Materials and methods : Sixty-four patients who had been taken the facial CT scans from 2000, Jan to 2003, June was selected. The patients who had the anterior or posterior teeth misssing, edentulous ridge, and jaw fracture were excepted. In the occulusal plane, the lingual surface angle (LSA) between the mid-sagittal plane and the mandibular molar lingual surface from the 2nd premolar to the 2nd molar, the inner ramal surface angle (IRSA), the maximum inner ramal surface angle (MxIRSA), and the outer ramal surface angle (ORSA) to the-mid sagittal plane were measured. The inner ramal surface angle in the ligular tip level (IRSA-L) and the outer ramal surface angle in the ligular tip level (ORSA-L), the ramal length (RL), and the anterior ramal length (ARL) were also measured in the lingular tip level. Results : In the lingular tip level, the mean IRSA-L and ORSA-L were $28.6{\pm}6.3^{\circ}$ and $17.9{\pm}4.9^{\circ}$ respectively. The larger was the IRSA, the larger was the ORSA. In the lingular tip level, the mean ramal length was 35.8${\pm}$3.4 mm. The larger was the IRSA-L, the shorter was the ramal length. On the lingular tip level, the mean anterior ramal length from anterior ramus to lingular tip was 19.6${\pm}$3.3 mm. when the ramal length was longer, the anterior ramal length was also longer. On the lingular tip level, there was positive correlation vetween the IRSA and the ORSA, negative correlation between the IRSA and the ramal length, and positive correlation between the ramal length and the lingular tip level to the anterior ramus. There was no statistical meaning of data between sex and age. Conclusion : In the clinical view of the results so far achieved, if the direction of needle is closer to posterior it is able to contact bone on lingular tip when the internal surface of ramus is wided outer.