Dental Anesthesia Management Quiz

Local Complications of Local Anesthesia

• Local anesthesia procedures can have adverse effects, though not always
• Complications can range from mild to serious
• These complications are noted in daily practice
• Written documentation is crucial
• Follow-up care is necessary

Needle Breakage

• Causes:
  • Unexpected movement
  • Small needle size (30G more likely to break)
  • Misplacement (hubbing the needle)
  • Bent needles
  • Forceful contact with bone
  • Defective needles
  • Weakness of the alloy
  • Needle reuse
• Prevention:
  • Using larger needles
  • Using longer needles for deeper injections (>18mm)
  • Avoiding hub insertion
  • Avoiding bending needles during insertion into tissue
  • Avoiding abrupt redirection
• Management:
  • Remain calm
  • Do not attempt extraction
  • Inform the patient to keep the mouth open
  • Refer to a specialist if the needle is not removable

Persistent Anesthesia or Paresthesia

• Definition:
  • Persistent numbness after anesthesia
  • Altered sensation lasting longer than expected after anesthesia
• Causes:
  • Nerve trauma (e.g., into forament)
  • Neurolytic agents (alcohol, phenol) - effect can last months to years
  • Intraneural injection
  • Hemorrhage into or around the neural sheath
• Problem:
  • Potential for biting or thermal injury
  • Potential for altered taste (lingual nerve)
• Prevention:
  • Careful injection technique
• Management:
  • Patient counseling and reassurance
  • Documentation
  • Follow-up
  • Referral to a specialist, if needed
  • Surgical repair, if necessary

Facial Nerve Paralysis

• Cause:
  • Anesthesia of peripheral facial nerve branches (temporal, zygomatic, buccal, mandibular)
• Result:
  • Transient unilateral paralysis of muscles controlling chin, lips, cheeks, and eye movement
  • Loss of tone in facial muscles
• Prevention:
  • Good injection techniques
  • Avoidance of excessive or improper penetration depths
  • Avoidance of arbitrary injections
• Management:
  • Reassurance to the patient
  • Examination to confirm the diagnosis
  • Cornea care (removal of contact lenses, lubricate eye)
  • Documentation of the event
  • Consider postponing dental treatments

Trismus

• Definition:
  • Spasm or difficulty opening the mouth caused by a nerve disorder after anesthesia
  • Prolonged or continuous spasm of the jaw muscles restricts mouth opening
• Causes:
  • Trauma to muscles or blood vessels, especially in the infratemporal fossa
  • Contaminated anesthetic solutions
  • Hemorrhage
  • Infection
  • Excessive volume of anesthetic solution
  • Multiple needle penetrations
  • Barbed needles
• Prevention:
  • Sharp, sterile, disposable needles
  • Proper handling of cartridges
  • Aseptic technique for injections
  • Minimizing needle insertions
  • Avoiding excessive injection volume
• Problem:
  • Acute phase: pain due to hemorrhage leading to spasm
  • Chronic phase: hypomobility, scar contracture, and fibrosis
• Management:
  • Examination to confirm the diagnosis -Conservative therapy (passive jaw exercises, analgesics, heat, muscle relaxants)

Lip Chewing/Soft Tissue Injury

• Cause:
  • Loss of sensation during the anesthetic block, allowing for unintentional biting
  • More common in children, patients with mental challenges or dementia
• Prevention:
  • Use local anesthetic of appropriate duration
  • Careful monitoring of the patient during the period of anesthesia
  • Placing a cotton roll between the mucobuccal fold for children
  • Educating patients with bleeding abnormalities
• Management:
  • Analgesics
  • Antibiotics
  • Saline rinses
  • Lip lubricants

Hematoma

• Cause:
  • Inadvertent nicking of a blood vessel during a local anesthetic injection
• Prevention:
  • Careful placement of needles
  • Limiting injection volume
  • Appropriate injection techniques
• Problem:
  • Visible extraorally: esthetic concern
  • Swelling and discoloration subsiding within 7-14 days
• Management:
  • Apply direct pressure if visible immediately following the injection
  • Apply ice intermittently for the first six hours
  • Avoid heat
  • Administer analgesics as required
  • Normal post-op expectations are discoloration
  • Treat as trismus if opening difficulties occur

Pain on Injection

• Causes:
  • Careless technique
  • Dull needles
  • Rapid deposit of solution
  • Needles with barbs
• Prevention:
  • Careful technique
  • Sharp needles
  • Topical anesthetics
  • Slow injections
  • Room-temperature solutions
• Management: (details not readily available for this slide)

Burning on the Injection

• Causes:
  • Incorrect solution pH (not 5)
  • Rapid injection
  • Solution contamination
  • Use of warmed solutions
• Prevention:
  • Correct solution pH
  • Slow injection rate (1 mL/min)
• Management:
  • Reassurance to the patient
  • Often, the pain is mild and short (usually a few seconds), and the patient may not be fully aware of if or when it occurs

Infection

• Causes:
  • Needle contamination
  • Improper handling of armamentarium
  • Infection at injection site
  • Improper handling of tissue
• Prevention:
  • Disposable needles
  • Proper equipment care
  • Strict aseptic techniques
• Management:
  • Trismus, as a sign of infection, resolves in 1-3 days
  • Antibiotics, if needed.

Edema

• Causes:
  • Trauma during injection
  • Infection
  • Allergy
  • Hemorrhage
  • Irritating solutions
• Management:
  • Focus on the cause
  • Treatment and management according to the specific cause

Sloughing of Tissues

• Causes:
  • Topical anesthetic use
  • Prolonged ischemia (poor blood supply)
  • Sterile abscess from prolonged ischemia
• Prevention:
  • Apply topical anesthetics for 1-2 minutes
  • Avoid overly concentrated solutions
• Management:
  • Observation
  • Patient reassurance
  • Symptomatic treatment for pain
  • Proper documentation

Post-anesthetic Intraoral Lesions

• Causes: -Trauma to the tissue from needle, local anesthetic solution, or instrument
  • Activation of a latent disease process already present
• Prevention:
  • No means of prevention in susceptible patients, so care is key
• Management:
  • Symptomatic treatment only