Local Complications of Dental Anesthesia

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is a common cause of needle breakage during local anesthesia injections?

Excessive use of long needles

Using larger gauge needles

Intentional bending of the needle by the doctor (correct)

Patient relaxation during injection

Which of the following is NOT a preventive measure for needle breakage?

Avoiding bending needles

Using short needles for inferior alveolar nerve blocks (correct)

Using appropriate gauge needles for the procedure

Not inserting the needle to its hub unless necessary

What is paresthesia in the context of dental local anesthesia?

Persistent anesthesia or altered sensation beyond expected duration (correct)

Temporary numbness following injection

Increased sensitivity to stimuli after injection

Complete loss of sensation in the affected area

Which nerve is commonly affected by paresthesia after dental local anesthesia?

Inferior alveolar nerve Signup and view all the answers

What is a recommended management step for a patient experiencing paresthesia?

Reassuring the patient and examining them in person Signup and view all the answers

What should be avoided when dealing with a previously traumatized nerve during anesthesia?

Using the same injection site again Signup and view all the answers

How long may paresthesia last before resolution begins?

2 months Signup and view all the answers

What should be done if a needle breakage occurs and the needle is not visible?

Refer the patient to a specialist for further management Signup and view all the answers

What can cause facial nerve paralysis during dental procedures?

Inadvertent deposition of anesthetic into the parotid gland Signup and view all the answers

What symptom is NOT associated with facial nerve paralysis?

Numbness in the lips Signup and view all the answers

Which of the following is an effective management technique for facial nerve paralysis?

Re-assuring the patient and removing contact lenses Signup and view all the answers

What is a common cause of ocular complications during dental anesthesia?

Intra-vascular injection affecting the central retinal artery Signup and view all the answers

Which preventive measure can help avoid facial nerve paralysis during an IANB?

Ensuring needle tip contacts bone before injecting Signup and view all the answers

What is trismus commonly associated with?

Trauma or inflammation of the muscles Signup and view all the answers

If ocular complications occur during dental anesthesia, what is the first step in management?

Patching the affected eye Signup and view all the answers

What is the average interincisal opening range in cases of trismus?

13.7 mm with a range of 5 to 23 mm Signup and view all the answers

What is a common cause of soft tissue injury after anesthesia in children?

Self-inflicted damage to lips or tongue Signup and view all the answers

Which of the following is NOT a recommended prevention strategy for soft tissue injuries?

Encouraging drinking hot fluids immediately after anesthesia Signup and view all the answers

What can occur approximately two days after an intraoral injection of local anesthetic?

Ulcerations around the injection site Signup and view all the answers

What is the ideal rate for the deposition of local anesthetic solution during an injection?

1.0 mL per minute Signup and view all the answers

Which of the following is a cause of edema following an injection?

Rapid injection of local anesthetic Signup and view all the answers

What type of management is typically recommended for edema caused by trauma during an injection?

No treatment required Signup and view all the answers

What type of needle can cause increased pain during injection?

Dull needles from multiple uses Signup and view all the answers

What can be used to manage mouth ulcerations after injection?

Topical analgesics for symptomatic treatment Signup and view all the answers

Study Notes

Local Complications of Dental Local Anesthesia

Needle Breakage:
- Causes: Intentional bending by the dentist before injection, sudden unexpected patient movement (especially in children), forceful contact with bone, redirection inside tissue, or "hubbing" the needle.
- Prevention: Avoid short needles for IANB in adults, 30-gauge needles for IANB, avoid bending needles, avoid inserting needles to the hub unless necessary.
- Management: Instruct the patient to remain calm, keep mouth open, insert bite block. If visible, remove needle with hemostat. If not visible, refer to an oral and maxillofacial surgeon for surgical removal under general anesthesia (GA), locating the fragment with panoramic and computed tomography scanning.

Paresthesia

Description: Persistent anesthesia or altered sensation beyond the expected duration of anesthesia due to nerve injury. Patients may feel an "electric shock" or "zap."
Affected nerves: Inferior alveolar nerve, lingual nerve.
Causes: Trauma from the needle, contaminated anesthetic solution (alcohol/sterilizing solutions), leading to nerve irritation and edema, and increased pressure in nerve region. Hemorrhage into/around the neural sheath.
Duration: Often temporary, but potentially permanent.
Management: Inform and reassure the patient, examine in person, determine degree of paresthesia. Explain that it may persist 2 months to a year or longer before resolving. Record findings on the patient's chart. Suggest regular observation. Avoid re-injecting into the traumatized region. Refer to a specialist if persistent.

Facial Nerve Paralysis

Mechanism: Anesthetic inadvertently deposited into the parotid gland, affecting the facial nerve. Possible during an IANB or Vazirani-Akinosi nerve block if the needle tip is placed within the parotid gland.
Symptoms: Temporary loss of motor function on the affected side of the face. Inability to close the eye, drooping of the lip.
Prevention: Follow standard protocols (needle contact with bone before injection for IANB/V-A block.)
Management: Reassure patient of transient nature, advise to remove contact lenses. Implement eye protection. Delay or avoid re-anesthetizing the patient.

Ocular Complications

Causes: Anesthetic solution diffusing through the inferior orbital fissure affecting the extraocular muscles (resulting in diplopia). Accidental intravascular injection harming the central retinal artery. Vasospasm leading to blindness.
Management: Reassure patient, patch affected eye, "wait and observe" approach. Seek ophthalmologist consultation if unsure about cause.

Trismus

Definition: Limited mouth opening due to muscle trauma or inflammation.
Average opening: 13.7 mm (range 5-23mm).
Causes: Muscle trauma in the infratemporal space following intraoral injections. Local anesthetics can be myotoxic, particularly those with vasoconstrictors. Multiple needle insertions, administering contaminated anesthetic agents (e.g., alcohol), or placing large amounts of anesthetic in limited areas can cause tissue distention.
Management: Standard care depends on the cause and severity. Consider analgesics, muscle relaxants, and appropriate interventions (e.g., oral antibiotics if appropriate).

Infection

Cause: Contamination of the needle before injection or improper handling of the needle. Needle passing through an infected area can spread the infection.
Prevention: Proper preparation of the injection site with antiseptic agents, carefully handling needles avoiding non-sterile surfaces, and using sterile disposable needles.
Treatment: Trismus management, analgesics, and muscle relaxants. If signs and symptoms persist for 3 days, consider antibiotic treatment.

Hematoma

Cause: Leakage of blood into tissues due to injection trauma.
Symptoms: Swelling, bruising, discomfort.
Prevention: Proper injection technique, minimize needle penetrations.
Management: Avoid additional dental therapy in the region until the symptoms subside. Apply direct pressure for at least 2 minutes.

Soft Tissue Injury

Cause: Self-inflicted damage to the soft tissue (lips, tongue, cheeks) due to anesthetic numbness. More common in children and patients with special needs.
Prevention: Placing a cotton roll between teeth and lip (if the area is numb) and warning the patient against biting or chewing hard, abrasive materials (if applicable).
Management: Analgesics as needed, antibiotics (rarely), warm saline rinses, and a lubricant (e.g., for lip lesions) to reduce discomfort.

Post-Anesthetic Lesions

Cause: Trauma to tissue by the needle, local anesthetic solution, swab, or instrument (e.g., rubber dam clamp) that can stimulate latent diseases (e.g., aphthous stomatitis or herpes simplex) present in the tissues.
Management: Symptomatic treatment, such as topical analgesics.

Pain on Injection

Causes: Dull needle from multiple injections, rapid deposition of the anesthetic causing tissue damage, or pain caused from a needle with barbs.
Prevention: Use sharp needles, topical anesthetic, and injection rate below 1.8ml/minute, and ideally at 1 ml/minute.
Management: No specific treatment is usually necessary.

Edema

Problem: Abnormal fluid accumulation below the skin, causing swelling and localized pain.
Causes: Trauma, infection, allergic reaction (angioedema), and hemorrhage.
Management: Edema from trauma, generally resolves within one to three days (with no treatment), analgesic use for discomfort. Edema from infection, hemorrhage,or allergic reactions require specific treatments (analgesics, antibiotics, antihistamines, blood products, supportive care), depending on the underlying cause and severity of the condition.

Sloughing of Tissues

Causes: Epithelial desquamation (skin peeling/sloughing) from extended periods of topical anesthetic use. Sterile abscess from prolonged ischemia from an anesthetic containing a vasoconstrictor (e.g., high concentrations of epinephrine)
Management: Treatment depends on whether sloughing is minor or severe, and is generally supportive.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers local complications associated with dental local anesthesia, focusing on issues like needle breakage and paresthesia. It discusses causes, prevention strategies, and management of these complications. Test your knowledge on this important topic in dental practice.