Trigeminal nerve injuries in relation to the local anaesthesia in mandibular injections

Post-implant neuropathy of the trigeminal nerve. A case series.

“…• A recommendation to minimise the use of repeated IAN blocks 33 • Provide light operative LA and ask patient to indicate when they feel pain during the procedure (Articaine infiltrations and no IAN blocks) 34 • To use implant drills that have lost their sharpness 35 • To use drill 'stops' 35 (The authors feel that this is an inappropriate recommendation as additional force would be required with a blunt drill) • Take intra-operative radiographs during implant bed preparation. 36 If known section to the IAN has occurred then immediate referral to a specialist is recommended.…”

Beware the mental foramen

“…Sir, I read recently with interest the article by Renton et al 1 regarding trigeminal nerve injuries secondary to mandibular local anaesthesia. Although I found this article interesting I was disappointed that the authors failed to mention damage that potentially can and, in reality, does occur at the site of injection for the mental nerve blockade.…”

“…Almost all dental decay remains untreated and creates a largely ignored public health problem affecting children in particular. 1,2 Weak health systems offering unaffordable or no oral care at all for the masses require a dramatic change in professional thinking and political priorities. The WHO and the world's leading oral health organisations recommend jointly that 'exposure to appropriate fluoride, in particular through fluoride toothpaste, will improve quality of life and enhance the achievement of the Millennium Development Goals by reducing the high dental disease burden of entire populations, especially children'.…”

Inadequate knowledge

“…A recent UK dental professional survey indicated an incidence of LA related NI may be around one in 10,000 patients with the majority being temporary NIs, making these injuries significantly more common than previously realised. However, it is relatively simple to prevent them and we have identified several risk factors which include: multiple IDBs, 2 pain on injection, 2 and high concentration LA IDBs. 3 The nerve more likely to be damaged during IDBs is the lingual nerve (70%).…”