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Complications of Local Anaesthesia in Endodontics

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Abstract: Complications of Local Anesthesia in Endodontics.

Local anaesthesia plays a critical role in pain management during endodontic procedures. This chapter discuss common reasons for failure to obtain pulpal anesthesia, explores recent evidence to improve successful pulpal anesthesia, and examines mechanisms of nerve injury from inferior alveolar nerve block along with its assessments and management.

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References

  1. Nusstein JM, Reader A, Drum M. Local anesthesia strategies for the patient with a “hot” tooth. Dent Clin N Am. 2010;54(2):237–47.

    Article  Google Scholar 

  2. Monteiro MR, Groppo FC, Haiter-Neto F, Volpato MC, Almeida JF. 4% articaine buccal infiltration versus 2% lidocaine inferior alveolar nerve block for emergency root canal treatment in mandibular molars with irreversible pulpits: a randomized clinical study. Int Endod J. 2015;48(2):145–52.

    Article  Google Scholar 

  3. Reader A, Nusstein J, Drum M. Successful local anaesthesia for restorative dentistry and endodontics. Chicago: Quintessence Books; 2011.

    Google Scholar 

  4. Simon F, Reader A, Drum M, Nusstein J, Beck M. A prospective, randomized single-blind study of the anesthetic efficacy of the inferior alveolar nerve block administered with a peripheral nerve stimulator. J Endod. 2010;36(3):429–33.

    Article  Google Scholar 

  5. Hannan L, Reader A, Nist R, Beck M, Meyers WJ. The use of ultrasound for guiding needle placement for inferior alveolar nerve blocks. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;87(6):658–65.

    Article  Google Scholar 

  6. Clark S, Reader A, Beck M, Meyers WJ. Anesthetic efficacy of the mylohyoid nerve block and combination inferior alveolar nerve block/mylohyoid nerve block. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;87(5):557–63.

    Article  Google Scholar 

  7. Foster W, Drum M, Reader A, Beck M. Anesthetic efficacy of buccal and lingual infiltrations of lidocaine following an inferior alveolar nerve block in mandibular posterior teeth. Anesth Prog. 2007;54(4):163–9.

    Article  Google Scholar 

  8. Dou L, Luo J, Yang D. Anaesthetic efficacy of supplemental lingual infiltration of mandibular molars after inferior alveolar nerve block plus buccal infiltration in patients with irreversible pulpitis. Int Endod J. 2013;46(7):660–5.

    Article  Google Scholar 

  9. Dou L, Luo J, Yang D, Wang Y. The effectiveness of an additional lingual infiltration in the pulpal anesthesia of mandibular teeth: a systematic review. Quintessence Int. 2013;44(5):457–64.

    PubMed  Google Scholar 

  10. Bitner DP, Uzbelger Feldman D, Axx K, Albandar JM. Description and evaluation of an intraoral cervical plexus anesthetic technique. Clin Anatomy (New York, NY). 2015;28(5):608–13.

    Article  Google Scholar 

  11. Malamed SF. Handbook of local anesthesia. 6th ed. Amsterdam: Elsevier; 2011.

    Google Scholar 

  12. Saatchi M, Khademi A, Baghaei B, Noormohammadi H. Effect of sodium bicarbonate-buffered lidocaine on the success of inferior alveolar nerve block for teeth with symptomatic irreversible pulpitis: a prospective, randomized double-blind study. J Endod. 2015;41(1):33–5.

    Article  Google Scholar 

  13. Schellenberg J, Drum M, Reader A, Nusstein J, Fowler S, Beck M. Effect of buffered 4% lidocaine on the success of the inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a prospective, randomized double-blind study. J Endod. 2015;41(6):791–6.

    Article  Google Scholar 

  14. Virdee SS, Seymour D, Bhakta S. Effective anaesthesia of the acutely inflamed pulp: part 1. The acutely inflamed pulp. Br Dent J. 2015;219(8):385–90.

    Article  Google Scholar 

  15. Nusstein J, Reader A, Nist R, Beck M, Meyers WJ. Anesthetic efficacy of the supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in irreversible pulpitis. J Endod. 1998;24(7):487–91.

    Article  Google Scholar 

  16. Huang JH, Thalhammer JG, Raymond SA, Strichartz GR. Susceptibility to lidocaine of impulses in different somatosensory afferent fibers of rat sciatic nerve. J Pharmacol Exp Ther. 1997;282(2):802–11.

    PubMed  Google Scholar 

  17. Hargreaves KM, Keiser K. Local anesthetic failure in endodontics. Endod Top. 2002;1(1):26–39.

    Article  Google Scholar 

  18. Byers MR, Suzuki H, Maeda T. Dental neuroplasticity, neuro-pulpal interactions, and nerve regeneration. Microsc Res Tech. 2003;60(5):503–15.

    Article  Google Scholar 

  19. Wallace JA, Michanowicz AE, Mundell RD, Wilson EG. A pilot study of the clinical problem of regionally anesthetizing the pulp of an acutely inflamed mandibular molar. Oral Surg Oral Med Oral Pathol. 1985;59(5):517–21.

    Article  Google Scholar 

  20. Modaresi J, Dianat O, Soluti A. Effect of pulp inflammation on nerve impulse quality with or without anesthesia. J Endod. 2008;34(4):438–41.

    Article  Google Scholar 

  21. Byers MR, Taylor PE, Khayat BG, Kimberly CL. Effects of injury and inflammation on pulpal and periapical nerves. J Endod. 1990;16(2):78–84.

    Article  Google Scholar 

  22. Renton T, Yiangou Y, Plumpton C, Tate S, Bountra C, Anand P, et al. BMC Oral Health. 2005;5(1):5.

    Article  Google Scholar 

  23. Esmaeili A, Akhavan A, Bouzari M, Mousavi SB, Torabinia N, Adibi S. Temporal expression pattern of sodium channel Nav 1.8 messenger RNA in pulpitis. Int Endod J. 2011;44(6):499–504.

    Article  Google Scholar 

  24. Roy ML, Narahashi T. Differential properties of tetrodotoxin-sensitive and tetrodotoxin-resistant sodium channels in rat dorsal root ganglion neurons. J Neurosci. 1992;12(6):2104–11.

    Article  Google Scholar 

  25. Gold MS, Reichling DB, Shuster MJ, Levine JD. Hyperalgesic agents increase a tetrodotoxin-resistant Na+ current in nociceptors. Proc Natl Acad Sci U S A. 1996;93(3):1108–12.

    Article  Google Scholar 

  26. Henry MA, Luo S, Foley BD, Rzasa RS, Johnson LR, Levinson SR. Sodium channel expression and localization at demyelinated sites in painful human dental pulp. J Pain. 2009;10(7):750–8.

    Article  Google Scholar 

  27. Luo S, Perry GM, Levinson SR, Henry MA. Pulpitis increases the proportion of atypical nodes of Ranvier in human dental pulp axons without a change in Nav1.6 sodium channel expression. Neuroscience. 2010;169(4):1881–7.

    Article  Google Scholar 

  28. Byers MR, Chudler EH, Iadarola MJ. Chronic tooth pulp inflammation causes transient and persistent expression of Fos in dynorphin-rich regions of rat brainstem. Brain Res. 2000;861(2):191–207.

    Article  Google Scholar 

  29. Huang J, Lv Y, Fu Y, Ren L, Wang P, Liu B, et al. Dynamic regulation of delta-opioid receptor in rat trigeminal ganglion neurons by lipopolysaccharide-induced acute pulpitis. J Endod. 2015;41(12):2014–20.

    Article  Google Scholar 

  30. Dahl JB, Brennum J, Arendt-Nielsen L, Jensen TS, Kehlet H. The effect of pre- versus postinjury infiltration with lidocaine on thermal and mechanical hyperalgesia after heat injury to the skin. Pain. 1993;53(1):43–51.

    Article  Google Scholar 

  31. Woolf CJ. Evidence for a central component of post-injury pain hypersensitivity. Nature. 1983;306(5944):686–8.

    Article  Google Scholar 

  32. Agnihotry A, Fedorowicz Z, van Zuuren EJ, Farman AG, Al-Langawi JH. Antibiotic use for irreversible pulpitis. Cochrane Database Syst Rev. 2016;2:Cd004969.

    PubMed  Google Scholar 

  33. Corbella S, Taschieri S, Mannocci F, Rosen E, Tsesis I, Del Fabbro M. Inferior alveolar nerve block for the treatment of teeth presenting with irreversible pulpitis: a systematic review of the literature and meta-analysis. Quintessence Int. 2017;48(1):69–82.

    PubMed  Google Scholar 

  34. Li C, Yang X, Ma X, Li L, Shi Z. Preoperative oral nonsteroidal anti-inflammatory drugs for the success of the inferior alveolar nerve block in irreversible pulpitis treatment: a systematic review and meta-analysis based on randomized controlled trials. Quintessence Int. 2012;43(3):209–19.

    PubMed  Google Scholar 

  35. Kanaa MD, Whitworth JM, Meechan JG. A prospective randomized trial of different supplementary local anesthetic techniques after failure of inferior alveolar nerve block in patients with irreversible pulpitis in mandibular teeth. J Endod. 2012;38(4):421–5.

    Article  Google Scholar 

  36. Kung J, McDonagh M, Sedgley CM. Does articaine provide an advantage over lidocaine in patients with symptomatic irreversible pulpitis? A systematic review and meta-analysis. J Endod. 2015;41(11):1784–94.

    Article  Google Scholar 

  37. Guglielmo A, Reader A, Nist R, Beck M, Weaver J. Anesthetic efficacy and heart rate effects of the supplemental intraosseous injection of 2% mepivacaine with 1:20,000 levonordefrin. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;87(3):284–93.

    Article  Google Scholar 

  38. VanGheluwe J, Walton R. Intrapulpal injection: factors related to effectiveness. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;83(1):38–40.

    Article  Google Scholar 

  39. Pogrel MA, Bryan J, Regezi J. Nerve damage associated with inferior alveolar nerve blocks. J Am Dental Assoc. 1995;126(8):1150–5.

    Article  Google Scholar 

  40. von Ohle C, ElAyouti A. Neurosensory impairment of the mental nerve as a sequel of periapical periodontitis: case report and review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;110(4):e84–9.

    Article  Google Scholar 

  41. Shadmehr E, Shekarchizade N. Endodontic periapical lesion-induced mental nerve paresthesia. Dent Res J (Isfahan). 2015;12(2):192–6.

    Google Scholar 

  42. Krishnan U, Moule A. Mental nerve paraesthesia: A review of causes and two endodontically related cases. Saudi Endodontic J. 2015;5(2):138–45.

    Article  Google Scholar 

  43. Kruse A, Hellmich N, Luebbers HT, Gratz KW. Neurological deficit of the facial nerve after root canal treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(2):e46–8.

    Article  Google Scholar 

  44. Guivarc’h M, Ordionic U, Ahmed HMA, Cohen S, CatherineJ-H, Bukiet F. Sodium hypochlorite accident: a systmatic review. J Endod. 2017;43(1):16–24.

    Google Scholar 

  45. Caissie R, Goulet J, Fortin M, Morielli D. Iatrogenic paresthesia in the third division of the trigeminal nerve: 12 years of clinical experience. J Can Dent Assoc. 2005;71(3):185–90.

    PubMed  Google Scholar 

  46. Hillerup S. Iatrogenic injury to oral branches of the trigeminal nerve: records of 449 cases. Clin Oral Investig. 2007;11(2):133–42.

    Article  Google Scholar 

  47. Pogrel MA, Thamby S. The etiology of altered sensation in the inferior alveolar, lingual, and mental nerves as a result of dental treatment. J Calif Dent Assoc. 1999;27(7):531. 4–8

    PubMed  Google Scholar 

  48. Kiyak HA, Beach BH, Worthington P, Taylor T, Bolender C, Evans J. Psychological impact of osseointegrated dental implants. Int J Oral Maxillofac Implants. 1990;5(1):61–9.

    PubMed  Google Scholar 

  49. Ziccardi VB, Zuniga JR. Nerve injuries after third molar removal. Oral Maxillofac Surg Clin North Am. 2007;19(1):105–15. vii

    Article  Google Scholar 

  50. Polycarpou N, Ng YL, Canavan D, Moles DR, Gulabivala K. Prevalence of persistent pain after endodontic treatment and factors affecting its occurrence in cases with complete radiographic healing. Int Endod J. 2005;38(3):169–78.

    Article  Google Scholar 

  51. Renton T, Yilmaz Z. Managing iatrogenic trigeminal nerve injury: a case series and review of the literature. Int J Oral Maxillofac Surg. 2012;41(5):629–37.

    Article  Google Scholar 

  52. Costigan M, Scholz J, Woolf CJ. Neuropathic pain: a maladaptive response of the nervous system to damage. Annu Rev Neurosci. 2009;32:1–32.

    Article  Google Scholar 

  53. Truelove E. Management issues of neuropathic trigeminal pain from a dental perspective. J Orofac Pain. 2004;18(4):374–80.

    PubMed  Google Scholar 

  54. Renton T, Yilmaz Z. Profiling of patients presenting with posttraumatic neuropathy of the trigeminal nerve. J Orofac Pain. 2011;25(4):333–44.

    PubMed  Google Scholar 

  55. Mohammadi Z. Endodontics-related paresthesia of the mental and inferior alveolar nerves: an updated review. J Canad Dental Assoc. 2010;76:a117.

    Google Scholar 

  56. Haas DA, Lennon D. A 21 year retrospective study of reports of paresthesia following local anesthetic administration. J Canad Dental Assoc. 1995;61(4):319–20. 23–6, 29–30

    Google Scholar 

  57. Pogrel MA, Thamby S. Permanent nerve involvement resulting from inferior alveolar nerve blocks. J Amer Dental Assoc. 2000;131(7):901–7.

    Article  Google Scholar 

  58. Renton T, Thexton A, Crean SJ, Hankins M. Simplifying the assessment of the recovery from surgical injury to the lingual nerve. Br Dent J. 2006;200(10):569–73. discussion 5

    Article  Google Scholar 

  59. Hillerup S, Jensen RH, Ersboll BK. Trigeminal nerve injury associated with injection of local anesthetics: needle lesion or neurotoxicity? J Amer Dental Assoc. 2011;142(5):531–9.

    Article  Google Scholar 

  60. Meechan JG. The use of the mandibular infiltration anesthetic technique in adults. J Amer Dental Assoc. 2011;142(Suppl 3):19s–24s.

    Article  Google Scholar 

  61. Kanaa MD, Whitworth JM, Corbett IP, Meechan JG. Articaine and lidocaine mandibular buccal infiltration anesthesia: a prospective randomized double-blind cross-over study. J Endod. 2006;32(4):296–8.

    Article  Google Scholar 

  62. Corbett IP, Kanaa MD, Whitworth JM, Meechan JG. Articaine infiltration for anesthesia of mandibular first molars. J Endod. 2008;34(5):514–8.

    Article  Google Scholar 

  63. Jung IY, Kim JH, Kim ES, Lee CY, Lee SJ. An evaluation of buccal infiltrations and inferior alveolar nerve blocks in pulpal anesthesia for mandibular first molars. J Endod. 2008;34(1):11–3.

    Article  Google Scholar 

  64. Smith MH, Lung KE. Nerve injuries after dental injection: a review of the literature. J Can Dent Assoc. 2006;72(6):559–64.

    PubMed  Google Scholar 

  65. Kingon A, Sambrook P, Goss A. Higher concentration local anaesthetics causing prolonged anaesthesia. Do they? A literature review and case reports. Aust Dent J. 2011;56(4):348–51.

    Article  Google Scholar 

  66. Pogrel MA. Damage to the inferior alveolar nerve as the result of root canal therapy. J Am Dent Assoc. 2007;138(1):65–9.

    Article  Google Scholar 

  67. Escoda-Francoli J, Canalda-Sahli C, Soler A, Figueiredo R, Gay-Escoda C. Inferior alveolar nerve damage because of overextended endodontic material: a problem of sealer cement biocompatibility? J Endod. 2007;33(12):1484–9.

    Article  Google Scholar 

  68. Yatsuhashi T, Nakagawa K, Matsumoto M, Kasahara M, Igarashi T, Ichinohe T, et al. Inferior alveolar nerve paresthesia relieved by microscopic endodontic treatment. Bull Tokyo Dent Coll. 2003;44(4):209–12.

    Article  Google Scholar 

  69. Gatot A, Tovi F. Prednisone treatment for injury and compression of inferior alveolar nerve: report of a case of anesthesia following endodontic overfilling. Oral Surg Oral Med Oral Pathol. 1986;62(6):704–6.

    Article  Google Scholar 

  70. Grotz KA, Al-Nawas B, de Aguiar EG, Schulz A, Wagner W. Treatment of injuries to the inferior alveolar nerve after endodontic procedures. Clin Oral Investig. 1998;2(2):73–6.

    Article  Google Scholar 

  71. Scolozzi P, Lombardi T, Jaques B. Successful inferior alveolar nerve decompression for dysesthesia following endodontic treatment: report of 4 cases treated by mandibular sagittal osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;97(5):625–31.

    Article  Google Scholar 

  72. Brkic A, Gurkan-Koseoglu B, Olgac V. Surgical approach to iatrogenic complications of endodontic therapy: a report of 2 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(5):e50–3.

    Article  Google Scholar 

  73. Oshima K, Ishii T, Ogura Y, Aoyama Y, Katsuumi I. Clinical investigation of patients who develop neuropathic tooth pain after endodontic procedures. J Endod. 2009;35(7):958–61.

    Article  Google Scholar 

  74. Coulthard P, Kushnerev E, Yates JM, Walsh T, Patel N, Bailey E, et al. Interventions for iatrogenic inferior alveolar and lingual nerve injury. Cochrane Database Syst Rev. 2014;4:Cd005293.

    Google Scholar 

  75. Sun H, Yang T, Li Q, Zhu Z, Wang L, Bai G, Li D, Li Q, Wang W. Dexamethasone and vitamin B (12) synergistically promote peripheral nerve regeneration in rats by upregulating the expression of brain-derived neurotrophic factor. Arch Med Sci. 2012;8(5):924–30. https://doi.org/10.5114/aoms.2012.31623. Epub 2012 Nov 7

    Article  PubMed  PubMed Central  Google Scholar 

  76. Renton T, Janjua H, Gallagher JE, Dalgleish M, Yilmaz Z. UK dentists’ experience of iatrogenic trigeminal nerve injuries in relation to routine dental procedures: why, when and how often? Br Dent J. 2013;214(12):633–42.

    Article  Google Scholar 

  77. Gaffen AS, Haas DA. Retrospective review of voluntary reports of nonsurgical paresthesia in dentistry. J Can Dent Assoc. 2009;75(8):579.

    PubMed  Google Scholar 

  78. Garisto GA, Gaffen AS, Lawrence HP, Tenenbaum HC, Haas DA. Occurrence of paresthesia after dental local anesthetic administration in the United States. J Am Dent Assoc. 2010;141(7):836–44.

    Article  Google Scholar 

  79. Renton T, Adey-Viscuso D, Meechan JG, Yilmaz Z. Trigeminal nerve injuries in relation to the local anaesthesia in mandibular injections. Br Dent J. 2010;209(9):E15.

    Article  Google Scholar 

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Correspondence to Unni Krishnan .

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Krishnan, U., Moule, A., Renton, T. (2018). Complications of Local Anaesthesia in Endodontics. In: Jain, P. (eds) Common Complications in Endodontics. Springer, Cham. https://doi.org/10.1007/978-3-319-60997-3_3

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