Dental anesthetic nerve damage

Dental anesthetic nerve damage – What is the cause?

Dental anesthetic nerve damage after administering dental anesthetic is a known risk factor, although it is very uncommon. The exact cause may never be known because multiple things are happening at once, physical and chemical trauma.

Dental anesthetic nerve damage recovery rates

Temporary paresthesia occurs in around 1 in 6000 IANBs and is much more common than anything permanent, which occurs in about 1 in 30,000 IANBs.  However, since the vast majority of cases go away on their own the reported rate of dental anesthetic nerve damage is likely much higher than reported.  More than 80% with temporary damage will recover within 3 months, usually in the first 2 weeks.  Another stat I have seen states 85% recovery in 8 weeks or less. After that time period about 1/3 do not recover. Some say their is no benefit to microsurgery, but that is debatable.

What is the cause of the nerve damage?

There exists three major theories on the cause of this nerve injury.  Lingual nerve damages occurs about twice as often as IAN damage.  Unfortunately around 1/3 of patients will experience dysesthesia instead of paresthesia. We do not give routine consent for IAN blocks due to the extreme rarity and this holds up in court.

  • Direct trauma to the nerve from the needle itself.
  • Intra-neural hematoma formation.
  • Local anesthetic toxicity.

Dental anesthetic nerve damage

Why does the lingual nerve get more damage?

First and foremost it is in the way of the removal of the tooth more often. Secondly, it has a lot of variation that nearly assures certain people are going to have issues when they have a wisdom tooth removal procedure. Since there is no way for doctors to trace the nerve, it is an unknown risk.

Atypical lingual nerve

Variation of lingual nerve from Ella JOI 2022

What is the treatment for nerve damage?

There is no known treatment for nerve damage resulting from dental anesthetic. Steroids and anti-inflammatory are often used for treatment, but there is no evidence they are beneficial.

How do we test the nerve damage?

We have an entire post on nerve damage testing in dentistry but one of the most basic tests is mapping the issue.

Which anesthetics are more likely to cause damage?

It appears that the higher percentage anesthetics can cause local anesthetic toxicity that results in nerve damage.  The approximate rate at which it happens overall is around 1:785,000.  Such a low rate makes it difficult to study directly.

A lot of studies do say that articaine and prilocaine have a higher likelihood to cause paresthesia.

Pogrel JADA 1995 found no correlation between using lidocaine, prilocaine, and mepivacaine.  There is a correlation between nerve damage and the number of times we inject a patient.  Although this could result from more chances for physical injury and/or higher doses.  There is also a correlation between the patient reporting a feeling of an electric shock, which is a sign the needle is injuring the nerve.  Finally, a correlation was found for those that had dental work requiring local anesthetic in that area recently.

Pogrel 2000 found prilocaine more likely to have caused dental anesthetic nerve damage.

Again in 2007 Pogrel found prilocaine to be far more likely to cause nerve damage than articaine or lidocaine.

Garisto 2010 found dental anesthetics with higher concentration were more likely to cause dental anesthetic nerve damage.  The main two anesthetics in the study are articaine and prilocaine.  Prilocaine was 7x more likely to cause damage and articaine was 3.5x more likely.  Others have found similar results, such as Haas 1995 and Gaffen 2009.

Unusual nerve damage from dental work or dental anesthetic

There are reports of taste changes after dental work that can occur from damage to the chorda tympani. These should all get better as most nerve damage from either needle or anesthetic heals and the body compensates for taste loss.

Unusual side effects of dental anesthetics

Facial blanching from dental anesthetics

Facial blanching occurs when anesthetic gets into a blood vessel and temporarily stops blood flow.

Twitching after numbness wears off.

Likely result of minor nerve damage either directly or from dental anesthetic itself. Twitching nerves respond well to tonic water because of the quinine.

Ophthalmologic complications from dental anesthetics

Double vision and droopy eyes will happen to many dentists in their career. In a survey of dentists on UIC dental facebook group we run 66% of respondents said they have had a patient have had this happen. That was 10% of all dentists who saw the survey. Since it it likely that those that have had a patient with ophthalmologic complications are likely more prone to participate, the true number of dentists that have seen this is likely lower than 66% but higher than 10%. Diplopia after inferior alveolar nerve block was a topic on facebook group. This is another post on the same topic.

A literature review on the topic by Alamanos 2016 shows 89 cases in the literature and 8% of those resulting in permanent damage. Since it is far more likely to be worthy of writing an article about if the damage is more severe the true number is certainly much smaller percentage of the cases. This case report has many nice references.

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54 Responses to “Dental anesthetic nerve damage”

  1. November 5, 2017 at 7:07 pm #

    I had a lower wisdom cavity filled two and a half weeks ago. four days after, I started having jaw pain on that side. It has been getting worse and I can not open my mouth very far. hurts like hell to try to eat. I called my dentist and he said it is probably trismus, and it will go away. Is this something I should worry about, and try to see a different dentist/doctor?

    • November 7, 2017 at 5:24 am #

      Trismus or dry socket. No reason to go elsewhere.

  2. March 13, 2018 at 2:56 pm #

    I had a root canal about 2 years ago, I still have some pain/sensitivity from that tooth. Could this be damage to a nerve, and what other symptoms might result from nerve damage to the mouth? Slurred speech, swallowing difficulties?

    • March 13, 2018 at 4:46 pm #

      Not nerve damage. Root canals are not always successful for many reasons and that is far more likely the issue. Nerve damage would not result in just one tooth hurting.

  3. March 13, 2018 at 7:01 pm #

    Are you familiar with any dental procedures that might result in slurred speech and swallowing issues?

    • March 13, 2018 at 7:06 pm #

      That sounds neurological. You need to have a medical doctor evaluate that.

  4. March 13, 2018 at 7:14 pm #

    Thanks so much for responding. I am working with several.
    I was just curious about any thing you might could share.

    • March 13, 2018 at 7:21 pm #

      Good luck! Not a dental procedure but sometimes a dental finding.

      • July 3, 2018 at 7:06 am #

        I had 4 of my wisdom teeth removed and a bone graft done last Friday and half of my bottom lip is still numb it’s been numb for 4 days now

        • July 3, 2018 at 6:32 pm #

          Call dentist. Most will resolve on own in few weeks but dentist needs to know

  5. March 25, 2018 at 3:09 pm #

    Please help, i had an extraction (top molar) 4 months ago but the tooth in front is sensitive on that side and i have sensitivity directly above the extraction site in the jaw bone when i press on it with my finger?

    • March 26, 2018 at 2:02 pm #

      When a tooth is removed it often causes some recession on the nearby tooth which results in sensitivity. Use a sensodyne toothpaste but make sure it is NOT a whitening one. And don’t press on the extraction site, there is no reason for your finger to be in there.

  6. March 26, 2018 at 2:48 pm #

    Thank you so much for your reply, where i press with my finger is actually outside of where the tooth used to be, above, right up inside the cheek, so where the root may have been in the jaw bone.
    It feels sensitive/tender in there, could the bone still be in the healing process 4 months later?
    It was a bit of a difficult extraction so a lot of damage may have been done?
    I would be very grateful if you could advise me.

  7. March 26, 2018 at 8:46 pm #

    I had a top 1st molar extracted about 5 months ago, and when I got out of the dentist’s chair I remember holding the opposite side of my face, as though I’d had the tooth taken out on the opposite side of the actual extraction.
    Since then, I have a strange sensitive feeling in that opposite 1st molar, and also an ache behind that eye from time to time.
    Is it possibly nerve damage from the extraction on the other side or anaesthetic used
    Also, the extracted tooth was infected, so could it have infected my sinus (maxillary) on the other side of my nasal area?

    • March 27, 2018 at 8:18 pm #

      Probably no to all of that. You could have a sinus infection that impacts both sides, meaning the sinus infection is causing both sides to hurt.

  8. April 9, 2018 at 3:56 pm #

    I had a root canal done about 8weeks ago, the location where the anasthetic was injected began being a problem 2weeks after the proceedure. Its painful Only to the touch and with facial movement (smiling, nose wiggling etc.) I went back after the 2nd week when it started and they xrayed it but couldn’t see anything so the said just try an antibiotic. It didnt help. The situation still persists with no changes neither mild or extreme, other than eating cold stuff via the tooth. I believe its nerve damage.

    • April 9, 2018 at 10:48 pm #

      Possible but doesn’t sound like root canal related or it would happen immediately after the root canal, not two weeks later. Is cold still bothering the tooth? That should not happen after a root canal. There shuold be no temperature sensation after a root canal.

  9. April 9, 2018 at 11:20 pm #

    Yes.. that makes 2problems. What kind of screening do u reccomend, cat scan? Theres no swelling or anything visual. How should i move forward. Please, Thank you.

  10. April 10, 2018 at 12:26 am #

    I went in for a few fillings about a month ago , and when she gave me the second numbing shot, I think the needle went in too deep. I can still feel slight discomfort where the needle went in. What do you think this is ?

    • April 10, 2018 at 8:41 pm #

      Normal. Trismus happens occasionally.

  11. April 12, 2018 at 5:27 am #

    Hi, I had a root canal on number 19 on March 8th. When novicaine wore off my jaw was excruciating. Could hardly open my mouth. I could only drink liquids for 2 weeks then I noticed the left side of my face went numb. Left temple down jaw, front of left ear, chin, bottom lip and inside my mouth on bottom left teeth and gums.The endodontist said it was a coincidence and sounded neurological. So I had an MRI that was completely normal. Neurologist said the procedure caused Tmj issues as well as trauma to the V3 nerve. Dentist won t help. What should I do now? Still have jaw pain but not as severe as the first 3 weeks.

    • April 13, 2018 at 3:52 am #

      Likely trismus. It happens.

      • April 13, 2018 at 4:20 am #

        That’s what I was thinking regarding the jaw but my face has been completely numb on the left side for weeks.

        • April 13, 2018 at 4:46 am #

          Sorry to hear that but the neurologist is likely right about the V3 trauma. Very bad luck. Most of the time it goes away within 6 weeks though. Sounds like some sort of inflammatory process happening. Needs time. Did the neuro recommend anything at all to help? Do whatever they recommend and if you don’t like their answer go see another neuro.

          • April 17, 2018 at 9:50 pm #

            No he said unfortunately there is nothing to do to speed up the nerve healing process. He said I may get the feeling back or I may not. It’s just a waiting game. He said for the TMJ issue that was brought on from having my mouth open so wide for so long for the procedure that I may benefit from TMJ therapy. I’m going to pursue that but as far as I can tell there isn’t anything I can do for the nerve damage. I’m just frustrated because my endodontist still doesn’t think that the numbness in my face has anything to do with the root canal she did on me!

  12. April 13, 2018 at 1:57 am #

    I suffered a lingual never injection injury about three weeks ago. Burn/tingling in my tongue as well as radiating pain the the lower jaw and teeth on that side. I have been reading that six weeks of non-changing symptoms is a good benchmark for a slim chance of recovery. What are your thoughts?

    • April 13, 2018 at 3:47 am #

      No. Around 90% recover in first 6 weeks, then about 90% of those left recover in the first 6 months. Those numbers may not be exact but they are ballpark.

      • April 13, 2018 at 4:58 am #

        Thanks for the reply. Makes a guy not want to get back in that dentist chair though!

        • April 13, 2018 at 5:02 am #

          You used to want to get into the dental chair before this?!?! JK! Don’t worry yet, like I said most go away. It sucks but it does happen. I hope you are in the majority that have a good result.

  13. April 13, 2018 at 9:06 pm #

    16 months ago my dentist was replacing a bridge on tooth # 2-5. He gave me a number of injection and cut out the bridge. A week later I returned for the new bridge. He had me try on the new unfinished bridge which I was to wear for a short period to see if it felt ok. He had place Vaseline on the abutments to make it easy to remove. Upon returning, he attempted to remove it with an instrument. After trying very hard unsuccessfully he decided to cut it out. This required more injections. Later that evening my face began to swell. The swelling size was around the diameter of a quarter, in the area of the # 5 tooth. I went to see him the next morning and he wrote me a prescription for amoxicillin. Before I got to fill the prescription by the evening the swelling at subsided. Later I notice my mouth appeared uneven. My upper lip, on the side that had swelled, had dropped. I later develop a 3/4 inch linear indentation on my facial skin corresponding to the area of the # 5 tooth. I mentioned my concern to my dentist and he attributed it to a root canal I had on the # 2 tooth. This root canal I had done 10 years previous with another dentist. I noticed 3 months after the new bridge was in that there was a gap at the top of the #5 abutment. I could see and feel my real tooth underneath. My dentist said the gum had reseeded and he would need to replace the bridge. I had more injections done prior to cutting out that bridge. The very next morning I my upper lip had dropped even more, to a point where very little of the upper right side of my lip can be seen. I thought it might correct itself but it’s now been 12 months without a change. I’d appreciate your thoughts as to whether I’ve given it enough time or should I be looking into plastic surgery to correct.

    • April 18, 2018 at 4:26 am #

      Too complex to answer. You need to go see a doctor or at least another dentist and get their opinion.

      • April 18, 2018 at 10:28 pm #

        Thank you, I intend to get another opinion. Can you advise me as to what type of medical specialist can best render a prognosis?

  14. April 24, 2018 at 10:45 pm #

    I got a lower tooth extraction Friday. I don’t have any pain where the tooth was but lots of pain in my cheek and where I got stuck with the needle. It feels like I have a lump in my cheek. The pain gets worse after eating and at night. Could it be bad bruising or nerve damage?

    • April 29, 2018 at 4:04 pm #

      Normal bruising.

  15. April 28, 2018 at 7:26 am #

    I had a Caine tooth filled about 5 weeks ago, I had pain that reminded me of a really bad toothache that lasted for weeks. My face bones up along my nose and under my eye was really tender to the touch. About 3 weeks ago I developed ear pain and a sinus infection. Could this be related?

    • April 29, 2018 at 4:16 pm #

      Yes the nerve in the canine is possibly dead and infected and you need a root canal.

  16. June 25, 2018 at 5:03 pm #

    I had a tooth ache and went to the dentist he gave me antibiotics because my benefits had exhausted ,that was last year. I had been on 6 prescriptions of antibiotics which briefly helped. I got a root canal and he said he had to save the tooth cause it was my anchor tooth for my bridge and he made me a new bridge I had severe swelling on the side of my face and I could barely move my lip to smile. That continued for weeks. then I had another root canal and my face continued to swell I had shock like sensation in my cheek and ear pain. I went to the ENT and had an MRI and that was clear for abscess also saw a neurologist the pain radiated down my jaw and I have feelings of something crawling on my cheek. It still continues to bother me and my eye closes due to the swelling in my cheek. Do I have permanent nerve damage?

    • June 25, 2018 at 8:17 pm #

      That sounds more like massive infection from a tooth. You should see a dentist or go to the ER asap.

  17. September 8, 2018 at 12:50 pm #

    Last Wednesday I had a broken filling fixed ( bottom left) and a new cavity filled ( top left. After the numbing wore off, the left side of my head, from eye socket down to back of ear started hurting. The headache is now on day 4, and is quite painful. It is a constant pulsing ache that radiates all of the left side of my head from top to bottom. The teeth do not bother me at all. I have never had this happen to me before and it in concerning.

    • September 11, 2018 at 3:09 am #

      Tooth pain can have strange effects on the brain’s perception of pain. I would have the dentist check it out and I personally would be highly suspicious of the bottom tooth causing some issues.

  18. September 16, 2018 at 11:54 pm #

    I had a root canal done on tooth number 18. After I noticed a strange red bump where the injection was. He gave me a total of 8 injections during this procedure and poking the needle everywhere because I couldn’t get numb. 2 days later I have ringing in my ears, and still then 6 days later I feel like I’m about to pass out, pain is now in the same injection site as well as ringing in the ears and pain behind left eye and on left side of the head. For the past week I been taking many anti inflammatory supplements and ibuprofen, and nothing is helping the pain except ibuprofen takes the pain from excruciating to bad. Still in a lot of pain. Spoke to another dentist and he told me the dentist who did my root canal damaged a nerve if there was a red bump on your gum after the injection.

    I spoke to many doctors and are all telling me to see a neurologist. Will this go away on its own? It’s actually getting worse and I’m really scared. It’s affecting my daily life and the pain is unimaginable. Please any advice would be appreciated. Thanks!

    • September 17, 2018 at 2:14 am #

      A red bump on your gum has nothing to do with nerve damage. 6 days is hardly long enough to know anything. Did the other dentist think the root canal looked good?

      • September 17, 2018 at 4:48 am #

        Thanks Bauer for your reply, In total since this root canal was done it has been 17 days but the pain began only 6 days after the root canal. So I have been in pain for 11 days now. The other dentist told me the root canal looks good. As of right now there is still pressure behind my left eye, ringing in my ears, and pain on the left side of my head, nausea, also still pain in the injection site near the molar. By 7pm everyday for the last 11 days I have been feeling like this and really don’t know who to turn to and what can be done. Went to a chiropractor to relieve some pressure but that didn’t help, went to urgent care and they told me to go to the emergency room. I still have not gone to the emergency room because I’m pretty sure they will bill me around $4k just to see me.

        • September 17, 2018 at 3:19 pm #

          Emergency room wouldn’t be of any help. I would check with an endodontist just to rule out the tooth. Have them take a CBCT too.

  19. September 17, 2018 at 9:51 pm #

    Had a root canal and crown done in late July on my left side. Crown was off for about two weeks before they finally got it to the right level. Started to have wicked ear pain in my left ear that’s gone from bad to worse and my pre-existing tinnitus kicked up a few notches. Jaw muscles feel relatively fine, though I know that I’m a clencher at night. Been to three dentists, one said TMJ, another said my jaw was misaligned and the last one was malocclusion. Wore a temporary TMJ splint for a few weeks that seemed to tick the ear pain off more, though it did alleviate the ringing and ear fullness. Wondering now if there wasn’t some nerve damage from the injections, as they had to reinject me three separate times because it kept wearing off. I’ve had CBCT on the root canal, no issues but hurting a lot.

  20. December 29, 2018 at 5:29 am #

    Almost a year ago I had some minor dental work done on my top teeth (I honestly can’t remember which ones) and a few hours after leaving and when the numbing begun wearing off I had a very strange sensation in my left nostril (the same side I had the work done on). It felt like I had a bead stuck way up in my nose. My nostril wasn’t blocked at all and even when the numbing completely wore off the feeling was still there just as strongly, like something was shoved waaaay up my nose blocking it without anything actually being up there. I tried using Afrin, healing ointment, saline, everything to try to make the feeling go away and nothing worked. Since then it’s gotten less severe but every now and then comes back with a vengeance (not because of sickness or anything, just totally random out of the blue I notice it strongly again but still there’s nothing blocking my nose!). What the heck is going on? Was a nerve damaged when the anesthetic was applied and now it’s just going to be like this forever? It’s making me Crazy, I get anxious thinking that I might have to feel this for the rest of forever! Is there any treatment either from the dentist or an ENT I should consider? Thanks!!

    • January 4, 2019 at 6:18 am #

      Have you had a dentist look at it? There aren’t really any nerves on the upper jaw that we can damage typically so that is very unlikely.

  21. April 22, 2019 at 11:54 pm #

    I have a question that I hope you can answer.

    About a month ago I had crowns put on my lower front teeth and a bridge on the left lower side. It took a lot of local anaesthetic over a period of 3 days.
    I run on painkillers still since without them I start feeling a little pain that progresses into severe pain in what feels like my entire face.
    Also, I can’t eat anything with salt in it or anything remotely sour because the taste is so intense my face turns into a dot.

    Can you think of something that would explain this?

    • April 30, 2019 at 10:30 pm #

      Too many variables to even begin to help you. Could be a tooth or could be inflammation from the trauma of the procedure itself. Could be something specific to you. The taste thing is very unusual.

  22. January 9, 2020 at 3:44 am #

    I went to the dentist yesterday to have four fillings redone. Two back top and two back bottom all on right side. My face swelled up and he told me to come back in. He said he thinks he hot a vein and blood and anesthesia travelled to my salivary gland. He prescribed a steroid and said i may get bruising on my face. My cheek is swollen and i have begun bruising and i am freaking out! What do i do? Do i need antibiotics? Help

    • January 9, 2020 at 4:03 am #

      This happens rarely. You are just unlucky most likely. Stay in close communication with your dentist. They will take care of you.

  23. June 24, 2021 at 11:53 am #

    Good day

    I had upper jaw (right) molar tooth feeling in April 23 2021. I was given Articaine 4 %. Next day, my tongue started to experience pins and needle, pain and roughness on the surface. Since, roughness feeling is gone but pins and needle on the left side only continue. Never had any issues on the right side of the tongue. Some dull pain appears on the tips area of my tongue usually after 3pm. Nothing during sleep nor in the morning. Pins and needle starts around 9 or 10 am.

    I had a similar experience in January 2021. Exact same symptoms lasted for about 3 months. 95% recovery achieved and at that point I thought it i was allergic to dental filling so I had the second dentist remove the original filling and redo it which was done in April 23rd. As it was in January, exact same symptoms appeared on my tongue. So it was clear to me that it was not allergy but anesthesia toxicity which a neurologist confirmed.

    No numbness, only pins and needle and some mild pain in tip area.

    Would this be a serious damage on sensory nerves or temporary? I understand it is permanent only if whole body of nerves are destroyed so shwann cell generation is no possible but in case of anesthetic toxicity how seriously nerves can be damaged? or they are just irritated?

    Thank you

    • July 1, 2021 at 1:46 pm #

      How exactly did they confirm anesthesia toxicity? Anesthetic in the upper arch can’t cause tongue issues. That makes no sense to connect the two. Sounds more like burning mouth syndrome brought on by stress or anxiety from a dental procedure. Burning mouth can have varied symptoms and tons of triggers.

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