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 dental anesthetic 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.

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

Dental anesthetic nerve damage

What is the treatment for dental anesthetic nerve damage?

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

Which dental anesthetics are more likely to cause nerve damage?

It appears that the higher percentage anesthetics can cause local anesthetic toxicity that results in dental anesthetic 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 was a correlation between dental anesthetic nerve damage and the number of times patient was injected.  Although this could result from more chances for physical injury and/or higher doses.  A correlation was also found with the patient reporting a feeling of an electric shock, which is a sign the nerve is being injured by needle.  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.

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38 Responses to “Dental anesthetic nerve damage”

  1. Jeff WatzigNovember 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?

    • bryanabauerNovember 7, 2017 at 5:24 am #

      Trismus or dry socket. No reason to go elsewhere.

  2. CarlaMarch 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?

    • Bauer BryanMarch 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. CarlaMarch 13, 2018 at 7:01 pm #

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

    • Bauer BryanMarch 13, 2018 at 7:06 pm #

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

  4. CarlaMarch 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.

    • Bauer BryanMarch 13, 2018 at 7:21 pm #

      Good luck! Not a dental procedure but sometimes a dental finding. https://www.bauersmiles.com/2013/01/eagle-syndrome.html/

      • LindseyJuly 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

        • Bauer BryanJuly 3, 2018 at 6:32 pm #

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

  5. Nang IrieMarch 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?

    • Bauer BryanMarch 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. Nang IrieMarch 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.
    Thanks

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

    Hi
    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?

    • Bauer BryanMarch 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. JermaineApril 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.

    • Bauer BryanApril 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. JermaineApril 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. Zach WilliamsApril 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 ?

    • Bauer BryanApril 10, 2018 at 8:41 pm #

      Normal. Trismus happens occasionally.

  11. nicole smithApril 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.

    • Bauer BryanApril 13, 2018 at 3:52 am #

      Likely trismus. It happens.

      • nicole smithApril 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.

        • Bauer BryanApril 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.

          • nicole smithApril 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. DrewApril 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?

    • Bauer BryanApril 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.

      • DrewApril 13, 2018 at 4:58 am #

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

        • Bauer BryanApril 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. Ron CansinoApril 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.

    • Bauer BryanApril 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.

      • Ron CansinoApril 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. Catherine HallmanApril 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?

    • Bauer BryanApril 29, 2018 at 4:04 pm #

      Normal bruising.

  15. WendyApril 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?

    • Bauer BryanApril 29, 2018 at 4:16 pm #

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

  16. LauraJune 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?

    • Bauer BryanJune 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.

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