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30.11.-0001

 Dear Prof Renton,

I spoke with you briefly at the last King's Alumni Day and took one of your business cards, so I hope you don't mind me emailing you.

I have concerns about a 43-year-old female patient of mine who I gave a 2% lidocaine right ID block 14 days ago for a deep filling. She felt the electric shock like sensation in her right tongue on inserting the needle so I moved the needle slightly before aspirating and injecting. 14 days later she reports to me her right tongue still feels different.

Clinically she has sensation but hypoaesthesia affecting her right lateral tongue (more towards the right side of the tip) and mild hypoaesthesia (not paraesthesia) over right lower lip and chin which is improving. She had 100% response to feather-light touch and two-point discrimination in the innervation of mental nerve. What does concern me a bit is that she mentions that brushing with toothpaste (sensodyne) and rinsing with mouthwash (aquafresh) can make the right tongue feel as though it is burning - i am unsure if this is classed as dysaesthesia as she is quite sensitive generally to strong mouthwashes.

I presume I scraped the lingual nerve on insertion of the needle and perhaps so too the ID nerve. I don't suppose there is anything I can do at this stage but wait for full sensation to return with time? And perhaps use the 4% articaine supracrestal technique more.

Thanks for your time

 

Thanks for your email
It does indeed sound as though your patient has LA related IANI and LNI
Burning sensations are evry common in these cases
Do take a look at our recent LA nerve injury paper BDJ june this year
 
Essential facts include
LA nerve injuries have a 25% permanency thus 75 % likely to be temporary
We know for smith & Lung 2006 that pain on ijnection is related to 60% increase in persistent neuropathy
As you have used 2% lidocaine you are not negligent in any way
 
helping the patient
do advuse her to take a look at the trigeminalnerve.org,uk website
infact if you type in trigeminal nerve you will find it on front page of google
 
your patienst could take
anti inflammatory- ibuprofen if there is no medical contraindication
vitamins B12 and folic acid
 
these are no evidence base but every little helps
keep me posted how it goes
 
Il also post this advice (anonymously) on my forum
 
3 weeks later
 
Dear Prof Renton,

Just wanted to update you on my lady with LA nerve injury.

Full sensation has now returned to her IAN and LN within 3 months of the injury.

Many thanks for your help.

Kind regards,
 
Great Good news!!!!
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