Clinical
InquiryParesthesia
Section snippets
Background
The sensations of burning, numbness, or twinging and/or the partial loss of sensitivity can indicate paresthesia, a disturbance of neurosensitivity caused by a neural tissue lesion. Endodontic-related paresthesia requires careful evaluation because of the close anatomic relationship between the root apex and nerve bundles, especially in the jaw. If the condition is severe, it may cause an irreversible condition. The literature on paresthesia as a complication of endodontic treatment was
Methods
The literature review noted the causes of paresthesia, diagnostic issues, the nerves most often involved, and treatment choices. Forty cases of paresthesia related to endodontic treatment were identified in publications between 2002 and 2012.
Causation
The inferior alveolar nerve (IAN) and the mental nerve are the most often involved in paresthesia related to endodontic treatment. Usually paresthesia and endodontic infection are observed in teeth with large-diameter radicular lesions. The neural injury may result from compression mechanisms, but inflammatory mediators from injured tissue and bacterial products in the periradicular lesions may also be causative. Inflammatory mediators such as interleukin 1, tumor necrosis factor, and nitric
Diagnosis
A complete medical history combined with an assessment of the symptoms provides the diagnosis of paresthesia or neural anesthesia. Contributing findings include reactions of the area to thermal stimuli, mechanical influences, and electrical and chemical tests, although these responses are subjective. Periapical radiographs establish the dental apex–nerve ending relationships, especially in the mandible.
Clinical evaluation of patients who have lingual nerve lesions begins with observing nerve
Treatment
No single approach is appropriate for all cases of paresthesia related to endodontic treatment. Treatment should reflect the causative agent. Paresthesia caused by overfilling of endodontic sealers or drug pastes may respond to surgical removal of the material. The success of this treatment can be altered depending on the time elapsed since the incident, the type of overfilling, and the extent and location of the extruded material. Paresthesia related to infection and inflammation may respond
Prevention
The occurrence of paresthesia associated with endodontic treatment can be prevented. Among the precautions to take to avoid problems are the following:
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Perform a thorough radiographic examination, noting the distance between the radicular apices and/or periapical lesions and the nerve structures.
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Maintain an appropriate working length.
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Avoid over-instrumentation and excessive dilatation of the apical foramen.
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Irrigate using chlorhexidine if the apex is excessively broad or incompletely formed.
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Discussion
The literature review indicates that the nerves most often involved in endodontic treatment–related paresthesia are in the jaw. The IAN and mental nerve should be evaluated through anamnesis, nociceptive and mechanoceptive tests, periapical and panoramic radiographs, and CBCT if indicated. Treatment is geared toward the cause of the injury, the extent of the injury, the time that has passed since the injury, and the patient's responses to the systemic administration of medications.
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Alves FR, Coutinho MS, Gonçalves LS: Endodontic-related facial paresthesia: Systematic review. J Can Dent Assoc 80:e13, 2014
Reprints available from FR Alves, Faculty of Dentistry, Estácio de Sá Univ, Av Alfredo Baltazar da Silveira, 580/cobertura, Recreio, Rio de Janeiro, RJ, Brazil 22790-710; e-mail: [email protected]