John Zuniga, D.M.D., Ph.D.
Department of Oral & Maxillofacial Surgery
UT Southwestern Medical Center
6263 Harry Hines Blvd.
4th Floor, Suite 110
Dallas, TX 75390-9193
214-645-3999
Dr. Zuniga's page at UT Southwestern
Transcript: Needle injections for dental procedures
Will needle injection for dental procedures cause trigeminal neuralgia or trigeminal neuropathic pain? The answer is probably no for trigeminal neuralgia but potentially yes for trigeminal neuropathic pain. I’m referring to needle injections used for simple dental procedures.
For a dentist to provide anesthesia in there for comfort for dental procedures such as drilling, implant placement, oral surgery, etc. on an ambulatory basis, we all, we being dentists and dental specialists, use dental injections via needle using special chemicals to provide that local anesthesia.
Prior to the 1960’s, Novacaine was principally used as the agent. After the 1960’s, Lidocaine was principally used. Since the 2000’s, a more potent local anesthetics have been used.
What we know about needle injection injuries and I’m referring to injuries of the trigeminal nerve associated with the placement of local anesthetics is early meaning that we do know that there is a correlation between the placement of a needle and injection of the local anesthetic and injury to both the inferior alveolar or mental nerve, and I’m going to refer to that area of this part of the face, and the lingual nerve. The lingual nerve serving the anterior 2/3’s of the tongue. The incidence in the literature for temporary injury to either of these nerves is about in 1 of 3,000 injections. The incidence for permanent injury to either of those nerves is 1 in 750,000 injections. So, it is a statistical probability that dentists and dental specialists can continue to provide local anesthesia for dental procedures in a safe fashion. And it is only a rare situation where an individual would suffer a significant injury.
If a person were to suffer a significant nerve injury, the chances that it’s going to be a lingual nerve injury versus a jaw, chin, and lip injury is about twice of the incidence. The probable reason is that the lingual nerve is twice the size of the nerve to the lip and chin. And as this is often a blind injection, the chance of hitting a larger structure than a smaller is greater.
What we also know about permanent damage to either of these nerves is that there does appear to be a relationship to the potency of the local anesthetic. Prior to the 2000 in the mid 90’s, the incidence of needle injection injury was very rare. Since the mid 90’s and currently, they’ve recorded in Canada, in Denmark, in the Netherlands, and now in the U.S., the incidence of needle injection injuries has increased. In fact in my practice, 15% of the patients that I see for evaluation of nerve injury are caused by needle injection injuries.
One potential correlate is the higher incidence with patients who receive local anesthetics of higher concentration, those principally being Septocaine and Articaine. The probable etiology being that the higher it’s concentration related effect, a higher concentration of local anesthetic would more likely than not theoretically cause a greater in neuritic response when injected directly into the nerve.
My recommendation is for anyone who has concern regarding needle injection injury is to not defer dental care because of this fear or insist on non-local anesthetic dentistry. The incidence still remains extremely rare. If you do receive or suffer from a needle injection injury, the recommendation is observe because more than 80 and probably 90% of the patients spontaneously recover by five months.