COMPLICATIONS/ CAUSES PREVENTION MANAGEMENT

DESCRIPTON
Needle Breakage
• IANB most common nerve
injection where needle
breakages occur, next is
PSAN.
• 30-Gauge short needle
has the highest incidence
of breakage, next is 27-
Gauge
• Intentional bending of • Do not use short needles • Immediate referral to a
the needle by the doctor for IANB. specialist for evaluation
before injection. • Do not use a 30-gauge and possible attempted
• Sudden unexpected needle for IANB. retrieval.
movement by the • Do not bend the needle o Oral and
patient while the needle whilst inserting it into maxillofacial
is still embedded in the the soft tissue. surgeon.
tissue. • Do not insert a needle o Panoramic and
• Forceful contact with into the soft tissue to its computed
bone. hub. tomographic
• Observe extra caution scanning.
when inserting needles • Record incident in
in younger children and patient chart.
in extremely phobic
adults and children.

Paresthesia • Trauma to the nerve or • Strict adherence to the • Reassure the patient.
• Prolonged anesthesia. nerve sheath. injection protocol and o Psychological
• Sensation of numbness, • Injection of a LA solution proper care and handling medications.
swelling, tingling, and contaminated by alcohol of dental cartridges. o Personally
itching. or sterilizing solution speak to the
• May cause tongue biting, near a nerve. patient.
drooling, loss of taste and • Hemorrhage o Explain
speech impediment. • Edema paresthesia is
• 1 day to 736 days. • Articaine (Most not uncommon.
• Most common nerves commonly causes • Examine the patient to
involved: paresthesia as it is more determine the degree
o IAN concentrated). and extent of
o Lingual Nerve paresthesia.
• Reschedule the patient
for examination every 2
months.
• Record the incident on
the patient chart.
Facial Nerve Paralysis • Introduction of LA into • Adhering to protocol • Reassure the patient.
• Transient facial nerve (C the capsule of the with the inferior alveolar • Remove contact lens
VII) paralysis. parotid gland. and Vazirani-Akinosi until muscular
• • Deflection of needle in Nerve Blocks. movement (tone)
the posterior direction • Always make sure there returns.
during IANB. is contact with bone. • Eye patch.
• Over Inserting during a o Medial aspect • Record the incident.
Vazirani-Akinosi Nerve of the ramus.
Block.
Trismus
• Prolonged, tetanic spasm
of the jaw muscles by
which the normal opening
of the mouth is restricted
(locked jaw).
Soft tissue injury
Hematoma
• The effusion of blood into
extravascular spaces.
• Present for 7-14 days.
• Trauma to muscles or
blood vessels in the
infratemporal fossa.
• LA solutions into which
alcohol or cold sterilizing
solutions have diffused
produce irritation of
tissues.
• LA solutions into which
alcohol or cold sterilizing
solutions have diffused
produce irritation of
tissues.
• Excessive volumes of LA
solution deposited into a
restricted area.
• Caused by a patient
inadvertently biting or
chewing the lips and
tongue while the tissues
are still anesthetized
• Can be caused by
inadvertent nicking of a
blood vessel (artery or
vein) during
administration of a local
anesthetic.
• Use sterile, sharp, • Heat therapy, warm
disposable needles. saline rinse (Salt and
• Properly care for and water), analgesics
handle dental LA (Ibuprofen or aspirin),
cartridges. muscle relaxants
• Use an aseptic (Diazepam).
technique. • Physiotherapy (Opening
• Practice atraumatic and closing the mouth,
insertion and injection as well as lateral
technique excursions of the
• Avoid repeated mandible, for 5 minutes
injections and multiple every 3-4 hours).
insertions into the same o Chewing gum.
area. • Record the incident.
• Use minimum effective
volume of LA.
• Local anesthesia of • Analgesics for pain.
appropriate duration • Antibiotics if infection
should be selected if occurs.
dental appointments are • Lukewarm saline rinses
brief. to aid in decreasing and
• Cotton roll on the buccal present swelling.
or labial fold. • Petroleum jelly or other
• A self-adherent warning lubricants to cover a lip
sticker may be used on lesion and minimize
children. irritation
o or nameplate
• Modify the injection • Soreness: Aspirin or
technique as dictated by NSAIDs.
the patient’s anatomy. • Analgesic.
• Use a short needle (27- • Ice.
gauge short needle is • Do not apply heat to the
recommended) for the area for at least 4-6
PSA nerve block to hours
decrease the risk of
hematoma that is
commonly a result of
needle over insertion.
• Minimize the number of
needle penetrations into
tissue.
• Never use a needle as a
probe in tissues
Pain on Injection • Careless injection
technique and callous
attitude.
• Dull needle after
multiple injections.
• Rapid deposition of LA
solution may cause
tissue damage.
• Needle with barbs from
impaling bone.
o Force against
resistance.
Burning on Injection • pH of solutions.
o Bupivacaine.
• Rapid injection of local
anesthetic especially in
denser tissues.
• Contamination of local
anesthetic cartridges.
Infection • Needle contamination
before administration.
• Improper technique in
the handling of local
anesthetic agents.
• Improper tissue
preparation.
• Periodontal ligament
infection
• Adhere to proper • None.
techniques of injection,
both anatomic and
psychological.
• Use sharp needles.
• Use topical anesthetic
properly.
• Use sterile LA solutions.
• Inject LA slowly.
• Make sure the solution
temperature is correct.
• Buffered local
anesthetics is preferable.
• Make sure that the
temperature of the
solution is correct.
• Buffered LA (7.4 pH) may
be more comfortable.
• Buffering to • Formal treatment is
approximately 7.4 pH usually not indicated.
before injection. • In those few situations in
• Slowing the speed of which post injection
injection. discomfort, edema or
• Cartridge should be at paresthesia becomes
room temperature in a evident, management of
container (blister-pack or specific problems is
tin) in which it was indicated.
shipped
• Use sterile disposable • Heat therapy, warm
needles. saline rinse (Salt and
• Proper care and handling water), analgesics
of needles and (Ibuprofen or aspirin),
cartridges. Take muscle relaxants
precautions to avoid (Diazepam).
contamination of • 29-41 tablets of Penicillin
needles. V.
• Properly prepare tissues • Record the incident.
before penetration. • Antibiotics.
• Use a cartridge only once • Record the progress and
(1 patient). management of the
• Store cartridges patient on the dental
aseptically in their chart.
original container, • When trismus results
covered at all times. from the infection,
• Cleanse the diaphragm manage trismus.
with a sterile disposable.
• Proper tissue
preparation.
Edema • Trauma during injection. • Proper care and • Analgesics for pain.
• Infection. handling of LA • Reduce swelling as
• Angioedema (Allergy armamentarium. quickly as possible.
from ester-type • Use atraumatic injection • Antibiotic therapy and if
anesthetic). technique. hemorrhage occurs,
• Hemorrhage. • Complete adequate follow the same
• Injection of irritating medical evaluation of procedure for
solutions. the patient hematoma
• Hereditary angioedema management.
• Allergy-induced
Sloughing of Tissues Epithelial Desquamation • When using • Management:
• Prolonged irritation or • Application of a topical vasoconstrictors for o Reassure the
ischemia of gingival soft anesthetic to the gingival hemostasis, do not use patient.
tissue. tissues for a prolonged overly concentrated o Analgesic.
• Norepinephrine period. solutions. o Orabase.
(Levophed) 1:30,000 is • Heightened sensitivity of • Use topical anesthesia as
the agent most like to the tissues to either recommended (1-2
produce ischemia of topical or injectable local minutes).
sufficient duration to anesthetic.
cause tissue damage and • Reaction in an area
a sterile abscess. where a topical has been
applied.
Sterile Abscess
• Secondary to prolonged
ischemia resulting from
the use of a local
anesthetic with a
vasoconstrictor (usually
norepinephrine)
• Usually develops on the
hard palate
Postanesthetic Intraoral Lesions • Recurrent aphthous • Treatment in prodromal • Symptomatic treatment.
• Ulcerations at the site of stomatitis (typically phase. • Reassure the patient.
injection. developing on gingival o Antiviral agents • Topical anesthetic
• Can occur intraorally after tissues that are not applied 4 times solutions.
a local anesthetic attached to underlying a day. o Strepsils.
injection or after any bone) o Ricola.
trauma to the intraoral • Herpes simplex (small o Difflam with
tissues. bumps on tissues that lidocaine.
are attached to • A mixture of equal
underlying bone) amounts of
• can occur intraorally diphenhydramine
after a local anesthetic (Benadryl) and milk of
injection or after any magnesia rinsed in the
trauma to the intraoral mouth.
tissues. • Orabase
• Tannic acid preparation
(Zilactin) applied
topically to the lesions
extraorally intraorally
(Dry the tissues first).
• Avoid rough, spicy, salty
and high preservative
food.
• Avoid extreme
temperatures