Local & systemic complications of LA. Important for dental & medical student.

1. Guided By: Dr. Anish Tiwari
Dr. Adarsh Deshai
Dr. Ravi Kalola
Prepared By: Shefali Kantaria
Parth Karavdia

2. Loss of sensation in a circumscribed area of the
body caused by depression of excitation in nerve
endings or inhibition of the conduction process in
peripheral nerves.

3. Types of LA
complications
Local complication
Systemic complication

4. Needle breakage
Prolonged anesthesia or paresthesia
Facial nerve paralysis
Trismus
Soft tissue injury
Hematoma
Pain on injection
Infection
Edema
Sloughing of tissues
Postanesthetic intraoral lesions

5. •Rare complication in dental LA injection.
•Long needle most likely have broken during
injection.
•Long needle is unlikely to have been inserted
to its full length into soft tissue(app. 32mm).
•Some portion would remain visible in
patient’s mouth.
•Retrival of fragment with hemostat easily
accomplished.
•Litigation does not occure in such incident.

6. •All situation needle fracture occurred at the
hub-never along shaft .
•Additional factor:
• 1. intentional bending of needle by the doctor
before injection.
• 2.sudden unexpected movement by patient
while needle is still embedded in tissue.
• 3.forceful contact with bone.
•Needle has been surgically retrieved and/or
forensic metallurgists have examined the hub of
the needle ,no evidence has reveald
manufacturing defects in needle.

9. •Sudden and unexpected movement by the
patient in the opposite direction of the needle
insertion when the needle penetrates the soft
palate
•Access to a hemostat enables the doctor or the
assistant to grasp the visible proximal end of
the needle fragment and remove it from the
soft tissue.
•Defective manufacturing.

10. •It does not often occur, needle fragment can
migrate, as it illustrated by the series of
panoramic films taken at 3 month intervals.

14. •Not use short needles for inferior alveolar
nerve block in adults or larger children
•Not use 30 gauge needles for IAN block in
adults or children
•Not bend needles when inserting them into
soft tissue
•Not insert the needles till its hub

15. •Remove needle if it is visible with help of a
haemostat.
•If not visible take radiographs of the region .
•If needle is lost into the tissue spaces ,e.g.
pterygomandibular space, infratemporal
space, assure (ખાતરિ કિાવિ)the patient and
review regularly.
•3D CT scanning recommended.

16. •As persistent(સતત) anesthesia or altered
sensation well beyond the expected duration
of anesthesia .
•In addition include hyperesthesia,
dysesthesia in which patient experiences both
pain and numbness.

17. •A patient report feeling NUMB [frozen] many
hours or days after LA injection.
•LA persist for days, weeks, months, potential
for the development of problem is increased.
•It causes of dental malpractice litigtion.
•Clinical response :sensation , swelling,
tingling, itching, oral dysfunction, tongue
biting drooling loss of taste speech
impediment.

18. •Trauma to any nerve may lead to paresthesia.
•It is uncommon complication of oral surgical
procedures and mandibular dental implants.
•Injection of LA solution with alcohol or cold
sterilising solution near a nerve produces
irritation and oedema of the tissue and
subsequent pressure on the nerve.
•Haemorrhage around the neural sheath also
causes pressure on the nerve, leading to
paraesthesia.

19. •Strict adherence to injection protocol and
proper care and handling of dental cartridges
help minimize risk of paresthesia.

20. •Most case resolve within 8 weeks
•Reassurance to the patient
•Examine the patient in person
•Reschedule the patient for examination every 2
months for as long as the sensory deficit persist.
•Dental treatment may continue , but avoid
readministering LA into region of the previously
traumatized nerve. Use alternate LA techniques if
possible.

33. •Self-inflicted trauma to the lips and tongue is
frequently caused by the patient inadvertently
biting or chewing this tissue while still
anesthetized.

36. •Most frequently in younger children, in mentally
or physically disabled children or adults and in
older old patient .
•However it can and dose occur in patients of all
ages.
•The primary reason is the fact that soft tissue
anesthesia lasts significantly longer than does
pulpal anesthesia.
•

37. •It can lead to swelling and significant pain when
the anesthetic effects resolve.
•A younger child or a handicapped individual may
have difficulty coping with the situation and may
lead to behavioral problems.

38. •A cotton roll can be placed between the lip and
the teeth if they are still anesthetized at the time
of discharge.
•The cotton roll is secured with dental floss
wrapped around the teeth.
•The patient and the guardian against eating,
drinking hot fluids, and biting on the lips or
tongue to test for anesthesia.
•A self-adherent warning sticker may be used on
children.

39. •Analgesics for pain, as necessary.
•Antibiotics, as necessary, in the unlikely
situation that infections results .
•Lukewarm saline rinses to aid in decreasing any
swelling that may be present.
•Petroleum jelly or other lubricant to cover a lip
lesion and minimise irritation.

40. •Swelling of the tissue is not a syndrome but a
clinical sign of the presence of some disorder.

43. •Trauma during injection
•Infection
•Allergy
•Hemorrhage
•Injection of irritating solution
•Hereditary angioedema is characterized by
sudden onset of brawny nonpitting edema
affecting the face extremities and mucosal
surface of the intestine and respiratory tract
without obvious precipitating factors.
•Lips, eyelids and the tongue are involved.

44. •Edema related to LA administration is seldom
intense enough to produce significant problems such
as airway obstruction.
•Edema result in pain and dysfunction of the region
and embarrassment for the patient.
•Angioneurotic edema produced by topical
anesthethc in the allergic individual although
exceedingly rare can compromise the airway.
•Edema of the tongue, Pharynx or Larynx may
develop and represents life threatening situation that
requires vigorous management.

45. •Proper care for and handle the local anesthetic
armamentarium.
•Use atraumatic injection technique.
•Comlete an adequate medical evaluation of the
patient before drug administration.

46. Traumatic oedema resulting from inflammation
resolves in one to three days with
antiinflammatory drugs.
Allergic oedema: requires immediate assessment
to avoid the risk of anaphylaxis : treated with
antihistaminics and steroidal antiinflammatory
drugs.
P(position): unconscious, the patient is placed
supine.
A-B-C: basic life support is administered as
needed.
D:emergency medical services is summoned.

47. Epinephrine :0.3mg adult
0.15mg child,every 5 minute until
respiratory.
Histamine block IM OR IV
Corticosteroid IM OR IV
Patient condition

64. •It is from greek prismos is define as a prolonged
tetanic spasm of the jaw muscle by which the normal
opening of the mouth is restricted.

65. •Trauma to the muscles and blood vessels in the
infratemporal space .
•Trauma to the muscle caused by repeated needle
insertion especially medial pterygoid in inferior alveolar
nerve block.
•Low grade infection.
•Excessive haemorrhage or haematoma which produces
irritation of the tissue and muscles dysfunction.
•Solution which contain alcohol or other cold sterilizing
solutions irritate the tissue and produces trismus.

66. •Limitation of movement associated with post
injection trismus is usually minor.
•In the acute phase of trismus pain produce by
haemorrhage lead to muscle spasm and limitation of
movement.
•Chronic phase develops if treatment is not begun.
•Chronic hypomobility occurs secondary to
organization of the haematoma with fibrosis and scar
contractore.
•Infection may produce hypomobility through
increase pain, increase tissue reaction and scarring.

67. •Use sharp, sterile, disposible needle as the trauma
and infection caused by them is less.
•Do not use contaminated needles.
•The injection techinque should cause a less trauma
as possible.
•Clean the area of needle insertion withan antiseptic
solution before injection.
•Avoid repeated insertion.
•Change needle for every new insertions made.
•Use minimal effective volumes of LA.
•Trismus is not always preventable.

68. •The degree of discomfort anf dysfunction varies
but is usually mild.
•The interrim prescribe heat therapy, warm
saline rinses analgesics and if necessary muscle
relaxent to manage the initial phase of muscle
spasm.
•Physiotherapy involving dynamic jaw exercise.
•Surgical intervention to correct chronic
dysfunction may be indicated in some instances.

80. •Recurrent aphthous ulcer or herpes simplex
sometimes develops after intraoral injection of
LA.
•Herpix simplex develop on oral mucosa attach to
the bone e.g. palate, attached gingiva.
•Recurrent aphthous somatitis develops on the
oral mucosa not attached to the bone. e.g. buccal
mucosa.
•Pain is major symptom and may last for 7 to 10
days.

81. •Trauma to the oral tissue caused by the needle or
any other instrument reactivates the dormant
diseases.

83. •Acute sensivity in the ulcered area.
•Risk of the secondary infection developimg in
the situation is minimal.

84. •It prevented or its clinical manifestations
minimised if treated in its produrmal phase.
•It consist of a mild burning or itching sensation
at the site where virus is present. E.g. lip.
•Antiviral agent such as acylovir applied qid to the
affacted area effectively minimize the acute phase
of this process.

85. •Primary management is symptomatic.
•Topical anesthetic solutions may be applied.
•Amixture of equal amount of diphenhydramine
and milk of magnesia rinsed in the mouth
effectively coats the ulcer.
•Orabase, a protective paste with kenalog can
provide pain releafe.
•Kenalog is corticosteroid not recommended
because antiinflammatory action, increase the
risk of viral involvement.
•A tannic aci preparation can be applied topically
to the lesion.