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Peripheral nerve blocks with local anaesthesia are routinely utilized in oral surgical procedures to achieve anaesthesia at the operative site. A number of local tissue factors as well as systemic conditions and medications may alter the onset, depth and duration of peripheral nerve blocks. This article describes two cases of extremely prolonged anaesthesia in patients treated with chronic oral lithium carbonate who had been administered inferior alveolar, lingual, long buccal, greater palatine and posterior superior alveolar nerve blocks with lidocaine with adrenaline for surgical removal of an upper and a lower third molar tooth. A possible relation with systemic lithium therapy and its probable mode of action are explored., (Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Background: Several studies have suggested that the likelihood of paresthesia may depend on the local anesthetic used. The purpose of this study was to determine if the type of local anesthetic administered had any effect on reports of paresthesia in dentistry in the United States., Methods: The authors obtained reports of paresthesia involving dental local anesthetics during the period from November 1997 through August 2008 from the U.S. Food and Drug Administration Adverse Event Reporting System. They used chi(2) analysis to compare expected frequencies, on the basis of U.S. local anesthetic sales data, with observed reports of oral paresthesia., Results: During the study period, 248 cases of paresthesia occurring after dental procedures were reported. Most cases (94.5 percent) involved mandibular nerve block. The lingual nerve was affected in 89.0 percent of cases. Reports involving 4 percent prilocaine and 4 percent articaine were 7.3 and 3.6 times, respectively, greater than expected (chi(2), P < .0001) on the basis of local anesthetic use by U.S. dentists., Conclusions: These data suggest that paresthesia occurs more commonly after use of 4 percent local anesthetic formulations. These findings are consistent with those reported in a number of studies from other countries., Clinical Implications: Until further research indicates otherwise, dentists should consider these results when assessing the risks and benefits of using 4 percent local anesthetics for mandibular block anesthesia.

Objective: To determine whether bilateral lingual and inferior alveolar nerve anesthesia affects the onset of swallowing including masticatory function., Study Design: Twenty young male volunteers were asked to chew and swallow corned beef and then a mixture of corned beef and liquid in their usual manner before and after local anesthesia. The oral and pharyngeal swallowing was investigated using videofluoroscopic examination in a lateral plane. Eight objective indicators including oral containment time, swallowing threshold, and pharynx-to-swallow interval were measured., Results: Oral containment time and total sequence duration, total number of chews, and total number of swallows for the 2 test foods varied significantly between those before and after anesthesia. Individual pharynx-to-swallow intervals varied with both foods without remarkable increases or decreases in the swallow duration and cricopharyngeal opening time., Conclusion: Bilateral lingual and inferior alveolar nerve anesthesia may affect early swallowing; changes in the onset of swallowing varied among the participants.

Background: This is a prospective study of patients referred to a tertiary care center with permanent alteration in sensation of the inferior alveolar nerves, lingual nerves or both that could have resulted only from an inferior alveolar nerve block., Methods: Working with a subject pool of 83 patients, the researchers outlined and photographed the area of altered sensation on each patient, tested it with von Frey's hairs and two-point discrimination and tested temperature sensation and direction sense., Results: Among a study population of 55 women and 28 men with a mean age of 41.2 years, the lingual nerve was affected in 79 percent of patients and the inferior alveolar nerve in 21 percent of patients. In 47 patients, the causative inferior alveolar nerve block was painful when administered, but to the other 36 patients [corrected], it felt like a normal injection. Of the local anesthetic agents used, prilocaine was found to be more frequently linked to cases of nerve involvement in this study., Discussion: Occasionally, an inferior alveolar nerve block can result in permanent involvement of the inferior alveolar nerve, lingual nerve or both. The incidence and exact mechanism of involvement still are unknown. By extrapolation from this study, an incidence of anywhere between 1:26,762 and 1:160,571 inferior alveolar nerve blocks can be surmised to result in this complication. A difference in referral rates for male and female patients is difficult to explain. The 34 percent [corrected] incidence of dysesthesia in the patients in this study is of concern., Conclusion: Permanent nerve involvement after receiving an inferior alveolar nerve block is a documented but very rare complication of the inferior alveolar nerve block, and the exact mechanism involved is still unknown., Clinical Implications: Permanent nerve damage can very occasionally occur as a result of an inferior alveolar nerve block. The exact mechanism is unknown, and there is no means of prevention. Knowledge of the risks and complications of local anesthesia is essential.

The aim of this study was to investigate the amount of damage to the lingual nerve by mandibular block anaesthesia alone. For this purpose the records of 12,104 patients in whom mandibular block anaesthesia was administered without any type of surgery were reviewed. The reason for treatment in those patients was, in 72.4% fillings and crown preparations, in 27.13% periodontal procedures and in 0.30% other treatment. The records showed a lingual sensory disturbance in 18 out of 12,104 patients (0.15%). In 17 out of these 18 patients the tongue sensation recovered after a period of 6 months. Only in one patient (0.008%) was there a slight sensory diminution of the tongue, even after one year.

The purpose of this study was to measure the degree of anesthesia obtained with 4% prilocaine and 3% mepivacaine compared with 2% lidocaine (1:100,000 epinephrine) for inferior alveolar nerve block. Using a repeated measures design, 30 subjects randomly received an inferior alveolar injection using masked cartridges of each solution at three successive appointments. The first molar, first premolar, lateral incisor, and contralateral canine (control) were blindly tested with an Analytic Technology pulp tester at 3-min cycles for 50 min. Anesthetic success was defined as no subject response to the maximum output of the pulp tester (80 reading) within 16 min and maintenance of this reading for 50 min. Although subjects felt numb subjectively, anesthetic success as defined here occurred in 43 to 63% of the molars, in 53 to 67% of the premolars, and in 30 to 37% of the lateral incisors. No statistically significant differences in onset, success, or failure were found among the solutions. We conclude that the three preparations are equivalent for an inferior alveolar nerve block of 50-min duration.