LOCAL COMPLICATIONS FROM

LOCAL ANESTHEISA
1)

How will the patients treatment record be affected by a complication associated

with the administration of local anesthetics?
A written entry must be made

2)

Should a needle be penetrated to the hub of the needle?

No, although it is extremely rare for a needle to break, if it breaks it will most likely
break at the hub and if you have penetrated to the hub you will not have an
exposed portion of the needle to use for removing the broken needle

3)

Should the direction of needle penetration be changed after entering the tissue?
Do not redirect unless within a few millimeters of correct depth of penetration for
the injection because the needle can deflect away from the trajectory of the
syringe that is being moved

4)

How should you manage a broken needle that is not visible?

1. Do not try to locate or remove
2. Calmly inform the patient
3. Note incident in the chart
4. Refer to Oral Maxillofacial Surgery for consultation

5)

What can cause a burning sensation when injecting local anesthetics?

1. PH of solution with or without vasoconstrictor
2. Rapid injection of solution
3. Difference in temperature between the local anesthetic and body temperature
4. Contamination of solution with alcohol or sterilizing agents

6)

How should local anesthetics be stored?

At room temperature, not in alcohol or sterilizing agents
Be careful of storing local anesthetic in areas exposed to very hot or cold
temperatures. How hot or cold does the storage place get when no one is
present?

7)

What are the causes of paresthesia from a dental injection?

1. Neurotoxicity of the local anesthetic agent, especially 4% solutions
(articaine & prilocaine). Based on statistics, this is by far the leading cause of
paresthesias related to the injection of local anesthetics.
2. Hemorrhage into or around the nerve sheath
3. Needle trauma to nerve sheath
4. Contaminants in the solution

8)

How long will most cases of paresthesia resolve within?

Most texts indicate 8 weeks, but there is no statistical basis for the claim

9)

What is a dysesthesia?
This term usually describes pain from the area of neural injury

10) How should a patient be managed who reports a paresthesia due to

administration of local anesthesia?
1. At time of patient call:
a. Speak directly to the patient when they call
b. Explain what is known about the condition
c. Make an appointment to examine the patient as soon as possible
d. Record conversation in treatment record
2. Examine the patient:
a. Determine the degree and extent of the paresthesia(s) and dysesthesia(s)
b. Record all findings in treatment record
3. Schedule exam every 2 weeks to record any change in the condition
a. Improvement in extent or degree of paresthesia is a good sign
4. Currently there is nothing an oral and maxillofacial surgeon or
neurologist can do to treat injuries due to a dental injection
5. Avoid re-administering local anesthetics to the area of paresthesia(s) and
dysesthesia(s)
11)

Define trismus.
A motor disturbance of the trigeminal nerve, especially spasms of the masticatory
muscles, with difficulty in opening the mouth

12) Trauma to what 2 tissues cause trismus?

1. Muscle
2. Blood vessels
13) What is recommended for the treatment of trismus?
1. Heat therapy moist hot towels to site 20 minutes of every hour
2. Analgesics aspirin usually adequate
3. Physiotherapy opening, closing and lateral movements for every 5
minutes every 3-4 hours. Possibly gum chewing or swishing solution.
14) Improvement of trismus that is managed will usually be seen within how much
time?
48-72 hours
15) Define hematoma.
Blood into extra-vascular spaces
16) How are the first signs of a hematoma immediately managed?
Direct pressure for about 2 minutes, possible ice or ice packs
17) How long will it take for the body to remove a hematoma?
7 14 days
18) Does an uncapped needle on a tray pose a potential problem of infection to the
patient if it is used on them?
Yes
19) Define edema.
Swelling of tissues
20) What are the causes of edema?
1. Trauma
2. Infection
3. Allergy
4. Hemorrhage
5. Injection of contaminated solutions

21) Briefly describe 2 conditions of sloughing tissue.

1. Epithelial desquamation caused by sensitivity to topical local anesthetic or
topical left on too long
2. Sterile abscess due to ischemia from vasoconstrictor. This is often due to
causing the tissue to be blanched for too long
22) What concentration of epinephrine could produce a prolonged diminished blood
supply to an area if it is inappropriately used?
Epinephrine 1:50,000. However, this is also possible from having the tissue
blanched for too long with local anesthetics containing other vasoconstrictors and
concentrations of epinephrine
23) How can the administration of local anesthesia cause a facial nerve paralysis?
By having the local anesthetic adjacent to the facial nerve (VII cranial nerve).
This is most likely from the local anesthetic being in contact with the capsule of
the parotid gland, that the nerve travels in, at the posterior or lateral border of the
mandibular ramus
24) How should a facial nerve paralysis be managed?
1. Reassure patient that condition is transient (a few hours will resolve without
residual effects) just as is the case with the sensory branches of trigeminal
nerve with other dental injections
2. Briefly describe what has happened
2. Advise patient to manually close lower eyelid to keep eye moist
3. Contact lenses removed
4. Record in patients chart
25) List 2 intraoral lesions that a patient might experience due to trauma to the
mouth.
1. Recurrent aphthous stomatitis.
2. Herpes simplex.