Many complications might result from third molar extractions including bleeding, pain, swelling, dry socket, trismus and paresthesia. Third molar extractions are very common procedures in most dental practices. Brann et al (1999) found that patients who underwent general anesthesia before third molar extraction had a five times higher incidence of lingual or inferior alveolar nerve damage. In a few rare cases there was an unresolved loss of sensation that lasted for more than six months. Loss of sensation may resolve in a matter of days, weeks or few months. There are numerous studies that present an array of clinical cases of prolonged lingual and mandibular anesthesia. However, almost half of the cases of inferior alveolar nerve damage exhibit no signs of nerve trauma caused by needle injection. It is argued that anesthesia could have a neurotoxic effect to the inferior alveolar nerve fibers especially if the needle delivering anesthesia penetrates the neuronal sheath. Taste loss, speech impairment and drooling are symptoms that may accompany oral paresthesia. Tongue paresthesia, then lip paresthesia was the most frequent side effects, with combined tongue and lip paresthesia in a few cases. Prilocaine came in the second place following Articaine. This data was supported by a previous study by Haas and Lennon (1995) that indicated that Articaine was used in the majority of non-surgical paresthesia cases in Ontario between 19. Gaffen and Haas (2009) reported that Articaine had the lion’s share of paresthesia cases (59%) compared to other classes of anesthetic used between 19. However, cell culture experiments and animal studies did not find a higher toxicity of Articaine compared to other anesthetics.
Articaine paresthesia was significantly higher than marketshare paresthesia in majority of studies. This wide range of difference in Articaine-related paresthesia may depend on the method, search queries and the database used in the study. Articaine-related paresthesia ranged as high as 71% and as low as 33% in other studies. Certain anesthetic formulations such as Articaine 4% and Prilcaine 3-4% have been suggested to have a neurotoxic effect causing sensory loss simply because of the higher concentration of the anesthetic.
The formula most commonly used in US and Canada is Articaine hydrochloride 4% with epinephrine 1:100,000. Its use is thought to be optimal as it is proven to be efficient and it is easily diffusible through bone and tissue. Articaine is the anesthetic of choice used in many dental practices. There is a wide variety of anesthetic agents used in dental procedures.
The majority of cases involving lingual nerve neuropathies (89%) were more frequent following mandibular nerve blocks. In some cases, paresthesia can be interpreted as injury to the inferior alveolar or lingual nerve bundle. Inferior alveolar or lingual nerve paresthesia is a complication of inferior alveolar nerve blocks. , reported paresthesia as a result of endodontic sealer extrusion that leaked into the mandibular canal. Endodontic treatment has been associated with paresthesia, Froes et al. Third molar extractions and oral pathologies can also cause inferior alveolar paresthesia as well. The etiology of inferior alveolar nerve paresthesia is somewhat unknown, yet may occur following various dental procedures ranging from simple anesthetic injections, surgical, orthodontic procedures. Paresthesia is defined as altered sensation exhibited as numbness, burning or tingling of patient skin.