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Abstract
Inferior alveolar nerve (IAN) block injections are commonly used in clinical practice, but they are not free from complications. The aim of the present systematic review is to assess the nerve-related adverse effects of IAN block anesthesia. A structured and systematic search was performed on the major electronic databases (PubMed, Cochrane Library, Web of Science, Scopus and CINAHL) for studies published in English until 30 September 2021. A total of 131 articles were identified through database searching using combinations of keywords. Fifteen papers were included and assessed for eligibility. Overall, nerve damage following an IAN block anesthesia injection is a rare occurrence, probably due to the direct nerve trauma of the needle, a neurotoxic effect of the used anesthetic solution and/or a combination of them. From a medico-legal point of view, a balanced discussion prior to nerve block anesthesia should be pursued in order to avoid patients’ reluctance to undergo necessary dental treatment due to the remote eventuality of nerve injury.
Highlights
The temporary decrease in the perception of pain during dental treatments is able to reduce the onset of anxiety among dental patients, and it is fundamental in clinical practice [1]
Local anesthetics are reliable and efficient drugs, but clinicians should be aware that complications may occur [2]
The Database of Abstracts of Reviews of Effects (DARE) was searched to examine any further existing systematic reviews and meta-analyses assessing the adverse effects related to Inferior alveolar nerve (IAN) block injections
Summary
The temporary decrease in the perception of pain during dental treatments is able to reduce the onset of anxiety among dental patients, and it is fundamental in clinical practice [1]. Allergic reactions may happen, even if the incidence of allergies to amide local anesthetics is less than 1% [4] These manifestations should be put in differential diagnosis with anxiety-induced events [5]. A local anesthetic may be toxic if a high concentration of the agent is reached in the bloodstream, especially if multiple injections are performed or because of an inadvertent intravascular injection [6]. Another adverse reaction, mainly associated with some anesthetic agents (e.g., prilocaine, articaine or the topical anesthetic benzocaine), is methemoglobinemia.
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