Trigeminal nerve injuries related to restorative treatment

Abstract

Abstract: Restorative dentistry provides many opportunities to cause trigeminal nerve damage. Chronic post-surgical pain, resulting from nerve damage, is rarely associated with dentistry as a result of local anaesthetic (LA) infiltration injections but is more commonly associated with injuries to the nerve trunks of division two and three caused by LA blocks, implants and endodontics. In dentistry, the term paraesthesia is often used inappropriately to mean neuropathy. Paraesthesia is only a descriptive term of symptoms, meaning altered sensation, and not a diagnosis. When sensory nerves are injured, a neuropathy (malfunction) may arise and this may be painful or non-painful. Fortunately, painful post-traumatic neuropathy, caused by injury to nerves, is rare in dentistry compared with other common general surgical procedures, where up to 20–40% of patients experience chronic post-surgical pain after limb amputation, thoracotomy and breast surgery. This article aims to highlight how to prevent nerve injuries using strategies for risk assessment, appropriate surgical techniques and suitable follow-up protocols to allow urgent management to optimize resolution of the nerve injuries when they occur. CPD/Clinical Relevance: Prevention of rare nerve injuries arising from common dental procedures is key, as many high risk procedures can cause lifelong neuropathic pain, functional and immense psychological impact for the patients involved, for which there is no simple remedy.