LA COMPLICATIONS

1. LOCALANAESTHESIA
COMPLICATIONS
 Anjali Savita
 MDS I Year
 Department of Conservative Dentistry
and Endodontics
 Peoples Dental Academy

2. CONTENTS
Definition of local anaesthetic complication
Local complication
Systemic complication
Hot tooth – a challenge to endodontists!

3. Definition of Local
anaesthesia
complication
•It is defined as any deviation
from the expected pattern during
or after the securing of regional
analgesia.
1. Local complications
2. Systemic complications

4. Local
complications
NEEDLE
BREAKAGE
PARASTHESIA TRISMUS
HEMATOMA
PAIN ON
INJECTION
INFECTION
OCULAR
COMPLICATIONS
EDEMA
SOFT TISSUE
INJURY
FACIAL NERVE
PARALYSIS

5. NEEDLE BREAKAGE
Causes
Sudden unexpected movement of the
patient opposite to that of the needle.
Smaller needles/ Prebended needles.
An attempt to change the direction of the
needle.
An attempt to force the needle against
resistance.

6. Prevention
Use large-gauge needles for deep
injections, specially with Inferior
Alveolar Nerve and Posterior
Superior Alveolar Nerve.
Avoid using 30 gauge needle for
IAN block in adults and children.
Use long needles.
Do not bend needles when inserting
them into soft tissue areas.
Redirect only when adequately
withdrawn.

7. Management of needle
breakage
Remain calm do not panic.
Instruct the patient not to move.
Keep the patient’s mouth opening
wide.
Place a bite block in patient’s
mouth.
If fragment is visible try to remove
with a hemostat or Magill’s
intubation forceps.

8. If the needle is lost and not visible and cannot be
easily retrieved
Do not proceed with an incision or probing
Calm the patient
Note the incident on patient’s chart. Keep the
remaining needle fragment. Refer the patient
to an oral and maxillofacial surgeon for
consultation.
 3D CT Scanning recommended.

9. Augello et al. reviewed the literature over 50 years and reported that 70% of
needle breakage events occur in the pterygomandibular space. This highlighted
the need to pay careful attention during the administration of inferior alveolar
nerve block.
Augello et al. reported that 76% of dentists use a 30-gauge needle, because of
the perception that the use of a thinner needle is associated with less pain.
However, it is generally known that pain is not associated with the diameter of
needles.
Fuller et al and Mollen et al. reported that although there are individual
differences in pain, there were no significant differences in the perception of
pain with the use of 25-, 27-, and 30-gauge needles. However, most private
clinics and university hospitals do not stock various sized needles. Currently, we
have three needle sizes, i.e., the 27-gauge 21 mm, 27-gauge 32 mm, and 30-
gauge 21 mm, thus, using a 30-gauge needle requires extreme care.

10. In addition, thinner needles are prone to cause more pain because the pressure
applied on the syringe is much greater with a small gauge needle, so it is
advisable to use of a 27-gauge 21 mm needle, instead of a 30-gauge 21 mm
needle, for young patients who have a low pain threshold.
Blum et al reported 100 cases of needle breakage that occurred during the 14
years, from 1914–1928. Since then, the incidence of needle breakage has
decreased owing to the development of stainless and flexible alloys, and the use
of disposable dental needles.
Kim and Moon reported the removal of a needle fracture fragment using three-
dimensional computed tomography (3-D CT). The surgeon must be familiar
with the anatomical structures to accurately locate the fragment using 3D-CT.
Lee et al reported the removal of broken needle via a microscopic approach..

11. Acham et al. in 2018 made an analysis of the literature complication of
needle fracture following dental local anesthesia on 36 reports and 59 needle
breakage events; they concluded that three-dimensional imaging techniques
should be taken to see the broken fragment and also surrounding structures
like vessels and the parotid gland. It is important because 27 out of 57 cannula
fragments were located in the pterygomandibular space, and the choice of the
removal of the fragment, whether general or local anesthesia, should be
dependent on the patient’s systemic condition.
Thompson et al. located the fractured needles with an image intensifier using
two 19-gauge venipuncture needles.
Lee and Zaid reported the removal of the fragment using surgical navigation
after locating the needle.

12. Nezafati and Shahi reported the retrieval of a broken needle using a mobile
digital C-arm/ C arm CT.
However, even with the use of various methods to locate the position of the
broken needle, the surgeon had to remove the tissue using surgery, while
being directly guided visually. As mentioned above, first, the anatomical
structures must be well-recognized. Then, a wide field of view must be
illuminated using a bright luminous source, such as a headlight. Thereafter,
homeostasis must be properly established, before the fractured segment can
be finally found with blunt dissection.

13. PERSISTENT ANESTHESIA
OR PARESTHESIA
Persistent anaesthesia or altered sensation well
beyond the expected duration of anaesthesia.
In addition it include Hyperesthesia,
Dysesthesia in which patient experiences both
pain and numbness.
Patient reports feeling NUMB(frozen) many
hours or days after local anaesthesia.
Clinical symptoms-
Swelling, tingling, itching, oral dysfunction,
tongue biting, loss of taste, speech impairment.

14. Causes
Injection of local anesthetic
solution contaminated by alcohol or
sterilizing solution near a nerve.
Hemorrhage into or around the
neural sheath.
Bleeding increases pressure,
leading to paresthesia.
Trauma to the nerve sheath
produced by the needle while
injecting.
Articaine and prilocaine

15. Prevention
Proper care and handling to injection
control and cartridge.
Management
Most paresthesia resolve within 8 weeks
without treatment.
Sequences of management
• Reassuring the patient.
• Examine the patient and follow up every 2
months.
• If sensory deficit is still more than 1 year,
consultation with neurologist and oral
surgeon.
Reassurance

16. Brann et al found that patients who underwent general anesthesia before third
molar extraction had a five times higher incidence of lingual or inferior
alveolar nerve damage.
Garisto et al. reported paresthesia occurring after dental procedures were
mostly involved mandibular nerve block.
Renton T et al. reported that Procaine and tetracaine cause more damage than
bupivacaine or lidocaine.
Sullivan et al. conducted a randomized, double-blind, placebo-controlled trial
on 496 patients with Bell’s palsy. They maintain treatment with steroids within
3 days after onset quite advances the chance for full recovery at 3 or 9 months

17. • Piccinni et al. conducted an analysis of reports to the FDAAdverse Event
Reporting System; about 573 cases of paresthesia and dysesthesia after local
anesthetics between 2004 and 2011 were performed. They concluded that the
use of prilocaine, articaine, or both drugs has a higher risk of paresthesia.
• Sambrook PJ et al. concluded that If a nerve is damaged due to dental local
anesthesia, the first treatment should be managing the pain. In order to
decrease local anesthesia-dependent nerve injury, avoiding high concentration
of anesthetic agent for inferior alveolar nerve blocks (use 2% lidocaine as
standard), avoiding inferior alveolar nerve blocks are done by using high
concentration agents (articaine) infiltrations only. The use of a low daily dose
of multivitamin B, to regaining nerve healing and function, has been
recommended.

18. TRISMUS
Prolonged spasm of the jaw
muscles by which the normal
opening of the mouth is restricted
Pain and difficulty of opening
most often after posterior superior
alveolar or inferior alveolar nerve
block if proper injection technique
do not follow..
 Onset 1-6 days post-treatment

19. Causes
Trauma to a muscle in the
infratemporal fossa during the insertion
of the needle
Irritating solutions – Local anesthetic
solutions into which alcohol or cold
sterilizing solutions have diffused
produce irritation to the tissues
Local anesthetic solutions have slight
myotoxic properties on skeletal muscle
Hemorrhage

20. Prevention
Use sharp, sterile, disposable needle.
Proper care and handling to injection
control and cartridge.
Atraumatic injection and avoid
repeating of it.

21. Management
Heat therapy
Warm saline rinse
Analgesic
 Aspirin(325mg) is usually adequate
 Codeine may be required if the discomfort is more
intense
Muscle relaxation
 Diazepam(10 mg bid) or Benzodiazepine is used
Physiotherapy
 opening and closing the mouth
 Chewing gums provide lateral extrusions of the
mandible
 Avoid further dental treatment in the area
 Therabite jaw motion rehabilitation system

23. Dr kumar MS et al(2019) reported a case of Intramuscular Hematoma As A
Cause For Trismus Following Inferior Alveolar Nerve Block - A Special
Consideration For Patients On Antiplatelet Therapy.
They’ve concluded that Comprehensive knowledge is required for the
management of such complications and injection techniques to prevent these
complications. In this case report authors have discussed about the possible role
of free haemoglobin in triggering specific pathophysiology that are associated
with adverse clinical outcome in a patient undergoing hematoma lysis. This
case report emphasize on management part of such complication and how a
meticulous history and special precaution can help in preventing such
complications in patients undergoing antiplatelet drug therapy.

24. HEMATOMA
Effusion of blood into extravascular
spaces as a result of a torn blood vessel
Causes
Arterial or venous puncture
following IANB and PSA nerve
block.
Hematoma rarely develops after a
palatal injection, because of density
of tissue in the hard palate and its
firm adherence to bone.
7 to 14 days the hematoma will be
presented.

25. Prevention
Knowledge of brief anatomy.
Use shorter needle for PSA nerve
block.
Minimize the number of the needle
penetration.
Never use a needle as a probe in the
tissue.

26. Management
Immediate
- When swelling becomes evident during or
immediately following local anesthetic injection,
direct pressure should be applied to the site of
bleeding for 2 minutes. This will effectively stop
bleeding
Inferior alveolar nerve block
- Pressure is applied to the medial aspect of
mandibular ramus

27. Infraorbital nerve block
- Pressure is applied to the skin directly over
infraorbital foramen.
Mental or incisive nerve block
- Pressure is applied directly over mental
foramen.
Buccal nerve block or any palatal injection
- Pressure is applied at the site of bleeding.
Posterior superior alveolar nerve block
- Digital pressure to the soft tissues in the
mucobuccal fold.
- If available ice should be used extra orally to
exert pressure on the site and help constrict the
vessel.

28. • Josip B et al (2019) reported a case of Large Cheek Hematoma as a
Complication of Local Anesthesia.
• An healthy 8-year-old boy who experienced a large cheek hematoma after a
routine infiltration anesthesia in the maxilla. Firstly, he was mistakenly treated
under the diagnosis of type1 allergic reaction. Subsequently, the topical therapy
for an evident, large hematoma was unsuccessful. Ultimately, incision of the
infected hematoma and antibiotic therapy (clavulanic acid + amoxicillin, 10mL
twice daily)were crucial for its resolution. Early recognition of clinical signs of
hematoma is of utmost importance for the surgeon in order to treat the patient
adequately.

29. Pain/Burning on Injection
Causes
Rapid deposition of the local anesthetic solution.
Acidity of the solution
Dull needles, needles with barbes
Aggressive insertion of needle.
Velocity of injection
Lidocaine causes an intense burning sensation
when injected locally
When the needle penetrates a nerve, the patient may
also feel a sudden “electric” shock, suddenly
moving the head, with the risk of self-inflicted
damage

30. Prevention
In order to prevent discomfort
Topical anesthetic
Warming local anesthetics to body
temperature
Smaller-gauge needle
Switching to a fresh needle when you have to
inject multiple times in the same lesion or
when you have multiple injection sites
Inject slowly and with low pressure
Rate of 30 seconds per mL of solution is
recommended.

31. Infection
Causes
Contamination of the needle, now become
rare after introduction of the sterile
disposable needle and glass cartridge.
Management
Antibiotic- Penicillin 250 mg qid.

32. Ocular Complications
The most common complications include
diplopia (dual vision)
ophthalmoplegia (paralysis or weakening of eye
muscles)
Ptosis and mydriasis (dilatation of pupil).
In extremely rare instances, amaurosis (partial/total
blindness) can be seen.
All these complications are transient and disappear on
interruption of the anesthetic effects.
Alamanos et al reported that 8% of ocular
complications were permanent.
 Among the documented ocular complications
Diplopia(39.8%) is most common followed by
Ptosis(16.7%), Mydriasis(14.8%),Amaurosis(13%).
These complications are most commonly associated
with IANB(45.8%), PSANB(40.3%) injected in
possible risk zones.

33. Causes
Orbital injection
Inadvertent injection into the orbit through the
inferior orbital fissure.
Prevention
Aspiration before actual injection.
Inject slowly.
Moving the needle during injection to avoid
deposition of solution at one location.

34. • Penarrocha-Diago and Sanchis-Bielsa (2000) presented a series of 14 cases of
ophthalmologic complications after intraoral anesthesia of the posterior
superior alveolar nerve. The most commonly encountered symptoms were
diplopia, mydriasis, palpebral ptosis, and abduction difficulties of the affected
eye. In all cases, these effects occurred a few minutes after injection of the
anesthetic, followed by complete resolution without sequelae on cessation of
the anesthetic effect. The pathogenic mechanism underlying such
ophthalmologic disorders is discussed in terms of a possible diffusion of the
anesthetic solution toward the orbital region.
• Steenen et al (2012) reviewed the literature from the years 1936 to 2011 and
showed 131 cases with this type of complication and also presented a case
report of a patient with right lateral rectus muscle palsy and blurred vision after
bimaxillary anesthesia.

35. • Yoon and Chussid (2012) presented a case report of 7-year-old male patient
who developed palpebral ptosis and paralysis of the extraocular muscles
following local anesthetic administration for a major operative procedure on
the permanent mandibular left first molar. Complete resolution occurred within
approximately 30 minutes.
• Alamanos et al. conducted a systematic review in 2016 on ophthalmologic
complications following dental local anesthesia with 66 reports and 89 cases.
They found that the Gow-Gates technique for mandibular block anesthesia is
only associated with diplopia. Vision impairment is more associated with
inferior alveolar nerve blocks than with posterior superior alveolar nerve
blocks, and the latter technique has rarely been reported as a cause of
amaurosis. Ocular complications in the literature are mostly with an injection
of lidocaine .

36. Treatment
Reassure the patient that is transient.
In case of Diplopia eye should be
covered with gauze dressing and
patient should be instructed about
safety risks.
Refer patients to an ophthalmologist
for evaluation if it last more than 6
hours.
Regular follow-up

37. Edema
Causes
1. Trauma
2. Infection.
3. Allergy, angioedema
4. Hemorrhage
5. Injection of irritating
solution(alcohol, cold solution)

38. Management
Minimal degree edema
- Just analgesic for pain and will
resolve in several days.
If large degree edema and sign and
symptom of infection.
- Antibiotic should be prescribed.

39. Soft Tissue Injury
Cause
Trauma to the lip or the tongue
caused by biting or chewing these
tissue while still anesthetized,
specially with children.
Prevention
Cotton roll placed between the lips
and the teeth.
Warn the patient priorly.
Self-adherent warning sticker.

40. Management
Analgesic for pain.
Antibiotic if there is infection.
Warm saline rinse to aid in
decreasing the swelling.
Petroleum jelly to cover the lesion
and minimize the irritation.

41. Facial Nerve Paralysis
Occur when anesthesia is introduced into
deep lobe of the parotid gland.
Causes
Transient FNP caused by local anesthesia
into capsule of the parotid gland, which is
located at posterior border of the
mandibular ramus enclosed by medial
pterygoid and masseter muscle.
Usually it occur during Inferior Alveoar
Nerve Block or Vazirani- Akinosi Nerve
Block.

42. Prevention
Proper care and handling to injection control
and cartridge.
Management
Reassuring the patient.
Contact lenses should be removed.
An eye patched should be applied to affected
eye or manually close the lower eyelid
periodically to keep the cornea lubricated.

43. Pogrel et al. reported that the amount of the nerve damage is neither related to
any type of local anesthetic agents nor to the number of injections given at one
site. In addition, they stated, as an interesting example, that the patients had
received multiple dental injections within 3 months before the nerve damage
occurred. They suggested that the nerve position is an important factor related
to nerve injury by a needle.
Miles et al suggested that the signs related with trigeminal neuropathy were
impairment of taste, vestibular insufficiency, hearing disturbance, facial palsy,
or cerebellar lesion signs. These signs led them to suspect a viral origin.
Further, recent studies have shown that patients treated with an antiviral drug
in combination with prednisolone demonstrated statistically full recovery in a
higher percentage than patients treated with prednisolone alone.[11]

44. SYSTEMIC
COMPLICATIONS SYNCOPE OVERDOSE
ALLERGY

45. SYNCOPE
Most frequent complication associated with local
anesthesia in dental office.
Definition
A transient and sudden loss of consciousness due to
cerebral ischemia which occurs secondary to
vasodilatation with a corresponding drop in blood
pressure

46. Clinical Features
Features Of Presyncope
Feeling of warmth
Heavy perspiration
Pallor especially in the forehead
area
Increased respiratory rate
Rapid pulse
Features Of Syncope
Pupils dilated
Giddiness
Hypotension
Bradycardia
Visual disturbance
Weak pulse
Features Of Post Syncope
Unconsciousness
Mental confusion

47. Management Of Syncope
Avoid precipitating factors.
Avoid waiting for prolonged periods.
Avoid starvation.
Explain the procedure to the patient.
Never go for sudden unexpected procedures.
Discontinue any procedures in progress.
Lower the chair back and the legs are slightly
elevated by 30-40° , thus placing the patient in
a semi reclining position.
This position aids venous return from the
lower body and prevents venous congestion in
the upper body

48. If the patient is conscious, ask him to take a
few deep breaths or smell ammonia spirit.
Check the vital signs.
Monitor airway, breathing, circulation
Airway
 Maintain patent airway
Breathing
 If the patient is unable to breathe go for
artificial ventilation
Circulation
 Oral fluids
 IV fluids

49. Introduction Precipitating Factors
Clinical Manifestations Management
OVERDOSE

50. Introduction
A drug overdose reaction has been defined as those clinical signs and
symptoms that result from an overly high concentration of a drug in
various target organs and tissues.
Normally there is constant absorption of the drug from its site of
admission into the circulatory system and a steady removal from the blood
by the liver.

51. Predisposing Factors
Patient Factors
Age
Weight
Medications
Gender
Presence of disease
Genetics
Mental attitude.
Drug Factors
Vasoactivity
Concentration
Dose
Route of administration
Rate of injection
Vascularity of the injection site.
Presence of vasoconstrictors.

52. Patient Factors
Age
 The function of absorption, metabolism, and excretion are
diminished in old people – increasing the half-life of the drug
in circulation blood.
Weight
 Greater body weight – larger dose.
Medications
 Meperidine “narcotic analgesic”,
 Phenytoin “anticonvulsant”,
 Quinidine “antidysrhythmic”, and
 Desipramine “antidepressant”
– increase local anesthesia blood level, because protein binding
competition.

53. Gender
Renal function during pregnancy may impaired
leading to increase local anesthesia in blood level.
In adult women the seizure threshold is 5.8 mgkg, in
new-born 18.4, in the foetus 41.9 mgkg.
Presence of Disease
Hepatic , renal dysfunction and congestive heart
failure decrease liver perfusion – increase amide local
anesthesia blood level.

54. Drug Factors
Vasoactivity
•Vasodilating properties of LA lead to
Shorter duration of clinical anesthesia.
•Increased blood level of LA.
Concentration
Lowest concentration should be given.
Dose
Smallest dose should be given.

55. Route of administration
Should be care about intravascular injection.
Rate of injection
Slow (60-seconds) IV administration per
cartridge (36 mg).
Vascularity of the injection site
Rapid of the absorption.
Vasoconstrictors
Decrease absorption of the drug.

56. Prevention
Use aspiration syringe.
Use a needle number smaller than 25 gauge.
Aspirate in at least two planes before injection.
Slowly inject the anesthetic.
Clinical Manifestation
Talkativeness.
Apprehension.
Excitability.
Slurred speech.
Stutter.

57. Sweating
Vomiting
Failure to follow commands.
Elevated blood pressure, heart and respiratory
rate.
Tonic- clonic seizure in high overdose.
CNS depression, Myocardial Depression and
cardiac arrest.

58. Management
Mild Overdose:
 Slow onset (>5 minutes)
 Slow onset (>15 minutes)
Severe Overdose:
 Rapid onset (within 1 minute)
 Slow onset (5 to 15 minutes)

59. Basic Emergency Management
Position.
Circulation.
Airway.
Breathing.
Definitive Care.
P-A-B-C-D-

60. Mild Overdose : “Patient conscious”
Slow onset (>5 minutes)
P-A-B-C
Reassure the patient.
Administer oxygen via nasal canal.
Monitor and record vital signs.
IV anticonvulsants (diazepam 5 mgmin. or midazolam 1 mmin.)
“optional”
Emergency medical assistance before patient discharge.

61. Slow onset (>15 minutes)
P-A-B-C
Reassure the patient.
Administer oxygen via nasal canal.
Monitor and record vital signs.
IV anticonvulsants (diazepam 5 mgmin. or midazolam 1
mmin.) “mandatory”
Emergency medical assistance before patient discharge.

62. Severe Overdose: “Patient unconscious”
Rapid onset (within 1 minute)
P-A-B-C
Protect the patient.
Immediately summon emergency medical assistance.
Continue Basic life support (BLS)
IV anticonvulsants(diazepam 5 mgmin. or midazolam 1 mmin.) “if
seizures protract more than 4 min.”

63. Slow onset (5 to 15 minutes)
P-A-B-C
IV anticonvulsants (diazepam 5 mgmin. or midazolam 1 mmin.)
and oxygen administration.
Immediately summon emergency medical assistance.
Continue Basic life support (BLS).
Vasopressor and IV fluid is recommended for management of
hypotension.

64. Introduction
Precipitating
Factors
Clinical
Manifestations
Management
ALLERGY

65. Introduction
Hypersensitive state, acquired through exposure to a particular
allergen.
Allergic reactions cover a broad spectrum or clinical
manifestations ranging from mild and delayed response occurring
as long as 48 hours after exposure to allergen, to immediate and
threatening reaction develop within seconds of exposure.

66. Predisposing Factors
Sodium Bisulfite
 Antioxidant in vasoconstrictor local anesthesia.
Epinephrine
Latex
Topical Anesthesia
 Mostly ester.
 Preservatives containing such as methylparaben, ethylparaben, or
propylparaben.

67. Clinical Manifestations

68. Dermatological Reactions
Urticaria
Angioedema

69. Respiratory reactions
Bronchospasm
Respiratory distress
Dyspnea
Wheezing
Flushing
Cyanosis
Perspiration
Tachycardia
Anxiety
Laryngeal Edema
Extension of Edema to the larynx
Life threatening emergency.

70. Generalized Anaphylaxis
Skin reactions
Smooth muscle spasm of gastrointestinal and genitourinary tracts
and bronchospasm.
Respiratory distress.
Cardiovascular collapse.
Treatment of the entire reaction may be terminated rapidly, but
hypotension and laryngeal Edema may persist for hours to days.

71. Management
Skin reaction
Delayed reaction.
Immediate reaction.
Respiratory reaction
Bronchospasm
Laryngeal Edema
Generalized anaphylaxis
Signs of allergy present
No signs of allergy present

72. Skin Reaction
Delayed reaction
P-A-B-C
Oral histamine blocker 50 mg diphenhydramine or 10 mg chlorpheniramine,
one q6h for 3-4 days.
Observation for 1 hour.
Medical consultation.

73. Immediate reaction
P-A-B-C
Epinephrine 0.3 mg IM.
IM histamine blocker 50 mg diphenhydramine or 10 mg chlorpheniramine.
Medical consultation
Observation for 1 hour.
Prescribe Oral histamine blocker 3 days.

74. Respiratory Reactions
Bronchospasm
P-A-B-C
Administer oxygen at flow 5-6 litresmin.
Epinephrine 0.3 IM or Bronchodilator “Albuterol” , dose repeated 10-15 min. if
needed.
Observation for 1 hour.
IM histamine blocker 50 mg diphenhydramine or 10 mg chlorpheniramine.
Medical consultation
Prescribe Oral histamine blocker for 3 days.

75. Laryngeal Edema
“unconscious patient”
P-A-B-C
Epinephrine 0.3 IM, dose repeated 10-15 min. if needed.
Activate Emergency Medical Services.
IM histamine blocker 50 mg diphenhydramine or 10 mg chlorpheniramine.
Corticosteroid IM or IV (100 mg Hydrocortisone sodium succinate to inhibit
and decrease Edema.
Perform cricothyrotomy.

77. Generalized Anaphylaxis
Signs of allergy present : “unconscious patient”
P-A-B-C
Summon medical assistance.
Epinephrine 0.3 IM, dose repeated 10-15 min
Administer oxygen.
Monitor vital signs, recorded every 5 min.
IM histamine blocker and Corticosteroid IM or IV “ If clinical
improvement noted increased blood pressure, decreased
bronchospasm”

78. No signs of allergy present : “unconscious patient”
P-A-B-C
Summon medical assistance.
Administer oxygen.
Monitor vital signs, recorded every 5 min.
Addition management, on arrival of the emergency medical
personnel depend on the cause of the loss of consciousness.

79. HOT TOOTH – A
CHALLENGE TO
ENDODONTISTS!
Although local anesthetics are very
useful in producing anesthesia in
normal tissue, however; local
anesthetics commonly fail in
endodontic patients with inflamed
tissue.
For instance, the inferior alveolar
nerve (IAN) block is associated with a
lapse rate of 15% in patients with
normal tissue.
Whereas IAN fails 44-81% of the
time in patients with irreversible
pulpitis.

80. The term "hot" tooth generally introduce to a pulp that has
been diagnosed with irreversible pulpitis, with spontaneous,
moderate to-severe pain. A typical example of one type of
hot tooth is a patient who is sitting in the waiting room,
sipping on a large glass of ice water to help control the pain.

81. CLINICAL
SIGNS &
SYMPTOMS TO
IDENTIFY HOT
TOOTH

82. MANAGEMENT
OF HOT TOOTH
Patient’s education
 Role of premedication
Management of anxious patient.
Use bupivacaine instead.
Supplemental intraligamentary or
intraosseous injections.

83. CONCLUSION
Administration of a local anesthetic can be associated with complications of
adverse events. In order to prevent local anesthetic complications, the
medical history of the patients should routinely be evaluated in details, and
effective anxiety management should be performed. Doses of local
anesthetics should be always strictly assessed with body weight, and the
maximum recommended dosages should be considered. While administrating
anesthesia, the painless injection should be performed, avoiding intravascular
or intramuscular or direct trauma to the nerve. New developments should be
followed by the practitioners to reduce possible complications associated with
the local anesthesia.

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