Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Complications of local anasthesia in dentistry

2,855 views

Published on

A lecture for third stage dentistry students

Published in: Health & Medicine
  • Hello! High Quality And Affordable Essays For You. Starting at $4.99 per page - Check our website! https://vk.cc/82gJD2
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Complications of local anasthesia in dentistry

  1. 1. Complications of local anasthesia in dentistry (part I) Dr.Mohamed Rhael Ali 2016 - 2017
  2. 2. I. Local complications : 1. Failure to obtain anasthesia 2. Pain during and after injection 3. Hematoma formation at the site of injection 4. Intravascular injection 5. Blanching 6. Trismus 7. Facial paralysis 8. Lip trauma 9. Prolonged impairment of sensation 10. Broken needle 11. Infection 12. Visual disturbance II. General complications : 1. Fainting 2. Drug interactions 3. Homologous serum jaundice 4. Sensetivity reaction 5. Occupational dermatitis 6. Cardio- respiratory emergencies
  3. 3. Local complications
  4. 4. Failure to obtain anasthesia It may be complete or partial Causes : Operator experience Inadequate amount of the local anasthesia Injection in to the blood vessel Presence of infection Expire date of local anasthesia solution Patient response to drugs
  5. 5. pain during and after injection Suggested causes : a. Injection of either non isotonic or contaminated solutions . b. Neurological pain during injection due to penetration of nerve sheath by the needle c. Use of excessive force during deposition of anasthesia solution
  6. 6. Hematoma formation Bleeding in the tissue due to injury to blood vessels during injection
  7. 7. Hematoma formation Mainly occure with block injection • Mostly superior posterior block injection • Less common inferior alveolar and infa-orbital block injection • Bleeding from pterygoid venous plexus clinically appear as swelling in the cheek followed by discoloration of the overlying skin due to break down of the blood within 24 -48 hours . • Bleeding from the infraorbital vessels appear as above with black eye • Bleeding in to the pterygo-mandibular space not show any swelling in the cheek but it may show trismus
  8. 8.  Management : • Reassurance of the patient • Antibiotic to avoid infections • Follow - up Hematoma formation
  9. 9. Intra – vascular injection • Result in Increase the toxicity of local anasthetic solution or vasoconstrictor in the blood . • Clinically patient may show fainting , pale,clammy skin and even decrease in the level of consciousness . • Can be avoided by using aspiration injection technique
  10. 10. Blanching at the site of injection Ischemia of the area as aresult of decrease in blood supply
  11. 11. Causes : • Increase tissue tension due to the deposition of fluid . • Local effect of local anasthesia Blanching at the site of injection
  12. 12. Blanching at the site remote from that of injection
  13. 13. Blanching at the site remote from that of injection Causes : • Intra-vascular injection • Interferance with the autonomic nerve supply of the blood vessels Treatment : • No treatment is needed just reassurance to the patient . Its usually transit
  14. 14. Trismus Difficulty in opening of the mouth due to muscle spasm
  15. 15. Causes :  Injection in to the medial pterygoid muscle may cause injury to the blood vessels inside the muscle and hematoma formation or infection  Inflamation in the pterygomandibular space  Blood that escape during injection in the pterygomandibular space may cause irritation to the muscle and produce trismus • Note : if trismus associated with pain ,fever so its due to infection and should treated by drainage of pus , antibiotic , and mouth wash by warm saline Trismus
  16. 16. Facial paralysis May be partial or complete
  17. 17. Causes : Due to deposition of anasthetica solution in the parotid which occure when the tip of needle inserted too far back and behind the ramus Facial paralysis
  18. 18. Facial paralysis Treatment • Reassurance , and if eyelids envolved than eye protection is necessary (protective pad or eye shade)
  19. 19. Prolonged impairment of sensation Occure due to nerve injury Main causes : Direct trauma from the nerve Injection of a solution contaminated with a neurotoxic substances as alcohol Hemorrhage and infection near the nerve Surgery near the nerve fibers as mental nerve
  20. 20. Prolonged impairment of sensation • Testing the degree and extent of parasthesia or anasthesia can done by measuring the reactions to pin – prinks and passing of cotton wall wisps over the skin
  21. 21. Prolonged impairment of sensation Treatment : In case of infection .. Drainage of pus and anti-biotic coverage Follow up to check the improvement If no improvement then refer the patient to a specialist
  22. 22. Broken needles Prevention • The needle must kept straight during injection . • If resistance is encounterd , force must not be applied to overcome it . • The direction of the needle should not changed within the tissue . • Bending of the needle should be avoided . • The needle should never embeded completely within the tissue , at least 5 mm must project from the mucosal surface .
  23. 23. Broken needles Treatment • If fracture occure the patient should told to stop any movment to prevent displacemnt of needle within the tissue . • The needle graspes by artery forceps or pleir and withdrawn . • If the needle displaced within the tissue then its position must determined radiographically ( two x- ray films must be taken one perpendicular to other ) to confirm the exact position of needle and then removed it surgically by dental surgeon .
  24. 24. infection • Use of contaninated needle may cause infection especially in pterygomandibular space during inferior alveolar nerve block
  25. 25. Lip trauma • Anasthetised lip after injection may suffer from trauma by chewing it espcially in children or thermal injury by hot drink or cigarrete in adult .
  26. 26. Visual disturbance • Rare complication of unknown causes but suspected to be due to vascular spasm or accidental intra-arterial injection Treatment • Reassurance , usually normal vision retained within 30 minute
  27. 27. Thank you for listening ….

×