SYSTEMIC AND LOCAL COMPLICATIONS OF LA IN EXODONTIA ORAL AND MAXILLOFACIAL SURGERY

1. Dr RESHMA GAFOOR
ORAL AND MAXILLOFACIAL SURGERY

2. CONTENTS
Introduction
Historical background
Defintion
Complicatons –local &
systemic
Conclusion
Reference

3. • Local anesthesia has been defined as “Loss of sensation in a circumscribed area of the
body caused by a depression of excitation in nerve endings or an inhibition of the
conduction process in peripheral nerves”
STANLEY F.MALAMED(1980)

4. INTRODUCTION
Local anesthetics allow dentistry to be practiced without patient discomfort.However,
regardless of appropriate preanesthetic patient assessment, good patient communication, and
use of proper technique according to all the recommended guidelines and procedures prior to
the administration of the local anesthetic agent, localized and systemic responses to
anesthetic injections are uncommon but may occur

5. HISTORY OF LOCAL
ANESTHESIA
• In the 1860s, the first local anesthetic COCAINE was isolated from coca leaves by ALBERT
NIEMANN in Germany
• Its anesthetic action was demonstrated by CARL KOLLER an ophthalmologist in 1884
• WILLIAM HALSTEAD (a surgeon) used an injection of cocaine to successfully anesthetize
the inferior alveolar nerve for the painless extraction of a patient’s
mandibular tooth in 1884
Carl Koller
1857 -1944

6. • First effective and widely used synthetic local anesthetic -PROCAINE (novocain) -produced
by ALFRED EINHORN in 1905 from benzoic acid & diethyl amino ethanol
• Its anesthetic properties were identified by BIBERFIELD and the agent was introduced into
clinical practice by BRAUN
• LIDOCAINE- LOFGREN in 1948
• The discovery of its anesthetic properties was followed in 1949 by its clinical use by
T. GORDH

7. COMPLICATION
SYSTEMICLOCAL

8. DEFINITIONS
• Complication is any deviation from the normally expected pattern during
or after securing local analgesia
• Local complications occur in the region of the injection and can be
attributed to the anesthetic needle, administration technique or to the
anesthetic drug administered.
• Systemic complications occur in the systems of the body and are
attributed to the drug administered such as hypersensitivity and allergy
or overdosage and toxicity

9. LOCAL
prolonged anesthesia (paresthesia)
facial nerve paralysis
ocular complications
trismus
soft tissue injury
hematoma
pain on injection
burning on injection
infection
edema
sloughing of tissues
postanesthetic intraoral lesions
SYSTEMIC
Allergy
Overdosage
Idiosyncracy
Needle breakage

10. •Needle breakage
•Soft tissue injury
•Pain on injection
•Burning on injection
•Allergy
•Overdosage
•Idiosyncracy
Intraoperative
complications
•Paresthesia
•Facial nerve paralysis
•Ocular complication
•Trismus
•Hematoma
•Infection
•Edema
•Sloughing of tissues
•Post anesthetic intraoral lesions
Post operative
complications

11. NEEDLE BREAKAGE
Rare because of disposable needles

12. Causes
•Bending of the needle
•Sudden unexpected movement of
the patient
•Entire length of the needle
inserted into the soft tissue
•Use of the smaller needles ( e.g 40
gauge )
Prevention
•Use large-gauge needles, specially
with Inferior Alveolar Nerve and
Posterior Superior Alveolar Nerve
•Use long needles
•Do not insert a needle into tissues
to its hub
•Do not redirect a needle once it is
inserted into tissue

13. Management
When a needle breaks ( visible) :
• Stay calm
• Instruct the patient not to move and let his mouth open
• If the fragment visible, remove it with hemostat or
a Magill intubation forceps
When a needle breaks ( not-visible) :
• No incision or probing
• Calmly inform the patient
• Take radiograph and determine if it is superficial, remove or leave it and follow up

14. PARESTHESIA
• Paresthesia is defined as persistent anesthesia or altered sensation well
beyond the expected duration of anesthesia
• Include hyperesthesia and dysesthesia, in which the patient experiences
both pain and numbness
• Patient may report feeling NUMB [frozen] for many hours or days after LA
injection.
• Clinical response :sensation , swelling ,tingling , itching , oral dysfunction ,
tongue biting , drooling ,loss of taste ,speech impediment

15. Causes
• Trauma to any nerve may lead to paresthesia
• It is a common complication of oral surgical procedures and mandibular
dental implants
• Injection of LA solution with alcohol or cold sterilising solution near a nerve
produces irritation and edema of the tissue and subsequent pressure on
the nerve
• Haemorrhage around the neural sheath also causes pressure on the nerve,
leading to paraesthesia

16. Prevention
• Strict adherence to injection protocol
• Proper care and handling of dental cartridges help minimize risk of
paresthesia

17. Management
• Most case resolve within 8 weeks
• Reassurance to the patient
• Examine the patient
• Determine degree and extend of paresthesia
• Record findings in patient’s own words such as “hot” ,“cold” , “painful”,
“increasing” , “decreasing” , “staying the same”
• Reschedule the patient until paresthesia is resolved
• Continue dental treatment but avoid administering local anesthesia into
the previously traumatized region

18. TRANSIENT FACIAL NERVE PARALYSIS
• Usually occur in inferior alveolar nerve block
• Facial nerve –motor supply to muscles of facial expression
• Loss of motor action of the muscles of facial expression produced by the
L.A lasts for 1 -7 hours
• Patient suffers unilateral paralysis of facial muscles

19. Facial nerve distribution

20. Cause
• Induction of local anesthetic into the deep lobe of the parotid gland which
is located at the posterior border of mandibular ramus through which
terminal portions of the facial nerve extend
• Usually it occur during IANB or Vazirani - Akinosi nerve block.

21. Problem
Facial nerve paralysis.
Inability to close eyelid and
drooping of lip on affected side
(patient’s right)
• Usually minimal or no sensory loss occurs
• The protective lid reflex of the eye is abolished
• Winking and blinking become impossible
• Corneal reflex is intact, and tears lubricate the eye
• Transient facial nerve paralysis lasts no longer than several hours
depending on the L.A formulation used and proximity to the facial nerve

22. Transient Delayed Facial Nerve Palsy After Inferior Alveolar Nerve Block Anesthesia
Fotios H. Tzermpos, Alina Cocos, Matthaios Kleftogiannis, Marissa Zarakas, Ioannis Iatrou
Anesth Prog. 2012 Spring; 59(1): 22–27
It can be of :
Immediate
Delayed

23. Prevention
• Proper care and handling to injection control and cartridge
• A needle tip that comes in contact with bone before depositing local
anesthetic solution essentially precludes the possibility that anesthetic will
be deposited into the body of the parotid gland during an IANB
Management
• Reassure the patient
• Contact lenses should be removed until muscular movement returns
• Hygiene measures such as an eye patch should be applied to the affected
eye or manually close the affected eyelid periodically to keep the cornea
lubricated

24. • In cooperation with the neurologist, prednisolone was prescribed as
follows:
• 20 mg, 3 times a day for the first week;
• 20 mg, 2 times a day for the second week;
• 20 mg, once a day for the third week; and
• 10 mg, once a day for the fourth week.

25. Ocular Complications
• Amaurosis (temporary blindness)
• Diplopia (double vision)
• Endophthalmitis
• Globe penetration
• Horner syndrome (blepharoptosis, miosis, anhidrosis)
Horner's syndrome
Diplopia

26. Endophthalmitis Horner’s syndrome
Ogurel, T., Onaran, Z., Ogurel, R., & Örnek, K. (2015). Endophthalmitis after tooth extraction in a
patient with previous perforating eye injury. The Pan African medical journal, 20, 72.
https://doi.org/10.11604/pamj.2015.20.72.6080

27. • Hemifacial flushing, conjunctival injection and enophthalmos
• Impaired visual acuity (double vision)
• Mydriasis (dilation of the pupil))
• Ophthalmoplegia (internal or external, partial or total)
• Ptosis (droopy eyelid)
• Strabismus (convergent or divergent)
From Alamanos C, Raab P, Gamulescu A, Behr M. Ophthalmologic complications after administration of
local anesthesia in dentistry: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol.
2016;121:e39–e350

28. The nerve blocks which are prone for ocular complications are as follows:

30. INFERIOR
ALVEOLAR
NERVE BLOCK
The central
retinal artery is
a small branch
of the
ophthalmic
artery
any anesthetic
solution
flowing
through the
middle
meningeal
artery may
enter the
ophthalmic
artery
retinal artery
causing
blindness and
loss of
pupillary light
reflex.

32. Prevention
• Aspiration before actual injection
• Inject slowly
Management
• Reassure the patient
• Cover the affected eye with gauze dressing
• Refer patients to an ophthalmologist for evaluation if it last more than 6 hours
• Regular follow-up

33. TRISMUS
• It is from Greek ‘prismos’ is defined as a prolonged tetanic spasm of the jaw
muscle by which the normal opening of the mouth is restricted
• Normal healthy individuals mouth opening is around 30-50mm
• When the mouth opening is limited to a maximum of 20mm the individual is
said to have a reduced mouth opening or trismus

34. Causes
• Trauma to the muscles and blood vessels in the infratemporal space
• Trauma to the muscle caused by repeated needle insertion especially medial
pterygoid in inferior alveolar nerve block
• Low grade infection
• Excessive hemorrhage or hematoma which produces irritation of the tissue
and muscles dysfunction
• Solution which contain alcohol or other cold sterilizing solutions irritate the
tissue and produces trismus

35. Problem
Limitation of movement
associated with post injection
trismus is usually minor
In the acute phase of
trismus pain produce by
hemorrhage lead to
muscle spasm and
limitation of movement
Chronic phase develops if
treatment is not begun
Chronic hypomobility occurs
secondary to organization of
the haematoma with fibrosis
and scar contracture
Infection may produce
hypomobility through
increase pain, increase
tissue reaction and
scarring

36. Prevention
• Use sharp, sterile, disposible needle
• Do not use contaminated needles
• Atraumatic injection and avoid repeating of it
• Clean the area of needle insertion with an antiseptic solution before injection
• Change needle for every new insertions made
• Use minimal effective volumes of LA
• Trismus is not always preventable

37. Management
Heat therapy
Soft diet
Warm saline rinse
Analgesic, aspirin
325 mg
Muscle relaxation
if necessary
Diazepam 10 mg
bid
Physiotherapy for
5 min. Each 3-4
hours
If there is
infection,
describea ntibiotic
for 7 days
Improvement
start within 2-3
days and recovery
range 4-20 weeks
Surgical
intervention in
some cases.

38. SOFT-TISSUE INJURY
• Trauma to the lip or the tongue caused by biting or chewing while still
anesthetized, specially with children

39. Prevention
• A cotton roll placed between the lips and the teeth
• Warn the patient
• Self-adherent warning sticker

40. Management
• Analgesic for pian.
• 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. HEMATOMA
• The effusion of the blood into extravascular spaces can result from inadvertent
nicking of blood vessel during administration of LA

42. Cause
• Damage to blood vessel during penetration of needle
• Denser the surrounding tissues (palate) less likely a hematoma is to
develop
• Most occur with IANB and PSA nerve block
• Hematomas that occur after the IANB are usually visible only intraorally
• Hematomas that occur after the PSA nerve block are visible extraorally

43. Hematoma following posterior superior
alveolar nerve block.
Hematoma that developed after mental
nerve block.

44. • Possible complications are include trismus and pain
• Bruise which may or may not be visible extraorally
• Complete resolution of Swelling and discoloration of the region usually subside
gradually occurring between 7 and 21 days
Problem

45. Prevention
• Knowledge of normal anatomy
• Use shorter needle for PSA nerve block ,eg: 27 gauge
• Minimize the number of the needle penetration
• Never use a needle as a probe in the tissue

46. Management
• Direct pressure applied on to the site of bleeding
• Ice may be applied to the region immediately- analgesic and vasoconstrictor -
minimize the size of hematoma
• Heat may be applied to the region beginning the next day
• Heat should not be applied to the areas after incident -risk of hematoma due to
vasodilatation
• Apply cold moist towels to affected area each 20 min every hour
• Advice the patient about soreness and limitation of the mouth opening possibility

47. PAIN ON INJECTION
Causes
• Careless injection and callous attitude “ Palatal Injection always hurt ”
• Dull of the needle because of multiple injection
• Rapid deposition of the local anesthetic solution
• Needles with barbs (from impaling bone) as they are withdrawn from
tissue

48. Problem
• Increases patient anxiety
• Increases risk of needle breakage
• Traumatic soft tissue injury to the patient or needle stick injury to the administrator

49. Prevention
• Adhere to proper techniques of injection, both anatomical and
psychological
• Sharp needles
• Topical anesthetic
• Inject slowly, ideal rate is 1.0 mL per minute; the recommended rate is
1.8 mL or a 2.2- mL cartridge over 1 minute
• A solution that is too hot or too cold may be more Uncomfortable than one
at room temperature
• Ph approximately 7.4

50. BURNING ON INJECTION
A burning sensation that occurs during injection of a local anesthetic is not uncommon
Causes
• Ph of the solution
 Ph of “plain” local anesthetics (no vasopressor included) is approximately 6.5
 Solutions that contain a vasopressor are considerably more acidic (3.5- 4.5)
• Rapid injection of local anesthetic in the denser, more adherent tissues of the palate
• Contaminated solution, or an overly warm solution

51. Problem
• Tissue irritation
• Burning caused by the ph of the solution rapidly disappears as the anesthetic
action develops
• Postanesthetic trismus
• Edema
• Possible paresthesia

52. Prevention
• Buffering the local anesthetic solution to a ph of approximately 7.4
immediately before administration
• Slowing the speed of injection also helps
Ideal rate of injectable drug administration is 1 ml per minute. Do not
exceed the recommended rate of 1.8 ml per minute
• Stored at room temperature in container without alchohol or other
sterilizing agents

53. Management
• Most instances of burning on injection are transient and do not lead to
prolonged tissue involvement
• Formal treatment is usually not indicated
• In those few situations in which postinjection discomfort, edema, or
paresthesia becomes evident, management of the specific problem is
indicated.

54. INFECTION
• Extremely rare occurrence since the introduction of single-use sterile
needles and glass cartridges
Causes
• Contamination of needle
• Improper technique in the handling of local anesthetic equipment and
improper tissue preparation for injection
• Administering local anesthetics through areas of dental infection

55. Problem
• Contamination of needles or solutions may cause a lowgrade infection when the needle
or solution is placed in deeper tissue
• This may lead to trismus
Prevention
• Use disposable syringes and needles
• Use appropriate sterilized needle
• Avoid cross contamination between different sites within the oral cavity

56. Management
• Treat with appropriate antibiotics
• Manage trismus: heat and analgesic if needed, muscle relaxant if needed,
and physiotherapy

57. EDEMA
Swelling of the tissue is not a syndrome but a clinical sign of the presence of some disorder
Causes
• Trauma during injection
• Infection
• Allergy
• Hereditary angioedema
• Hemorrhage
• Injection of irritating solution (alcohol, cold solution)

58. Problem
• Pain and dysfunction of the region
• Angioneurotic edema produced by a topical anesthetic can compromise
the airway, edema of the tongue, pharynx, or larynx
Management
• Proper care and handling of the local anesthetic armamentarium.
• Use atraumatic injection technique.
• Complete an adequate medical evaluation of the patient before drug
administration.

59. • Traumatic edema resulting from inflammation resolves in one to three days
with antiinflammatory drugs
• Edema after hemorrhage resolves more slowly (over 7 to 21days) as
extravasated blood elements are resorbed into the vascular system
• Allergic edema
Requires immediate assessment to avoid the risk of anaphylaxis
 treated with Antihistaminics and steroidal anti-inflammatory drugs

60. If edema
compromises
breathing :
P(position):
unconscious,
the patient is
placed
supine A-B-C: basic
life support is
administered
as needed
D:emergency
medical
services is
summoned
Epinephrine :0.3mg
adult ,0.15mg
child,every 5 minute
until respiratory
distress dissolves
Histamine
blocker IM
OR IV
Corticosteroid
IM OR IV
Cricothyrotomy
if total airway
obstruction
appears to be
developing

61. SLOUGHING OF TISSUES
• Prolonged irritation or ischemia of gingival soft tissues
Causes
• Epithelial desquamation - topical anesthesia – long time,
Heightened sensitivity to LA
• Sterile abscess – secondary to prolonged ischemia- site usually develops: hard
palate
Problems
• Pain & infection

62. Prevention
• Vasoconstrictors - do not use overly concentrated solutions
• Allow the solution to contact the mucous membranes for 1 to 2 minutes
• Norepinephrine (levophed) 1:30,000 - most likely to produce ischemia and
sterile abscess
Management
• Resolution in 7-10 days
• Analgesics

63. POSTANESTHETIC INTRA ORAL LESIONS
• Ulcers develop in the mouth after 2 days of application of LA
Causes
• Recurrent aphthous stomatitis or herpes simplex
• Trauma to tissues
Problem
• Burning or itching sensation
• Acute sensitivity in the ulcerated area-tissue infected-risk of secondary
infection-chance very less

64. Prevention
• Treatment of extraoral herpes simplex in its prodromal phase – antiviral
agents
Management
• Rinse mouth using diphenhydramine & milk of magnesia
• Orabase, a protective paste, without triamcinolone acetonide (Kenalog)
can provide a degree of pain relief.
• A tannic acid preparation (Zilactin) can be applied topically to the lesions
extraorally or intraorally

65. SYSTEMIC COMPLICATIONS
Principle 1:
No drug ever
exerts a
single action
Principle 2:
No clinically
useful drug is
entirely
devoid of
toxicity
Principle 3:
The potential
toxicity of a
drug rests in
the hands of
the user

66. Classification of adverse drug
reactions- toxicity
1. Toxicity caused
by direct extension
of pharmacological
effects
•Side effects
•Over dose
•Local toxic effects
2. Toxicity caused
by alteration in the
recipient
•Presence of disease
•Emotional
disturbances
•Genetic aberrations
•Idiosyncrasy
3. Toxicity caused by
allergy to the drug

67. TOXICITY OF LA
• It refers to the symptoms manifested as a result of overdosage or
excessive administration of the solution
• Toxins are poison
• All drugs are poison when administered too much
• Methylparaben has been excluded from all L.A Cartridges manufactured in
USA from 1984
• Overdose is also a synonym for toxic reaction because 99% of total toxicity
is due to overdose

68. LOCAL ANESTHETIC OVERDOSE
Pre disposing factors:
•Age
•Weight
•Sex
•Presence of
disease
•Genetics
•Mental attitude
and environment
PATIENT
FACTORS
• Vasoactivity
• Concentration
• Dose
• Route of
administration
• Rate of injection
• Vascularity of
injection site
• Presence of
vasoconstrictor
DRUG
FACTORS

69. CLINICAL MANIFESTATION OF
LOCAL ANESTHETIC OVERDOSE
Signs:
MINIMAL TO MODERATE OVERDOSE LEVELS:
• Apprehension
• Talkativeness
• Excitability
• Slurred speech
• Generalized stutter
• Muscular twitching
• Nystagmus, dysarthria
• Sweating , vomiting
• Elevated BP, heart rate and respiratory rate
MODERATE TO HIGH BLOOD LEVELS:
• Generalized tonic clonic seizure, followed by
• Generalized CNS depression
• Depressed BP, heart rate and respiratory

70. Symptoms:
• Light headedness
• Restlessness
• Nervousness
• Numbness
• Metallic taste
• Visual disturbances
• Auditory disturbances (tinnitus)
• Drowsiness
• Loss of consciousness

71. Pathophysiology
Local anesthetics cross blood-brain barrier,
producing CNS depression as level rises
Blood level Action produced
< .5 ug/ml - no adverse CNS
defects
0.5-4 ug/ml - anticonvulsant
4.5-7.5 ug/ml – agitation,
irritability
> 7.5 ug/ml – tonic clonic
seizures
Local anesthetics exert a lesser effect
on the cardiovascular system
Blood level Action produced
1.8-5 ug/ml-treat PVCs,
tachycardia
5-10 ug/ml – cardiac depression
>10 ug/ml- severe depression
Bradycardia, vasodilatation, arrest

72. Management
Place patient in supine position
If seizure occurs, protect from nearby objects and suction oral cavity if vomiting occurs
Medical assistance
Monitor vital signs
Administer oxygen
Start IV
Administer diazepam 5-10 mg slowly or midazolam 2-5 mg slowly
Institute BLS if necessary
Transport to emergency care facility

74. EPINEPHRINE
Maximum Dose for Dental
Appointment
Normal healthy patient:
0.2 mg per appointment
Significant cardiovascular
impairment:
0.04 mg per appointment

75. How much is too much ?
• 2% solution has.... 20mg/ml
• A cartridge of 2ml, therefore has 40mg of L.A
• M.L.D for lignocaine hydrochloride with epinephrine is 7mg/kg
• For a 70kg man, the maximum dosage of L.A he can receive is 7x70kg =490mg
• In 1 cartridge there is 2ml of L.A which contains 40mg of L.A, therefore the number
of cartridges needed to achieve maximum lethal dose is 12.25 cartridges
(490 x 1/40)

76. Recommended volumes of LA for
intraoral injections

77. ALLERGIC REACTIONS
• 1% of all reactions occuring during administration of LA are allergic in nature
• Caused by antigen – antibody reaction leading to release of histamine or
histamine like substances
• Most commonly methylparaben has been implicated in production of allergic
reactions

78. Predisposing Factors
• Sodium Bisulfite
--Antioxidant (reducing agent) in vasoconstrictor local anesthesia
• Topical Anesthetic Allergy
--ester
• Epinephrine
• Latex
• Topical Anesthesia
• Methylparaben, Ethylparaben or Propylparaben,
--Bacteriostatic agent (preservative)

79. Clinical Manifestation
• Dermatological reaction
• Urticaria
• Angioedema
• Respiratory reaction
• Bronchospasm
• Laryngeal edema
• Generalized anaphylaxis
• Skin reactions
• Smooth muscle spasm of
gastrointestinal and genitourinary
tracts and bronchospasm.
• Respiratory distress
• Cardiovascular collapse

80. Prevention:
• Medical History Questionnaire –
-Describe your Reaction
-How was your reaction treated
-What position were you in at the time of the reaction
-What is the name, address, and telephone number of a Doctor in whose office this
reaction occurred
• Allergy Testing – though no form of allergy testing is 100% reliable
• Alternative Techniques of Pain Control

82. Delayed skin reactions (Developing 60 mnts or post exposure)
P A B C D
Position the conscious patient comfortably
A,B,C are assessed as adequate
Definitive care:
• Oral histamine blocker: 50mg diphenhydramine or 10mg chlorpheniramine
• Patient should remain in the office under observation for 1 hour before discharge to ensure
that the reaction does not progress
• Obtain medical consultation ,if necessary to determine the cause of reaction
• A complete list of all the drugs and chemicals administered to or taken by the patient should be
compiled for use by the allergy consultant

83. Immediate skin reactions (Developing within 60 mnts or post exposure)
P A B C D
Position the conscious patient comfortably
A,B,C are assessed as adequate
Definitive care:
• Oral histamine blocker: 50mg diphenhydramine or 10mg chlorpheniramine
• Monitor and record vital signs for every 1 hour
• Patient should remain in the office under observation for 1 hour
• Prescribe an oral histamine blocker for 3 days
• Fully evaluate the patient’s reaction before further dental care is provided
• If uncertainity exists activate emergency medical services

84. Bronchospasm
• P-A-B-C-D
• Administer Oxygen
• Administer Epinephrine or Other Bronchodilator such as Albuterol via inhalation
• Activate emergency medical services.
• Administer AntiHistamines (50 mg Diphenhydramine or 10 mg Chlorpheniramine)
Syringe preloaded with epinephrine 1:1000

85. Laryngeal edema
• P-A-B-C-D
• If airway is maintained and the victim’s chest is making spontaneous respiratory
movements but no air is being exchanged, immediate and aggressive treatment is
mandatory to save the victim’s life
Definitive care:
• Administer epinephrine IM
• Activate emergency medical services
• Administer oxygen
• Maintain the airway
• Administer histamine blocker im/iv and corticosteroid im/iv
• Perform cricothyrotomy if the preceding steps have failed to secure patent airway

86. Bronchodilator inhaler (Albuterol)
Skin Reaction
1. Oral histamine blocker 50 mg diphenhydramine or 10 mg
chlorpheniramine, one q6h for 3-4 days
2. Observation for 1 hour
3. Medical consultation
4. If skin reaction is immediate , administer epinephrine
0.3 mg IM

87. IDIOSYNCRASY
• Any reaction to LA that cannot be classified as toxic or allergic is often
called idiosyncrasy
Treatment
• Purely symptomatic
• Aimed at maintenance of patent airway and cardiovascular support

88. CONCLUSION
Local anesthesia is required for almost all the procedures performed in present day
dentistry. Hence we as the dentists should be aware of various techniques, adverse
effects, actions and indications along with the pharmacological aspects so that we
can use it judiciously according the patients condition.

89. REFERENCE
• Handbook of local anesthesia stanley malamed
• Bennett C. Monheim's local anesthesia and pain control in dental practice.
New delhi: CBS; 1990
• Alamanos C, Raab P, Gamulescu A, Behr M. Ophthalmologic complications
after administration of local anesthesia in dentistry: a systematic review.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;121:e39–e350
• Arodiya, A., Thukral, R., Agrawal, S. M., Rai, A., & Singh, S. (2017). Temporary
blindness after inferior alveolar nerve block. Journal of clinical and
diagnostic research : JCDR, 11(3), ZD24–ZD25
• Ogurel, T., Onaran, Z., Ogurel, R., & Örnek, K. (2015). Endophthalmitis after
tooth extraction in a patient with previous perforating eye injury. The Pan

90. • Transient Delayed Facial Nerve Palsy After Inferior Alveolar Nerve Block
Anesthesia Fotios H. Tzermpos, Alina Cocos, Matthaios Kleftogiannis,
Marissa Zarakas, Ioannis Iatrou Anesth Prog. 2012 Spring; 59(1): 22–27