13 July 2010

Q. In order to extract a lower first molar it was necessary to repeat the ID block three times. The patient now has some residual numbness of the lower lip. How should I manage the situation?

Considering the number of ID blocks that are given every year the risk of causing permanent damage is low. When a patient reports a persistent loss of sensation, the clinician needs to be sympathetic to their concerns which could lead to a distrust of future dental treatment and a real fear of a similar problems arising.

Management usually involves counselling and medication for any pain if present. In addition the patient needs to be reassured and given realistic expectations of recovery. Referral to a suitable oral surgery facility for assessment is also desirable.

An explanation of why they were not warned of this complication may also be required.

You do not say what local anaesthetic solution was used but the risk of damage can be reduced if the clinician can;

  • avoid multiple blocks where possible
  • avoid using high concentration local anaesthetic for ID blocks (eg. use 2% Lidocaine as standard).

Always document any unusual patient reaction during local analgesic blocks (such as sharp pain or an electrical shock–like sensation) and contact your indemnity provider for advice if the patient’s loss of sensation persists.

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