From Volume 49, Issue 1, January 2022 | Pages 48-50
Diagnosing the cause of paraesthesia can be challenging. A patient with an unremarkable medical history, non-smoker and no known allergies, presented with paraesthesia in the distribution of the mental nerve with no obvious dento-alveolar pathology. After further investigations the patient was found to have multiple brain metastases and a solitary mandibular deposit, with the primary site being an adenocarcinoma of the lung.
Paraesthesia or anaesthesia of the lower lip is commonly associated with damage or compression of the inferior alveolar nerve and there are multiple causes. These include peripheral causes, such as past dental treatment involving inferior dental nerve blocks, post-surgical damage, trauma, infection (osteomyelitis), extensive ridge resorption with associated compression from a denture, and neoplastic or non-neoplastic jaw lesions in anatomical proximity to neural structures.
Paraesthesia in the lower lip can also be a sign of intracranial disease, such as multiple sclerosis, tumour, trigeminal neuralgia or cerebrovascular disease (stroke). There are also psychogenic (eg hyperventilation syndrome and hysteria), drug-induced (acetazolamide, labetalol, sulthiame), and systemic (electrolyte abnormalities such as hypocalcaemia causing tetany) causes, along with haematinic deficiency, and some connective tissue diseases.1
Red flags (but not exhaustive) indicating urgent referral to secondary care include: spontaneous focal neuropathy with no known associative cause; presence of a palpable mass in patients aged under 50 years; and associated neurological symptoms, such as seizures, headaches, limb weakness and a confirmed past medical history of cancer.2 Cancers most likely to metastasize to the jaw are breast, prostate, lung and leukaemia.3
Thank you for visiting Dental Update and reading some of our resources. To read more, please register today. You’ll enjoy the following great benefits:
What's included
