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References

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Hillerup S, Jensen RH, Ersboll BK. Trigeminal nerve injury associated with injection of local anesthetics: needle lesion or neurotoxicity?. J Am Dent Assoc. 2011; 142:531-539
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Malamed SF. Nerve injury caused by mandibular block analgesia. Int J Oral Maxillofac Surg. 2006; 35:876-877
Hillerup S, Jensen R. Nerve injury caused by mandibular block analgesia. Int J Oral Maxillofac Surg. 2006; 35:437-443
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Articaine-only buccal infiltrations for mandibular molar extractions: an alternative to inferior dental nerve blocks

From Volume 44, Issue 9, October 2017 | Pages 838-845

Authors

Danyal H Awal

BDS BSc(Hons)

Senior House Officer, King's College Hospital, London, UK

Articles by Danyal H Awal

Zehra Yilmaz

BSc(Hons), MSc, PhD

Research Affiliate, King's College Hospital, London, UK

Articles by Zehra Yilmaz

Samira Osailan

BDS, MSc, FDS RCSeng, PhD

Consultant Oral Surgeon, King's College Hospital, London, UK

Articles by Samira Osailan

Tara Renton

BDS, MDSc, PhD

Professor of Oral Surgery, King's College London; Honorary Consultant in Oral Surgery, King's College Hospital NHS Foundation Trust and Guy's and St Thomas' NHS Foundation Trust, London

Articles by Tara Renton

Abstract

This article assesses the efficacy of the articaine-only buccal infiltration technique (AOBIT) in providing LA for adult mandibular molar extractions. In 112 patients the AOBIT effectiveness was judged against the need for repeat or supplemental infiltrations and rescue 2% lidocaine inferior dental blocks (IDBs). Sufficient anaesthesia was achieved in 57% of patients using the AOBIT, with another 27% requiring an additional dose via the AOBIT. The remaining 16% required a rescue 2% lidocaine IDB. The AOBIT could be a suitable alternative to 2% lidocaine IDBs for routine adult mandibular molar extractions, and may subsequently reduce the incidence of LA-related nerve injury.

CPD/Clinical Relevance: Debilitating nerve injury in relation to the administration of IDBs may be more common than we think. This article assesses the articaine-only buccal infiltration technique (AOBIT) as an alternative in providing local anaesthesia for routine adult mandibular molar extractions.

Article

Nerve injuries related to the administration of local anaesthesia (LA) can leave patients with lifelong neuropathic pain and may occur more frequently than we think.1,2 Inferior dental blocks (IDB) and other nerve blocks are routinely used to anaesthetize mandibular molar teeth in the UK and are often associated with an increased risk of nerve damage when compared with infiltrative techniques.3,4,5 IDBs have up to a 1 in 14,000 risk of temporary or permanent inferior dental nerve injury and this rate indicates a higher incidence of motor or sensory neuropathy when compared with spinal and epidural blocks.6 It must be mentioned that a majority of neuropraxic injuries tend to be temporary in nature, however, those that go on to be permanent tend to be life-changing.

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