Many dental procedures, whether routine dental procedures or surgical dental procedures, involve an injection of anesthetic. This is the part of the dental procedure that many of us fear the most because we have all felt the stinging pain of a needle in our gums and surrounding areas. We see the dentist closing in with a needle, and we wince, anticipating the excruciating injection and the stabbing pain in our gums.
However, the pain we experience when the dentist injects the anesthetic is often only a fraction of the pain we would feel if we did not have any anesthetic at all. Thus, anesthetic is usually a good thing, at least most of the time. Other times, however, dental injections can cause nerve damage, and that nerve damage can form the basis for a dental malpractice claim. That is what this article is all about.
Symptoms of Nerve Damage after Dental Injection
Nerve damage can show itself in many different ways. Some of the signs of nerve damage after receiving a dental injection may include some of the symptoms below.
- A lack of sensation in the area of the dental injection lasting more than a day
- Numbness in the tongue, gums, cheeks, jaw or on the face
- Tingling sensation in tongue, gums, cheeks, jaw, or face
- Burning or crawling sensation in these areas
- Loss of taste or alteration of taste
- Difficulties speaking
- Difficulties eating
- Consistent biting of the cheeks or tongue
The symptoms above may drastically interfere with a person’s social interactions. Consequently, people suffering from nerve damage after a dental injection often report significant reductions in their quality of life. Moreover, they often have serious psychological problems associated with their nerve damage and the problems it causes in their social lives.
If you have experienced nerve damage after a dental injection, it is very important that you recognize the symptoms of nerve damage so you can get treated as soon as possible. In some instances, nerve damage can be reversed if treated quickly. However, if left untreated for a long enough time, iatrogenic nerve damage (nerve damage caused by the dentist) can become permanent and irreversible.
Trigeminal Nerve Damage After Dental Injection
The trigeminal nerve includes the lingual nerve and the inferior alveolar nerve. Injuries to the inferior alveolar nerve and the lingual nerve can be caused by injections of local anesthetic, and they can be severe and debilitating. Studies show that the estimated occurrence is somewhere between 1 in 26,762 and 1 in 800,000. See T. Renton et al., Trigeminal Nerve Injuries in Relation to the Local Anaesthesia in Mandibular Injections, 209 British Dental Journal, 1 (2010).
Damage to the lingual nerve or inferior alveolar nerve can occur in several ways. Sometimes, the nerve injury will occur because of a physical injury from the needle. Other times, nerve damage may result from chemical damage from the anesthetic solution. Either cause could result in a viable dental malpractice claim in Florida.
Lingual Nerve Injury from Anesthetic Injections
Most nerve injuries that occur as a result of dental injections involve damage to the lingual nerve. The lingual nerve is vulnerable to damage from dental injections because the lingual nerve is situated along the bottom of the mouth near the tongue. In fact, lingual comes from the Latin word, “Lingua,” which means “tongue” or “that which is produced with the tongue.” Thus, when dentists perform procedures on lower teeth, the lingual nerve is often in harm’s ways, especially when the back molars are involved.
Lingual nerve injuries caused by a dental injection may be described as “lingual nerve paresthesia” or “lingual nerve dysesthesia.” Lingual nerve dysesthesia would typically describe an abnormal sensation that becomes intense or painful. In contrast, lingual nerve paresthesia typically corresponds to altered sensations, which may include feelings like tingling, crawling, pins and needles, or numbness. The difference is that lingual nerve paresthesia typically describes sensations that are painless and temporary, whereas lingual nerve dysesthesia typically describes sensations that are painful.
The lingual nerve supplies feeling to the floor of the mouth and to two-thirds of the tongue, and it is involved with taste fibers and salivary glands. The lingual nerve is extremely important to providing sensory feedback in the tongue. Therefore, when a dentist causes permanent injury to a patient’s lingual nerve, the effects can be devastating and life-altering.
Living With Lingual Nerve Damage
Lingual nerve injuries can drastically affect a person’s ability to speak and taste, and thus this type of damage can seriously impact a person’s daily life. For example, if a person’s speaking is altered, then any social interaction is impacted by lingual nerve damage. In the same way, we all appreciate our meals. Therefore, if a person’s taste is permanently altered, this affects that person every time he or she eats a meal.
Dental Injection Sites
The location of a dental injection site is depending on the location of the tooth to be treated and the precise treatment to be administered. Regardless of the specific procedure or location of the tooth, a dentist will typically administer the local anesthetic in proximity to the nerves that belong to the tooth that the dentist plans to operate on.
Each person will have unique teeth and unique nerves, each with their own unique anatomy. Thus, there is no set injection site. Accordingly, a dentist should take special care to know where he or she is injecting anesthetic in order to avoid unnecessary nerve damage, just as a surgeon should be certain of what he or she is cutting before he or she makes a cut.
Mistakes can often be avoided by slowing down. Being in a hurry to get to the next patient is no excuse for causing a patient permanent nerve damage by blindly stabbing a patient’s nerve or damaging a patient’s nerve with an injection of anesthetic. Unfortunately, restrictions on a dentist’s time and schedule can cause the dentist to make unacceptable mistakes.
Dentist Responsibilities After Causing Dental Injection Damage
There are many examples of Administrative Complaints involving nerve damage. These Administrative Complaints are issued when a patient complains to the State Board of Dentistry of dental malpractice after being injured as a result of dental malpractice. In Florida, aggrieved or injured patients file the Complaint with the Florida Department of Health. Past disciplinary actions can be found at the Florida Department of Heath's website, and these discplinary actions provide valuable insight into how and why a dentist may be disciplined for breaching the standard of care.
Relevant language from Administrative Complaints in Florida regarding nerve damage after dental injections is below:
“Upon a report of paresthesia, the minimum standards of diagnosis and treatment in [the] practice of dentistry requires that dentists perform an examination which includes mapping and identification of specific areas of decreased sensation.”
“The minimum standards of diagnosis and treatment in practice of dentistry requires that dentists be aware of the current standard protocols with regard to paresthesia secondary to injections which may require a referral to the proper dental or medical specialist for additional evaluation and management.”
“The minimum standards of performance require a practitioner to ensure a timely, thorough neurologic evaluation is conducted and to document baseline data post injury, either by the practitioner themselves or by referring to another practitioner.”
“The minimum standards of diagnosis and treatment in the practice of dentistry requires a dentist to adequately diagnose and manage surgical complication(s).”
“Management of post-operative complication(s) such as nerve injury includes providing the patient with a timely referral to a specialist or otherwise providing appropriate treatment for the complication.”
“To adequately diagnose and facilitate treatment for a postoperative nerve injury, a dentist must properly evaluate and document the type and extent of the injury. To perform a proper evaluation of the injury, a dentist must test the differences in various types of sensations (e.g., light touch, pressure, sharp sensation, temperature, two-point discrimination test). If paresthesia is indicated, the dentist should reevaluate the patient’s progress approximately every two to three weeks. If a patient with lingual nerve paresthesia does not show signs of progress within approximately four to six weeks following the onset of the injury, then the dentist should refer the patient to a specialist such as a neurosurgeon for possible surgical intervention.”
To summarize some of the language above, there are several ways a dentist may breach the standard of care in the field of dentistry regarding nerve damage after dental injections. The breach of the standard of care may include the following.
- Failure to examine or identify specific areas of decreased sensation;
- Failure to refer patient to a dental or medical specialist;
- Failure to timely perform an appropriate neurologic evaluation of patient;
- Failure to timely evaluate and/or diagnose patient’s post-operative complication(s); and
- Failure to timely refer patient to a specialist or otherwise provide adequate treatment for the post-operative complication.
The language above regarding past Administrative Complaints for dental malpractice in Florida is by no means comprehensive, and there are many ways a dentist can breach the standard of care. These breaches of the standard of care are from the most recent Complaints, and they are specific to nerve damage after a dental injection. Therefore, these Administrative Complaints and the language therein are relevant to only a small fraction of the total number of dental malpractice occurrences in Florida each year.
Other Types of Injuries After Dental Injection
Although we have discussed mostly nerve damage in this article, studies have shown that there are many other possible injuries associated with dental injections, including but not limited to the injuries listed below.
- Ocular and neurological adverse effects
- Allergic reactions
- Hematomas
- Needle breakage
- Tissue necrosis
- Blanching
- Jaw ankylosis
- Osteomyelitis
- Isolated atrial fibrillation
Some of the above injuries could cause permanent disability or death. Thus, nerve damage after a dental injection is not the only reason for filing a dental malpractice claim after a dental injection. Depending on what type of damage you suffered after a dental injection and whether the dentist breached the standard of care, you may have a viable dental malpractice claim, regardless of whether you suffered nerve damage.
