Gerald S. Fine, D.D.S.
Oral and Maxillofacial Surgery
This past week a local physician (E.N.T.) called my office asking me to see his patient. The patient was from Honolulu and visiting with his son, an anesthesiologist at the N.E. Medical Center. He was in severe pain, swollen, and had numbness. There had not had any dental care for many years. My examination revealed a patient in acute pain from a badly decayed mandibular first molar tooth, significant facial swelling, and paresthesia. The patient was placed on a course of antibiotics and later had the first molar tooth extracted. His recovery was uneventful and the paresthesia fully resolved.
The development of a paresthesia was similar to another recent patient. In late January an endodontist asked me to treat his patient. In December the endodontist had started a root canal on a lower first molar tooth. The patient did not complete treatment because of the impending Christmas/New Year holidays. Pain, swelling, and paresthesia suddenly developed. Upon examining the patient and x-rays, I prescribed antibiotics and performed an I&D a few days later. Copious purulence was obtained via the I&D and the patient's symptoms resolved. The endodontist was later able to complete the root canal treatment and three weeks later there was a complete resolution of the paresthesia.
Paresthesia is described as a burning, prickling or partial numbness that results from neural injury. Either local or systemic factors can produce paresthesia including, traumatic injury, expanding lesions, impacted third molar, local infection and implantation. Infectious factors usually involve mechanical pressure and ischemia caused by the inflammatory process or pressure on the mental nerve by purulent exudate that has accumulated in the mandible.
The paresthesias in both of these cases were caused by different mechanisms. Paresthesia in the first instance appeared to be caused by the mechanical pressure, edema and the effect of the microbial products on neural function. In the second case the pressure and inflammation as well as a compression neuropraxia, resulted in the paresthesia.
Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery