Paresthesia Quandaries: thoughts?

I had two weird cases of paresthesias this month, one involving a bone graft, and I am hoping that the group could offer insight.

Case 1: Tooth #15 was prepared for a crown. 36 mg of articaine was used via infiltration. Impressions were taken, temporary seated and the patient left. The next day he had bilateral paresthesia of his tongue. He stated that when he was younger he developed an allergy to cinnamon that would do the same thing. Three weeks later he returned for the permanent crown and at that time the paresthesia had diminished by 40%. Question: What could cause such a reaction? Temporary, cement or other materials?

Case 2: I had a patient with a bridge from 20 to 18 (Lower left second molar to lower left second premolar). The molar fractured and was not restorable with failed endo, split root. I sectioned the bridge, removed the molar and granulation tissue. I grafted a composite of FDDB and FDMB with calcium sulfate hemihydrate. I placed a cytoplast single PTFE barrier and the patient was to return in 4 weeks for the removal of the barrier. Upon return he reports that there are times when his jaw “gets cold and becomes numb (along the path way of the inferior alveolar nerve). It only happens when he is physically active. He also gets referred pain to the TMJ and upper left molar area. He states he has a history of TMJ problems. I took an x-ray at the 4 week mark to see if there was anything to see. What do you think is causing these strange symptoms?

16 thoughts on “Paresthesia Quandaries: thoughts?

  1. GMM says:

    Did you use a rubber dam for the preparation of the #15? I have had patients who experience tingling sensation post operatively from the latex component of the dam. Can you provide a panorex or more information for your second case?

  2. Dr. Alex Zavyalov says:

    A day after my second lower left molar root extraction performed by a friend of mine (experienced certified dental surgeon), I got a unilateral tongue amnesia. While applying anesthesia, for a better result, he has changed the needle position a few times, and I suppose during this manipulations my left lingual nerve was scratched. The amnesia lasted about three months and then went away.
    P.S. I do not have any allergies.

  3. Dok says:

    Did you map the position of the inferior alveolar nerve canal. Infection induced periapical bone destruction around the second molar apices may leave the nerve canal in close proximity to the currette as you debrided the granulation tissue. Pressure from aggressive debridement and packing of the graft material could potentially cause nerve compression ( direct or indirect ) and paresthesia.

  4. Osbert Usher says:

    It is very unlikely that as a result of infiltration in the area of #15 paresthesia of the tongue can be caused. I believe that they are completely unrelated. Patient may have developed an allergy to something he used or placed in the mouth which was coincidental post dental visit.

    • Dr Bill says:

      1- Do you have cinnamon in the alginate I used to use a cinnamon flavored alginate The patients allergic to it knew it had Cinnamon in it as I walked it in the door with the impression. Sounds like a contact issue and he possibly gave you a clue

      2-Nerve appears pretty far away I wouldn’t think this is a direct affect on the nerve from manipulation Removing those teeth changed his ability to chew quite a bit Now he is using the other side to chew everything and he’s probably continuing to clench since he has a TMF hx. Sounds like he’s overloading the system and with out posterior support compressing that left condyle. Weird things show up when the joint and muscles get affected and worked beyond their tolerances Dr Bill

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