Dr. Sophia Liberatus

Often paraesthesia is caused due to the needle injury. When the dentist inserts the needle for a block, the patient might experience a sharp sensation on the tongue equivalent to that of an electric shock. This is known as paraesthesia and is defined as a change in the sensation or anesthesia that is persistent and the duration generally extends. This condition cannot be prevented and is a complication in some patients who undergo a dental treatment. Though it is commonly seen in the implant therapy, paraesthesia is more of a dental malpractice.

The feeling of the electric shock is felt when the needle comes in close contact with a nearby nerve. This is enough to develop paraesthesia. Severing of the nerves with a local anesthesia and small gauge needle is uncommon. The exact cause of paresthesia has not been ruled out, but it is believed that the block happens because of using 4% solutions of local anesthesias. In case a paresthesia occurs, then it usually gets resolved within some days, weeks or months, but if it lasts for more than 6-9 months, then it is considered to be permanent.

When the paraesthesia is due to a surgical trauma, then getting help from an oral and maxillofacial surgeon is recommended. They assess that if a surgical intervention can be used to fix the problem. In case the paraesthesia is due to the anesthesia given locally by the dentist, then he/she does the following:

1. Patient Management: Reassurance of the patient is must as they get jittery about the situation. The dentist often speaks about the condition with the patient personally. The patient is made to understand how a paraesthesia might have occurred and how much time it would take to resolve. This is also recorded in the patient book so as to avoid any such incidents in the future.
2. Examination of the patient: The dentist should discuss the whole phenomenon and procedure of how paraesthesia can take place. It is important to let the patient know that the condition subsides, but it might take some time. The extent and the degree of paraesthesia should be assessed and the findings should be noted in the examination records.
3. Follow up with patient: It is the dentist's duty to keep a tab on the follow up with the patient. The patient should go for a re-checkup within 1 month of developing a paraesthesia and then again in 1-2 month intervals. The visits could be more and can last until the paraesthesia completely resolves. Improving signs and symptoms usually promise that the paraesthesia is getting better. If paraesthesia is still persistent, then help from an oral and maxillofacial surgeon should be taken for a surgical approach.

Remember the sensation similar to that of a warm liquid flooding your tongue when you smell a deliciously baked chocolate cake? Or a freshly baked brown bread early in the morning? That is your saliva. The salivary glands present in the inner linings of the lips, cheeks and the mouth produce saliva. Saliva protects one from tooth decay, keeps the mouth moist and helps in the digestive process. Any disease that affects the saliva gland comes under the domain of ‘salivary gland disorders’.

Causes

There are three salivary glands in humans known as the Submandibular, Parotid and the Sublingual gland. The most common disorder that affects salivary glands is that of ‘blocked salivary glands’. Sialothiasis is a disorder wherein, calcium stones are formed in the salivary glands, which obstruct these glands. Obstruction of the salivary glands leads to an infection called sialadenitis, caused by strep or staph bacteria.

Sjogren’s syndrome is another condition which affects the salivary glands. In this condition, the antibodies in the body target the cells that produce saliva. This occurs mostly in women who suffer from autoimmune disorders. Viral infections are also common; flu virus and mumps are a few examples.

Symptoms

The symptoms of salivary gland disorders are problem specific; for Sialolithiasis, you will feel a painful lump below the tongue, which tends to aggravate when you eat. In case of Sialadenitis, there will be an odorous pus-filled discharge along with a lump beneath the chin. For viral infections, the symptoms will include muscle pain, swelling and fever. Symptoms of Sjogren’s syndrome are dry eyes and mouth, joint pain, fatigue and tooth decay.

Treatment

Like the symptoms, the treatments for salivary gland disorders are also problem specific. For salivary gland tumors, surgery is required. If it is a malignant tumor, then radiation therapy will be prescribed which may cause dry mouth syndrome (Xerostomia). For bacterial and viral infections, anti-bacterial and anti-viral medications are required for treatment, respectively. It is also important that you take good care of your oral health for an even more effective treatment. Brushing and flossing your teeth on a regular basis will help keep salivary gland disorders at bay. If you wish to discuss about any specific problem, you can consult an ENT-specialist.