Trigeminal neuropathies following dental anesthetic blocks: a review of the literature

Background and Objective: Trigeminal nerve injuries (TNI) represent possible complications associated with oral and maxillofacial procedures, which in some instances may persist and result into longlasting chronic symptomatology. This review offers an overview of TNI, summarizes dental procedures responsible for nerve injuries, specifically focusing on dental anesthetic injections, and presents possible early and late management options, with the aim of educating the clinicians on the importance of early management and prompt referral to enhance patient care. Methods: The current research comprises a comprehensive literature review conducted on PubMed, Google Scholar, Scopus, Ovid, and Web of Science until February 2024. The search was conducted for English-language articles discussing injuries to the trigeminal nerve following dental procedures. Key Content and Findings: Classification of TNI, dental procedures and injection-related TNI are described. Predictive factors for long-term persistence of somatosensory disturbance include female sex, higher number of painful comorbidities, presence of thermal and mechanical hyperesthesia, higher pain scores and maxillary nerve lesions. Pre-existing neuropathic conditions should be identified and adequate radiographic images should be obtained before performing any dental procedure. In confirmed cases of TNI, early management and intervention depend on the etiology and duration of TNI. In cases where chronic post-traumatic neuropathic pain persists, appropriate management necessitates prompt referral and longterm use of neuropathic pain medications. Conclusions: Predictive factors associated with patients, procedures, and providers are identified. Adequate education in TNI is essential as early identification and management of TNI are advised to enhance prognosis.