Lower lip paresthesia as a sequel of mental nerve irritation secondary to periradicular periodontitis

Abdullah Mahmoud Riyahi; Abdelhamied Y Saad

doi:10.4103/sej.sej_100_16

CASE REPORT

Year : 2018 | Volume : 8 | Issue : 1 | Page : 55-57

Lower lip paresthesia as a sequel of mental nerve irritation secondary to periradicular periodontitis

Abdullah Mahmoud Riyahi, Abdelhamied Y Saad
Department of Restorative Dental Sciences, Division of Endodontics, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia

Date of Web Publication

10-Jan-2018

Correspondence Address:
Dr. Abdullah Mahmoud Riyahi
Department of Restorative Dental Sciences, Division of Endodontics, College of Dentistry, King Saud University, P. O. Box 60169, Riyadh 11545
Kingdom of Saudi Arabia

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/sej.sej_100_16

Abstract

The aim of this work was to present a case report describing lower lip paresthesia following failed endodontic treatment and development of periapical lesion. A 42-year-old female presented difficulty in swallowing with pain in right mandibular second premolar and numbness in the right side of her lower lip. Radiographic examination revealed inadequate root canal and a large periapical lesion in the mental nerve area. The lesion appeared extending into the inferior alveolar canal causing irritation of inferior alveolar nerve and its mental branch. Following root canal retreatment, there was improvement of the clinical symptoms and gradual reduction in size of the lesion. A full resolution of symptoms was demonstrated 4 months after successful endodontic therapy. It was concluded that careful clinical and radiographic diagnosis followed by proper endodontic treatment proved to be successful in treating lower lip paresthesia occurred following failed root canal therapy.

Keywords: Endodontic retreatment, inferior alveolar nerve irritation, lip paresthesia, periapical lesion

How to cite this article:
Riyahi AM, Saad AY. Lower lip paresthesia as a sequel of mental nerve irritation secondary to periradicular periodontitis. Saudi Endod J 2018;8:55-7

How to cite this URL:
Riyahi AM, Saad AY. Lower lip paresthesia as a sequel of mental nerve irritation secondary to periradicular periodontitis. Saudi Endod J [serial online] 2018 [cited 2021 Jan 23];8:55-7. Available from: https://www.saudiendodj.com/text.asp?2018/8/1/55/222756

Introduction

Lower lip numbness is a common symptom that occurs due to damage, injury, or irritation of the inferior alveolar nerve or its mental branch. It is usually described by a patient as a unilateral loss of sensitivity of the lower lip and gums, numbness, a tingling sensation, and dryness of the affected mucosa. It is often preceded by intense pain and burning sensation in the affected area. Furthermore, most of reported cases were from lower molars or premolars.^[1],[2]

The common causes of nerve injury are due to trauma, hematoma, local anesthetics, and surgical endodontic procedures. Furthermore, implant endodontic causes extrusion of the materials used in treatment, irrigation liquids, over instrumentation, elevated temperatures proximal to the inferior alveolar nerve. Moreover, orthogenetic surgery, localized and metastatic neoplasms, malignant blood diseases, metastatic tumors in the mandible, and certain systemic disorders represent other reasons.^{[1],[2],[3],[4],[5],[6],[7]} In addition, acute or chronic periodontal infection can cause irritation or damage to the inferior alveolar nerve or its mental branch resulting in paresthesia or anesthesia of the lower lip. This can occur before or after endodontic therapy.^{[1],[2],[5],[7],[8],[9],[10],[11]} Accordingly, careful consideration of all possible causes is necessary for accurate diagnosis, management, and presentation.

The purpose of this case report was to describe lower lip paresthesia in the mental nerve region due to periapical infection occurred after endodontic therapy.

Case Report

A 42-year-old female was referred to Endodontic Clinic, College of Dentistry, King Saud University, Riyadh, with a chief complaint of severe pain to swallowing, pain in the right mandibular second premolar area, and numbness in the right side of her lower lip and chin. The patient reported that 11 years earlier she had previous endodontic treatment in the same tooth with symptoms of apical periodontitis due to carious exposure. Her medical history was noncontributory. On clinical examination with endodontic probe, the area of numbness was extending from the mandibular midline to the right second premolar both exraorally and intraorally. Tenderness to percussion was also obvious. Radiographic examination revealed inadequate root canal filling and a large periapical radiolucency involving the mandibular second premolar extending into inferior alveolar nerve canal. Moreover, periapical bone resorption with loss of periodontal ligament space and lamina dura was evident [Figure 1]. Diagnosis of symptomatic apical periodontitis with irritation of inferior alveolar nerve and its mental branch with lower lip paresthesia was established. The decision was to do retreatment and the patient agreed and signed written consent.

Figure 1: Periapical radiograph of the right mandibular second premolar showing large periapical lesion extending into the inferior alveolar canal

Click here to view

Retreatment was performed after rubber dam application using chloroform and Hedsteom files. Working length was then determined using size 15 K-file combination with apex locator (DentaPort ZX, J. Moriata Mfg. Crop., Koyoto, Japan). Complete chemomechanical debridement was completed with a combination of hand instruments and nickel titanium rotary ProTaper NEXT (Dentsply, Maillefer, Switzerland) to size X4 (040/06) until the working length was reached. Glide was used as lubricant. Sodium hypochlorite 5.25% and 17% ethylene diaminetetraacetic acid were used carefully, to irrigate the root canal space using a 27 gauge-side-venting Max-i-Probe (DENTSPLY DETREY GmbH, Konstaz, Germany). Canal was then dried with paper points, dressed with calcium hydroxide [Ca(OH)₂] paste (UltraCal XS, Ultradent Products, USA). Then, cotton pellet and Cavit (3M ^™ ESPE ^™ Cavit ^™ Temporary Filling Materials, USA) were used to close the tooth. No antibiotic or anti-inflammatory medications were prescribed. After 2 weeks, tooth was obturated with corresponding sized gutta-percha using warm vertical compaction and AH Plus sealer (DENTSPLY DETREY GmbH, Konstaz, Germany). Tooth was restored with acid-etch and composite technique [Figure 2]. The patient reported that symptoms improved. She was seen after 4 months following obturation. Clinical examination revealed numbness disappeared, no symptoms and no tenderness to percussion. Radiographic examination showed reduction in the lesion size with good bone healing [Figure 3]. The patient failed to come after 1 year and she informed that numbness disappeared completely.

Figure 2: Periapical radiograph showing retreatment of the same premolar

Click here to view

Figure 3: A 4-month follow-up radiograph showing periapical healing taking place

Click here to view

Discussion

Review of the literature revealed that paresthesia of inferior alveolar nerve and/or its mental branch due to periradicular infection is relatively rare.^{[7],[8],[9],[10],[11]} This may support the current case report where paresthesia may be caused by the large periradicular lesion that extended to the inferior alveolar canal and resulted in swelling and violent tissue reaction. This edema can cause pressure and ischemia that compresses the blood supply surrounding tissues and the nerve fibers that may be enough to induce the symptoms of pain and lip paresthesia which may be true with the current case. In addition, some researchers stated that the presence of bone between the apices and the inferior alveolar canal does not necessarily protect against injury to the nerve. This is due to that there is no compact layer of cortical bone surrounding the mandibular nerve sheath. Cancellous bone with multiple perforations is usually found.^[12],[13] They added that the proximity of the inferior alveolar canal to the apices of the lower molars and the proximity of the lower premolars to the mental foramen and nerve should be considered.^[12],[13]

In the present case report, the periradicular lesion healed following proper chemomechanical preparation with Ca(OH)₂ as intracanal medicament and a good three-dimensional root canal seal which eliminated the source of infection that was the stimulus for propagation of lesion. Similar findings were stated by several investigators.^{[1],[2],[5],[7],[8],[9],[10],[11]} Moreover, others recommended applying the “transcutaneous electrical neural stimulator” to the lower lip and the related area in three sessions, 8–10 each, to accelerate healing. They also added that with proper antibiotic or corticosteroids and analgesics medication in addition to Vitamin B complex or antineurologic medication for quicker nerve generation.^[8]

Conclusion

From this case report, we conclude that careful clinical and radiographic diagnosis followed by proper endodontic retreatment proved to be successful in treating lower lip paresthesia occurred after failed root canal therapy. This resolves both the pathology and symptoms and minimizes the lesion's pressure and leads to nerve regeneration in short time.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Terauchi Y. Inferior alveolar nerve injury. In: Managing Iatrogenic Endodontic Events. Pathway of the Pulp. 11^th ed.., Ch. 19. St. Louis, Missouri: Elsavier; 2016. p. 745-8.
2.	Krishnan U, Moule AJ. Mental nerve paraesthesia: A review of causes and two endodontically related cases. Saudi Endod J 2015;5:138-45. [Full text]
3.	Andrabi SM, Alam S, Zia A, Khan MH, Kumar A. Mental nerve paresthesia secondary to initiation of endodontic therapy: A case report. Restor Dent Endod 2014;39:215-9. [PUBMED]
4.	Buyukkurt MC, Arslan H, Topcuoglu S, Omezli MM. Prognosis of a case with paresthesia associated with prolonged touching of an endodontic paste to the inferior alveolar nerve. J Clin Exp 2011;3 Suppl 3:e377-81.
5.	Gluskin AH, Peters CI, Ming Wong RD, Ruddle CJ. Damage to the neurovascular anatomy: Causes and outcomes, retreatment of non-healing endodontic therapy and management of mishapes. In: Ingle's Endodontics. 6^th ed.., Ch. 31. Hamilon, Ontario: BC Decker Inc.; 2008. p. 1141-4.
6.	Hauman CH, Love RM. Biocompatibility of dental materials used in contemporary endodontic therapy: A review. Part 1. Intracanal drugs and substances. Int Endod J 2003;36:75-85.
7.	Orstavik D, Brodin P, Aas E. Paraesthesia following endodontic treatment: Survey of the literature and report of a case. Int Endod J 1983;16:167-72. [PUBMED]
8.	Kaya C, Gorduysus O, Gorduysus M, Ertan A. Recovery of a paraesthesia in lower lip caused by a large periapical lesion by applying “TENS” and root canal therapy. Clin Dent Res 2012;36:36-40.
9.	Jerjes W, Swinson B, Banu B, Al Khawalde M, Hopper C. Paraesthesia of the lip and chin area resolved by endodontic treatment: A case report and review of literature. Br Dent J 2005;198:743-5. [PUBMED]
10.	Ngeow WC. Lower lip numbness due to peri-radicular dental infection. Med J Malaysia 1998;53:446-8. [PUBMED]
11.	von Ohle C, ElAyouti A. Neurosensory impairment of the mental nerve as a sequel of periapical periodontitis: Case report and review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:e84-9. [PUBMED]
12.	Heasman PA. Variation in the position of the inferior dental canal and its significance to restorative dentistry. J Dent 1988;16:36-9. [PUBMED]
13.	Tilotta-Yasukawa F, Millot S, El Haddioui A, Bravetti P, Gaudy JF. Labiomandibular paresthesia caused by endodontic treatment: An anatomic and clinical study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:e47-59. [PUBMED]