Local Complication of Local Anesthesia

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... Pain on injection; Burning on injection; Persistent anesthesia : paresthesia; Trismus; Hematoma; Infection; Edema; Sloughing of tissues. 10. Lip-Chewing.
Local Complication of Local Anesthesia 1. Needle Breakage 2. Pain on injection 3. Burning on injection 4. Persistent anesthesia : paresthesia 5. Trismus 6. Hematoma 7. Infection 8. Edema [pic] 9. Sloughing of tissues 10. Lip-Chewing 11. facial nerve paralysis 12. Post anesthetic intraoral lesions

| |Introduction |Causes |Problem |Prevention |Management | |1.|Become rare |Sudden unexpected |No problem exists if |Use larger gauge |When the needle breaks: | |Ne|due to the |movement of the pt. |the needle can be |needle for injection|be calm , don't panic | |ed|introduction |as the needle |easily retrieved |[pic] 25-gauge |Instruct the pt. not to move; don't | |le|of disposable|penetrates the |without surgical |needles are |remove ur hand from the pt's mouth and | |Br|needle, but |muscle or contacts |intervention |appropriate for |keep the mouth opened & place the bit | |ea|still occur..|periosteum.(esp. if | |nerve block of |block if possible.. | |ka| |the pt. moves |Needles that break off|(inferior alveolar, |If the fragment is protruding ( remove it| |ge| |oppositely to the |within tissues & can't|mandibular, |with cotton pliers or a small hemostat | | | |needle) |be readily retrieved |posterior & anterior|if the needle is lost & can't be readily | | | | |usually enclosed by |superior alveolar& |retrieved: | | | |Needles of smaller |scar tissue and rarely|maxillary) |Don't proceed with incision or probing if| | | |gauge |produce infection( | |the fragment invisible | | | | |leaving it better than|Use long needle for |Calmly inform the pt. and relieve his | | | | |performing traumatic |injection |fears & apprehension | | | |Needle that have |surgical removal |Don't insert the |Note the incident in the pt's records & | | | |previously bent | |needle into tissue |inform your insurance carrier | | | | | |to the hub(the point|Refer the pt for oral surgeon | | | | | |at which the needle |consultation not to remove the needle | | | | | |shaft meets the hub |When is needle breaks, consideration | | | | | |is the weakest point|should be given for it's immediate | | | | | |of the needle) |removal: | | | | | | |if the needle is superficial & easily | | | | | |Don't redirect the |located through radiographic & clinical | | | | | |needle once it is |examination ( removal is possible by oral| | | | | |inserted into |surgeon , so if attempted retrieval is | | | | | |tissues |unsuccessful in reasonable length of time| | | | | | |( allow the fragment to remain | | | | | | |if the needle is located in deeper | | | | | | |tissues or if it hard to locate ( permit | | | | | | |it to remain without an attempt at | | | | | | |removal. |

| |Introduction |Causes |Problem |Prevention |Management | |2.|Can be prevented|Careless injection technique & |Increase pt anxiety |carefully adhere to proper technique|No management| |Pa|through careful |callous attitude; N.B: Palatal | |of injection, both anatomically & |is required; | |in|adherence to the|injection always hurt.. |May lead to sudden |psychologically |however, | |on|basic rules of |Dull needle from multiple |unexpected movement(|Use sharp needles |steps should | |in|atraumatic |injections with the same |needle breakage |Use topical anesthetic prior to |be taken to | |je|injection |needle.. | |injection |prevent | |ct| |Rapid deposition of the | |Use sterilized local anesthetic |recurrence | |io| |solution | |solutions |with future | |n | |Needle with barbs; impaling the| |Practice slow injection of solutions|injections. | | | |needle on bone may produce a | |Be certain temperature of solution | | | | |''fishhook barb''( pain as the | |is correct; N.B: too hot of a | | | | |needle withdrawn from the | |solution is more uncomfortable than | | | | |tissue.. | |one which is too cold | |

| |Introduction |Causes |Problem |Prevention |Management | |3.|Burning during|PH of the solution |Transient in nature |Difficult or even impossible |Formal | |Bu|deposition of |N.B: cause mild burning sensation , |Indication of tissue |but with short duration & low |therapy is | |rn|the L.A is not|prepared to be 5 and those |irritation |intensity |usually not | |in|uncommon |containing vasoconstrictor having |Rapidly disappears when| |indicated | |g | |more acidic |the L.A action develops|Slow injection( ideal rate is |only if there| |on| |Rapid injection of the L.A solution |No residual sensitivity|1ml/min , don't exceed 1.8 ml |is post | |in| |esp. in the denser more adherent |after action |in 1 min |injection | |je| |tissue of the palate |termination of the L.A | |discomfort or| |ct| |Contamination of the L.A cartilages |Greater opportunity of |Proper care & handling of the|edema, or | |io| |with sterilizing solution results |the tissue damage to |L.A cartilage : |paresthesia | |n | |when the stored in alcohol or other |develop with subsequent|@ room temperature | | | | |sterilizing solution ( diffusion of|postanesthatic trismus |suitable container without | | | | |this solution into the cartilage |, edema , or |alcohol or any sterilizing | | | | |Temperature of the solution even if |paresthesia |solution | | | | |it's warm | | | |

| |Introduction |Causes |Problem |Prevention |Management | |4.|*Rare |Trauma to any nerve or the |Sometimes total but |*Proper |Most paresthesia resolves in 8 | |Pe|*Disturbing |nerve sheath ( electrical shock|mostly partial ( tissue|injection |weeks without ttt& will be | |rs|complication |& paresthesia |injury |technique |permanent only if there is severe| |is| | | | |nerve damage. | |te| |Injection of contaminated L.A |Biting or thermal or |*Proper care & |Reassure the pt | |nt| |cartilage by alcohol or |chemical insult can |handling of the |The dentist must talk to the pt | |an| |sterilizing solutions near the |occur without a |dental cartilage|Don't relegate the duty of | |es| |nerve ( irritation & edema ( |patient's awareness | |reassuring | |th| |increase pressure on the region| | |Explain that it's not uncommon | |es| |( paresthesia | | |after injection | |ia| | | | |Arrange appoint 4 examining the | |( | | | | |pt | |Pa| |Hemorrhage into or around the | | |Record the incident in the dental| |re| |neural sheath ( increase | | |chart | |st| |pressure on the nerve ( | | |Examine the pt | |he| |paresthesia | | |Determine the paresthesia degree | |si| | | | |Explain to the pt that | |a)| | | | |paresthesia may persist at least | | | | | | |2 months or may be prolong to 1 y| | | | | | | | | | | | | |Tincture of time is the | | | | | | |recommended medicine | | | | | | |Record the finding in the pt's | | | | | | |chart | | | | | | |Reschedule the Pt for examination| | | | | | |every 2 months as long as sensory| | | | | | |deficit persists | | | | | | |Should sensory deficit still be | | | | | | |evidence 1 y after that consult | | | | | | |the surgeon or neurologist to | | | | | | |mange |

| |Introduction |Causes |problem |Prevention |Management | |5.|Motor |Trauma to muscles or|In the acute phase of |use sharp , sterile , |Arrange an appointment for | |Tr|disturbance |blood vessels in the|trismus: |disposable needles |examination. | |is|of the |infratemporal space |Pain produced by |properly care for & |Heat therapy: | |mu|trigeminal |is (the most common |hemorrhage ( muscle |handle dental L.A |Placing moist eat with towels to the | |s |nerve esp. |cause following the |spasm & limitation of |cartilage |affected area about 20 min every hour.| | |spasm of the |dental injections) |movements. |Cleanse the site of |Analgesics | | |masticatory |Contaminated dental |In the chronic phase of|injection with an |Aspirin is usually adequate in | | |muscles with |cartilage by |trismus: |antiseptic solution |damaging pain associated with trismus.| | |difficulty in|diffusion of alcohol|Usually develops if the|prior to needle |Codeine (30-60 mg every 3 hours) if | | |opening the |or any sterilizing |ttt is not begun. |penetration |the discomfort is more intense. | | |mouth. |agent ( irritation |Hypomobility can be due|Use a septic technique|Muscle relaxants | | | |to the muscle ( |to: |; contaminated needle |Diazepam (about 10 mg every 12 hours) | | |Although post|potential trismus |secondary to hematoma |should be changed |Advice the pt. t initiate | | |injection |Hemorrhage (large |with subsequent |immediately |physiotherapy for 5 min every 3-4 | | |pain is the |volume of blood)( |fibrosis & scar |Practice atraumatic |hours by opening and closing the mouth| | |most common |tissue irritation ( |contracture |insertion & injection |as well as lateral excursions & | | |L.A |muscle dysfunction |infection through |technique |chewing gum(sugarless) | | |complication,|as blood is slow |increase tissue |Avoid repeat |Record the incident, finding, ttt in | | |trismus can |resorbed. |reaction (irritation ) |injections & multiple |the pt's dental chart. | | |become one of|A low grade |& scarring |insertions through |Avoid any further dental ttt in the | | |the more |infection |In most cases a pt will|knowledge of anatomy &|involved region till symptoms resolves| | |chronic & |Multiple needle |repost pain and |proper technique ( use|& pt is more comfortable | | |complicated |penetrations. |difficulty in opening |regional block instead|7 full days Antibiotics is required if| | |problem to |Overly large amount |the mouth the day after|of infiltration |the pain and dysfunction continued | | |manage. |of L.A solution |the dental appointments|wherever possible & |beyond 48 hours due to possibility of | | | |deposited in |in which posterior |rational) |infection. | | | |restricted area. |superior alveolar or |use minimal effective |Refer the pt to oral surgeon if no | | | | |inferior alveolar nerve|volumes of L.A |improvement within 2-3 days without | | | | |blocks are |solutions; refer to |antibiotics or 5-7 days with | | | | |administered. |specific techniques |antibiotics or severe limited mouth | | | | | |for recommended |opening. | | | | | |volumes |TMJ involvement is quite rare in the | | | | | | |1st 4-6 weeks following injection. | | | | | | |Surgical intervention may be indicated| | | | | | |in some instance. |

| | |Causes |Problem |Prevention |Management(Time is the most important element of hematoma ) it | | | | | | |presents 7-14 days with or without ttt | |6.|It|The inadvertent |* Rarely |Knowing the |Immediate : | |He|'s|nicking of a blood |produce |normal anatomy |When swelling becomes evident( Direct pressure should be applied to | |ma|th|vessel, either |significan|of the proposed |the site of bleeding for not less than 60 sec. against bone | |to|e |artery or vein |t problem |injection; |Inferior alveolar nerve block | |ma|ef|during an injection | |certain |Pressure is applied to the medial aspect of the mandibular ramus. | | |fu|of L.A |* Possible|technique has a |Intraoral clinical manifestation which are tissue discoloration & | | |si|Nicking of the |complicati|greater risk of |swelling in the medial (lingual) aspect of the mandibule ramus | | |on|artery( usually |on include|hematoma like |Infraorbital nerve block | | |of|increase in size |trismus & |posterior |Pressure in applied to the skin directly over the infraorbital | | |bl|rapidly till the ttt|pain |superior |foramen. | | |oo|is instituted | |alveolar nerve &|Extraoral clinical manifestation which is discoloration of the skin | | |d |Nicking of the vein(|* The |inferior |below the lower eyelid | | |in|may or may not cause|swelling &|alveolar nerve |Mental & incisive nerve block | | |to|hematoma |discolorat|in second. |Pressure is applied directly over the mental foramen, either on the | | |ex|The density y of the|ion |Modify the |skin or on the mucous membrane. | | |tr|tissue surrounding |usually |injection |Clinical manifestation is observed @ the skin over the mental | | |a |the injured vessel |subsides |technique as |foramen and/or by swelling in the mucobuccal fold in the region of | | |va|will be a |within |indicated by the|the mental foramen | | |sc|determining factor |several |pt's anatomy |Buccal nerve block or any palatal injection | | |ul|e.g. hematoma is |days |e.g. lessen the |Place the pressure @ the site of bleeding. | | |ar|rarely developed | |penetration of |Only intraoral clinical manifestations are visible | | |sp|after palatal | |posterior |Posterior superior alveolar nerve block | | |ac|injection but | |superior |Usually produce the largest & most esthetically unappealing | | |es|usually following | |alveolar nerve |hematoma& can accommodate large volume of blood. | | | |nicking of the B.V | |block in pt with|Not recognized till the swelling appears on the side of the face | | | |in posterior | |smaller facial |progressing inferiorly & anteriorly toward the lower anterior region| | | |superior or inferior| |characteristics |of the cheek. | | | |alveolar nerve block| |Minimize the |Difficulty in applying pressure @ the site of the bleeding in this | | | |coz the tissue | |number of needle|region (post.super.alveolar & facial arteries & pterygoid plexus | | | |accumulate the blood| |penetrations of |of vein) | | | |in these areas( | |tissue |They r located posterior Superior & medial to the maxillary | | | |blood effusion until| |Never use needle|tuberosity | | | |extra vascular | |as probe in |Bleeding normally halts when external pressure of blood exceed the | | | |pressure exceed | |tissues |internal one. | | | |pressure within the | | |Digital pressure can be applied to the soft tissues in the | | | |B.V | | |mucobuccal fold as far as it can be tolerated by the pt. without | | | | | | |gagging. | | | | | | |Apply pressure in a medial & superior direction . | | | | | | |Subsequent: | | | | | | |* Avoid any additional dental therapy in hematoma region till the | | | | | | |sign & symptoms relived. | | | | | | |* Advice the pt about possible trismus( ttt as previously | | | | | | |mentioned_ Discoloration( resorbed over 7-14 days_ soreness( ttt | | | | | | |by analgesic e.g. aspirin, no heat application at least 4-6 hr. till| | | | | | |the next day by warm towels 20 min every hr., Ice is applied | | | | | | |immediately( (analgesic & vasoconstrictor) |

| |Intro|Causes |Problem |Prevention |Management | |7. |* |The major cause is the |Contaminated needle of|Use disposable syringe |Low grade infection (rare)( will | |Inf|becom|contamination of the |solution may lead to | |seldom be recognized immediately &| |ect|e |needle prior to |low grade infection |Properly care for & handle |the pain will report post | |ion|extre|administration of the L.A.|when there is in |needles: |injection pain & dysfunction one | | |mely |& it's always occurring |deeper tissue ( |Recap the needle when not in |or more days following the dental | | |rare |when the needle touches |trismus => initiation |use to avoid contamination |therapy | | |since|the mucous membrane in the|of proper ttt |through contact with non |Rarely will be overt signs & | | |the |oral cavity. | |sterile surfaces. |symptoms of infection present. | | |intro| | |Avoid multiple injections |Immediate ttt should consist | | |ducti|Improper technique in the | |with the same needle. |procedures for trismus management | | |on of|handling of the L.A | | |(heat, analgesic & if needed | | |steri|armamentarium & improper | |Properly care for 7 handle of|muscle relaxant & physiotherapy | | |le, |tissue preparation for | |the dental cartilage of L.A |Trismus produced by factors other | | |dispo|injection. | |solution. |than infection will normally | | |sable| | |single use only |respond with a lessening of signs | | |needl| | |store aseptically in original|& symptoms within 1-3 days , but | | |es. | | |container , covered at all |if trismus signs & symptoms don't | | | | | |times |respond to the conservative | | | | | |Cleanse the diaphragm with |therapy so a 7 day course | | | | | |sterile, disposable alcohol |antibiotic is started. | | | | | |wipes. |Prescribe 29 tablets of penicillin| | | | | | |V250 mg tablets; the pt. takes 500| | | | | |Properly prepare the tissues |mg immediately then 250 mg four | | | | | |prior to penetration; dry the|times a day until they are gone. | | | | | |tissue & apply topical |Erythromycin for allergic pt. to | | | | | |anesthesia. |penicillin | | | | | | |Report the progress & management | | | | | | |of the patient on the dental | | | | | | |chart. |

| |Intro |Causes |Problem |Prevention|Management | |8.|* |Trauma during |1. Airway obstruction|Properly |Management is predicated to reduce the swelling as | |Ed|Edema |injection | |care for &|quickly as possible. | |em|is the| |2. Pain & dysfunction|handle the|Edema due to traumatic injection or introduction of | |a |swelli|Infection |of the region & |L.A |irritating solution ( have a minimal degree of edema & | | |ng of | |personal embarrassment|armamentar|resolved within 1-3 days | | |tissue| |for the pt. |ium. |It's necessarily to prescribe analgesics for pain due to| | |s. |Allergy | |Use |edema | | |* |(Angioedema is a |3. Angioedema swelling|atraumatic|Follow the management of hematoma if the edema is | | |Edema |common reaction to |in allergic responded |injection |followed by hemorrhage & it will resolved within 7-14 | | |isn't |topical anesthesia in |pt. ( lead to |technique.|days | | |a |an allergic pt. |compromised airway |Complete |Edema produce by infection will not resolved | | |clinic|(Localized tissue | |an |spontaneously but may be become progressively more | | |al |swelling occurs due to|4. Edema of the |adequate |intense. if the sign of infection ( pain, mandibular | | |syndro|vasodilatation |tongue, pharynx, and |medical |dysfunction , edema) don't appear to resolved within 3 | | |me but|secondary to histamine|larynx may develop ( |examinatio|days ( Antibiotic therapy as mentioned in the infection | | |repres|release |life- threatening |n of the |ttt | | |ents a| |situation need |pt. prior |Edema produce by allergy is the most potentially life | | |clinic|Hemorrhage; effusion |vigorous management. |to drug |threatening. The degree of the edema & its location is | | |al |of blood into soft | |administra|highly significant. If the swelling is develops in the | | |sign |tissues ( swelling | |tion. |buccal soft tissue & there is no airway obstruction ( | | |of | | | |ttt is I.M & oral antihistamine administration & a | | |some |Injection of | | |medical consultation to an allergist to determine the | | |disord|irritating solution | | |precise cause of the edema. | | |er. |(alcohol or cold | | |When edema compromised breathing : | | | |sterilizing solution | | |Epinephrine 0.3 mg IM or IV | | | |–containing cartilage)| | |Antihistamine IM or IV | | | | | | |Corticosteroid IM or IV | | | | | | |medical assistance summoned | | | | | | |pt. positioned supine position if unconscious | | | | | | |Basic cardiac life support | | | | | | |preparation of cricothyrotomy if total airway obstruction| | | | | | |develops | | | | | | |Through evaluation of the patient prior to next | | | | | | |appointment to determine the cause of the reaction. |

| |Intro |Causes |Problem|Prevention |Management | |9. |Prolonged|Epithelial desquamation : |Pain |use topical anesthesia as |Usually no formal | |Slo|irritatio|Application of topical anesthesia agents|Possibi|recommended ; Allow the |management is required for | |ugh|n to the |to the gingival tissues for a long |lity of|solution to contact mucous |both epithelia d | |ing|gingival |period of time |infecti|membrane for 1-2 min to |desquamation or sterile | |of |soft |heightened sensitivity of tissues to |on |maximize its effectiveness & to|abscess. | |tis|tissue |chemical agents ( L.A) |develop|minimize toxicity. | | |sue|may lead |Reaction in area where the topical |ing in | |Management may be | |s |to ( |anesthetic is applied. |these |When using vasoconstrictors for|symptomatic | | |number of| |area |homeostasis ( don't employ | | | |unpleasan| | |overly concentrated solutions | | | |t |Sterile abscess: | |Epinephrine 1:50,000 |For pain ( analgesic | | |complicat|secondary to prolonged ischemia | |Levophed (nor epinephrine) |(aspirin , codeine 7 a | | |ions |resulting from the use of L.A with | |1:30,000 |topically applied ointment | | |including|vasoconstrictors | |Are the 2 agents most likely to|such as Orabase to minimize| | |epithelia|Almost always occurs in the firm soft | |produce ischemia of a long |the irritation of the | | |l |tissue of the hard palate. | |enough duration to produce |tissue . | | |desquamat| | |tissue damage & a sterile | | | |ion & | | |abscess. |Epithelial desquamation | | |sterile | | | |will resolved within few | | |abscess. | | |N.B: the palatal tissues are |days. | | | | | |virtually the only tissues in | | | | | | |the oral cavity where this | | | | | | |phenomenon might occur. |Sterile abscess run for | | | | | | |7-10 days | | | | | | | | | | | | | |Record dada in the pt's | | | | | | |chart . | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |

| |Intro |Causes |Problem |Prevention |Management (is | | | | | | |symptomatic) | |10. |* Trauma of the lips & tongue |[pic] The |Swelling & pain when the|Selection of proper |Analgesic for pain. | |Lip-C|of the anesthetized pt. is |primary |anesthetic action |duration of L.A action |Antibiotics, in the | |hewin|frequently caused by the pt. |cause is |dissipate. |depends on the duration of|unlikely situation | |g |inadvertently biting or chewing|the use of| |the dental procedures. |that infection | | |these structures. |long |Behavior management |A cotton roll can be |results. | | | |acting L.A|problems in the young |placed between the lips pf|Lukewarm saline rinses| | |* Trauma occurs most frequently|in pt. |child or handicapped |the pt. if they are still |to aid in decreasing | | |in children & mentally |undergoing|individual copying |anesthetized @ the time of|any swelling that may | | |handicapped children & adult. |shorter |difficulty with this |discharge. |be present. | | | |dental |situation |Warn the pt. & adult |Petroleum jelly or | | | |procedures| |guardian against eating |other lubricant to | | | |. | |while still anesthetized, |cover the lesion (on | | | | | |against drinking hot |the lips) to minimize | | | | | |fluids, and against biting|irritation. | | | | | |on the lips & tongue to | | | | | | |test for anesthesia. | | | | | | |A self-adherent warning | | | | | | |sticker is available that | | | | | | |states "Watch me, my lip &| | | | | | |cheek are numb" placing in| | | | | | |the pt's forehead. | |

| |Introduction |Causes |Problem |Prevention |Management | |11.|The facial nerve is the 7th |* Transient facial |Loss of facial expression |Adherence to |Reassure the pt. | |fac|cranial verve which is a motor|nerve paralysis is |muscles function( will last |proper technique| | |ial|nerve to the muscle of facial |commonly caused by |from 1-several hours |in the inferior |Advice the pt. to | |ner|expression, scalp & external |the introduction of |depending o the L.A agent, |alveolar nerve |periodically close | |ve |ear & others. |L.A solution into |volume injected, & its |block. |the upper eyelid | |par|Occasionally it can |the capsule of the |proximity to the facial |If the needle |manually to keep the| |aly|anesthetized by the |parotid gland , |nerve. |tip in contact |cornea lubricated. | |sis|inadvertent deposition of L.A |which is located @ |The primary |with bone | | | |into its vicinity, always |the posterior border|problem(Unilateral paralysis|(medial aspect | | | |occur when the solution |of the ramus of the |during this time with |of ramus) prior |Contact lenses | | |introduce in the deep lobe of |mandible , clothed |inability to use theses |to L.A |should be removed | | |the parotid gland. |by the medial |muscle normally (cosmetic |deposition ( |until muscular | | |The nerves supplied by these |pterygoid & masseter|appearance problem ) |preclude the |movement returns. | | |branches & the muscles they |muscles. |No ttt except waiting till |possibility of | | | |innervate are listed: | |the action wears off |the deposition |Record the incident | | |Temporal branches |* Directing of the |The secondary problem ( the |of solution in |in the pt.'s chart. | | |frontalis muscles |needle toward or its|pt. unable to close the eye,|the parotid | | | |Orbicularis oculi muscle |inadvertent |winking & blinking become |gland. | | | |Corrugator muscle |deflection in a |impossible to perform. |If the needle |Although there is no| | |Zygomatic branches |posterior direction |The cornea retains to its |deflects |contraindication for| | |Orbicularis oculi muscle |during an inferior |innervation so if irritated(|posteriorly ( |re anesthetized the | | |Buccal branches(supply region |alveolar nerve block|corneal reflex & the pt. |should be |pt.to achieve | | |inferior to orbit & around the|may place the needle|will be able to lubricate |entirely |mandibular | | |mouth) |tip within the |the eye during this period |withdrawn & |anesthesia, it may | | |Procerus muscle |substance of the |of time. |direct it more |be prudent to forego| | |Zygomatic muscle |parotid gland( |With sec. – min following |anteriorly till |further dental | | |Levator labii superioris |paralysis may |deposition of L.A ( the pt. |it contacts |therapy @ this | | |muscle |result. |will sense a weakening of |bone. |appointment. | | |Buccinator muscle | |the muscle of the affected | | | | |Orbicularis oris muscle | |side of the face. | | | | |Mandibular branch (supplies | | | | | | |muscles of lower lip & chin) | | | | |

| |Intro|Causes |Problem|Prevention |Management | |12.|* Pt.|Recurrent apthous stomatitis &/or |Acute |In the intraoral lesions( |Primary management is symptomatic: | |Pos|might|herpes simplex can develop intraorally|sensiti|No mean of prevention in |Pain ( approximately 2 days after | |t |repor|following L.A injection or any |vity in|the susceptible pt. |injection | |ane|t |traumatic insult |the | |If not severe( no management | |sth|painf| |ulcerat|Extra oral herpes simplex |If the pt. complain from pain: | |eti|ul |Recurrent aphthous stomatitis is the |ed |can be prevented or |keep the ulcerated area covered | |c |ulcer|most frequently observed intraorally |area. |minimizing its |topical anesthetic solution (viscous | |Int|ation|in the movable gingival tissue (not |Develop|manifestation if it's in |lidocaine) can be applied to the | |rao|of |attached to the bone) e.g. buccal |ing of |its prodromal phase |painful area | |ral|the |vestibule) not viral infection but it |seconda| |A mixture of equal amount of diphenhy | |Les|mouth|might be autoimmune process or L-form |ry | |dramine & milk magnesia rinsed in the | |ion|follo|bacterial infection. |infecti|Prodrome consists of mild |mouth ( effectively coat the ulcerated| |s |wing | |on risk|burning or itching |area & provide relief of the pain . | | |2 |Herpes Simplex can develop intraorally|is low.|sensation @ the site where|Orabase , a protective paste without | | |days |but it's most commonly extra orally on| |the virus is present (lip)|Kenalog ( provide degree of pain | | |of |the fixed tissue (not attached to the | | |relief .N.B: Kenalog is corticosteroid| | |denta|bone) | |Either applied topically |not recommended because it's | | |l | | |by cotton swab 3-4 times |anti-inflammatory action provide | | |injec| | |daily ( minimizes the |increase risk of either viral or | | |tion.|Trauma to tissues by needle, L.A , | |acute phase only extra |bacterial involvement. | | | |cotton swab, or any other instrument | |orally. |Ulceration duration about 10 days with| | | |(R.D clasp , hand piece ) ( reactivate| | |or without ttt | | | |the latent form of the disease process| | |Negatol( chemical cauterizing agent | | | |that has been present in the tissue | | |for pain relief | | | |prior to the injection. | | |Keep adequate records in the pt's | | | | | | |chart. |

Best of Luck

[pic]Strawberry[pic][pic][pic][pic]

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