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Nerveskader opstået ved lokalanalgesi i tandlægepraksis

ABSTRACT

Oversigtsartikel Dato: 23.05.2006

Den senere tids diskussion i Tandlægebladet om årsagen til nerveskader opstået i forbindelse med lokalanalgesi har været ført på væsensforskellige præmisser, og det har kunnet føles svært at bevare overblikket. Vi vil jo gerne bedøve vore patienter effektivt, men også sikkert. Lokalanalgesi er et så værdifuldt hjælpemiddel i udøvelse af tandlægegerningen i alle sektorer at tandlægestanden fortjener en orientering om alt væsentligt nyt. Det er derfor denne artikels formål at videregive den nyeste faktuelle information vedr. nerveskader i forbindelse med injektion af lokalanalgetica.

Nerve injuries associated with the injection of local analgesics in dental practice: Seventy-eight injection injuries in 74 patients were caused by injection of local analgesics in current clinical use for restor- ative dental treatment. All patients were examined with a standardized test of neurosensory functions. The perception of the following stimuli was assessed: feather-light touch, pinprick, sharp/dull discrimination, warm, cold, point location, brush-stroke direction, two-point discrimination, and pain perception. Gustation was tested for recognition of sweet, salt, sour and bitter. All grades of reduced neurosensory and gustatory functions were found, and a range of persisting neurogenic malfunctions was reported. Subjective complaints and neurosensory function tests indicate that lingual nerve lesions are more incapacitating than inferior alveolar nerve lesions. Unlike most mechanical injuries after surgery, injection injuries were not followed by a course of spontaneous recov- ery of neurosensory and/or gustatory function. This may indicate neurotoxicity as a central etiologic factor. The dis- tribution of nerve injuries on the market shares of the different formulations indicate that needle lesion may be disregarded as an important etiologic factor. Fifty-six percent of the nerve injuries were associated with Articaine 4%, and a substantial increase in the number of injection injuries followed its introduction to the Danish market.