Facial paresthesia secondary to endodontic treatment

Limb paresthesia is not a disease. This is a clinical symptom indicating trophic disorders occurring in the area of ​​passage of a particular nerve. In order to understand what paresthesia of the limbs is and what symptoms it gives, it is necessary to take a short excursion into the anatomy and physiology of the human body.

So, every cell of the human body is controlled by the autonomic nervous system. It is connected to the central nervous system via the spinal cord, located in the spinal canal of the spinal column. Paired radicular nerves arise from the spinal cord. They pass through the foraminal openings in the vertebral bodies, branch and are directed to different parts of the body. They are the basis of the entire innervation system of the human body.

Root nerves contain two types of axons: motor and sensory. With the help of the first type, a signal is transmitted to the muscle fiber that some action is required in response to a command or external irritation. Sensitive (or sensory) types of axonal nerve fibers transmit information to the brain structures about the state of body tissues, the result of their interaction with the environment; thus, the brain learns that a cold or hot substance is touching the skin, or that a compressive or wounding effect occurs.

This article describes in detail what it is - paresthesia of the limbs, what symptoms it gives and what treatment can be used to restore impaired sensitivity. But first, we offer a definition. Paresthesia is a type of disturbance of skin sensitivity, accompanied by the sensation of crawling goosebumps, electric shocks, and increased pain that is inadequate to the force of impact.

Paresthesia of the upper and lower extremities is always associated with damage to the exclusively sensory (sensitive) type of axons. The cause may be nerve compression, inflammation, swelling, impaired microcirculation of blood and lymphatic fluid, or traumatic disruption of integrity. In order to effectively treat paresthesia of the extremities, it is necessary to first exclude the causes of its occurrence and treat the underlying disease, which is accompanied by a similar symptom.

It makes no sense to treat paresthesia separately, since the symptom of the disease can only be dealt with by eliminating pathological changes in the tissues of the human body. Accordingly, any therapy should begin with a differential diagnosis. For an experienced neurologist, just one face-to-face examination of the patient with a series of functional diagnostic tests is often sufficient to make an accurate diagnosis. In case of difficulty, radiography of the cervical and lumbar spine, MRI of large nerve plexuses, tunnels, angiography and neurography may be recommended.

In Moscow, you can make an initial free appointment with a neurologist at our manual therapy clinic. Here you will be given a preliminary diagnosis and prescribed additional examination (if necessary). The doctor will give individual recommendations for the treatment of the identified pathology.

Description

Paresthesia is a type of sensitivity disorder that includes subjective sensations of tingling, burning, and “crawling.”
All these unpleasant sensations have bothered every person more than once; they could appear when sitting for a long time in an uncomfortable position, squeezing the arms or legs, or in case of a feeling of strong fear. However, this condition passes quickly and does not cause any particular inconvenience.

In the event that these sensations appear for no apparent reason and do not go away for a long time, you should consult a doctor to determine the cause and prescribe the necessary treatment.

Paresthesia occurs when a nerve root, nerve ending, area of ​​the spinal cord or brain is damaged or irritated. The localization of symptoms depends on the location of the nerve lesion.

The causes of paresthesia are varied and varied, depending on the location of the symptoms.

Paresthesia of the tongue occurs against the background of:

• irritation of its surface with sharp edges of teeth;
• rubbing with dentures used in dentistry;
• bite changes.

However, the development of paresthesia of the tongue occurs only when, against the background of the listed factors, there are also internal causes (diseases of the stomach, diseases of the ENT organs, arachnoiditis).

Paresthesia of the lower extremities occurs when:

• any medical intervention in the area of ​​the spinal cord and spinal column;
• spinal cord injury;
• multiple sclerosis;
• polyneuropathy (mainly alcoholic and diabetic in nature);
• osteochondrosis of the lumbar spine;
• obliterating endarteritis;
• hypovitaminosis.

Paresthesia of the upper extremities appears against the background of:

• osteochondrosis of the cervical spine;
• the presence of formations of a malignant or benign nature;
• Raynaud's disease;
• multiple sclerosis;
• injuries to the cervical spine;
• stroke;
• inflammatory process affecting the neck muscles.

Lip paresthesia, which develops against the background of:

• osteochondrosis of the cervical spine;
• neuritis of the facial nerve;
• migraine;
• inflammatory lesions of the gums;
• hypertensive crisis.

In addition, there are reasons such as:

• poisoning by chemicals or heavy metals;
• prolonged exposure to stress factors;
• long-term and uncontrolled use of certain medications (isoniazid, cycloserine, ofloxacin, antiepileptic drugs, some antihypertensive drugs).

Paresthesia can occur equally in men and women.

Causes of paresthesia of the arms and lower extremities

All causes of paresthesia of the limbs can be divided into several large groups: inflammation, trauma, compression, infection and tumors. Let's look at these causes of paresthesia of the upper and lower extremities in more detail.

Let's start with the most common option - compression. This is the pressure exerted on the passing nerve fiber. It can be caused by the following negative factors:

• development of osteochondrosis of the spinal column with gradually developing protrusion, extrusion and disc herniation;
• displacement of the vertebral bodies and pinching of the radicular nerves;
• spasm and tonic muscle tension in the paravertebral region during any pathological processes;
• poor posture (scoliosis, kyphosis, lordosis, round back, stoop);
• Bechterew's disease (ankylosing spondylitis), in which there is a violation of the patency of the nerve fiber;
• deposition of calcium salts (osteophytes) on the edges of the vertebral bodies;
• violation of the patency of the tunnels in which large nerves are located (sciatic, median, ulnar, tibial, etc.);
• lymphadenitis putting pressure on regional nerve plexuses (for example, brachial).

Inflammatory diseases accompanied by numbness and the occurrence of paresthesia in certain areas of the upper and lower extremities include lymphadenitis, myositis, neuritis, etc. Infectious inflammation can be provoked by tuberculosis bacillus, staphylococcus, streptococcus (with erysipelas of the leg), Haemophilus influenzae, etc.

Among the probable causes of the development of paresthesia of the upper or lower extremities, injuries and their long-term consequences often appear:

1. fractures and cracks of long tubular bones, resulting in impaired nerve conduction;
2. sprains and ruptures of ligament and tendon tissue (swelling and hematoma develop, which compress the nerve fiber passing next to them);
3. the formation of coarse scar tissue that interferes with the normal process of innervation of certain areas of the upper and lower extremities;
4. cuts and other types of violation of the integrity of the nerve fiber itself.

As the tumor grows, pressure is exerted on the soft tissue surrounding the tumor. When a nerve fiber enters this zone, severe paresthesia is observed. Other potential causes may also include:

• incorrectly chosen position for night sleep;
• violation of workplace ergonomic rules;
• engaging in certain types of professional activities (most often, as a result of this, carpal tunnel syndrome occurs);
• the habit of sitting with one leg crossed over the other;
• development of diabetic angiopathy with impaired blood supply to distant areas of the arms and legs;
• atherosclerosis of small blood vessels against the background of high cholesterol levels in the blood;
• development of varicose veins of the lower extremities with impaired outflow of venous blood and edema syndrome;
• Raynaud's disease;
• improper application of a hemostatic tourniquet.

When you first contact your doctor, you must honestly talk about all your existing risk factors for developing nerve fiber trophism disorders. If you smoke, drink alcoholic beverages, or regularly violate your diet, you should inform your doctor about this. So, if you have recently begun to notice that you are drinking too much liquid, then you are very likely at risk of developing impaired glucose tolerance and diabetes. And these diseases can provoke the appearance of systematic transient paresthesias of the upper (arms) and lower extremities.

Symptoms

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The appearance of paresthesia occurs when several electrical impulses of different potential occur in a sensitive nerve fiber. The impulses are layered on top of each other, and, as a result, information from the skin or mucous membrane enters the brain in a distorted form.

The location of symptoms depends on the location of the nerve damage. For example, during a stroke, paresthesia develops on the opposite side of the body (from the area of ​​the brain where the circulatory disorder occurred). Migraine attacks may be accompanied by precursors in the form of paresthesia in the mouth. Polyneuropathy is characterized by localization in the area of ​​the feet and hands.

Symptoms of paresthesia are:

• tingling or burning sensation;
• feeling of "crawling";
• pale skin in the affected area;
• feeling of numbness.

This condition can occur unexpectedly and suddenly, or it can develop gradually with an increase in symptoms. Typically, outbreaks of paresthesia go away over time, then attack again. But there is also a continuous course, for example, in multiple sclerosis with a long history of the disease, when paresthesia is a constant concern.

Frequently asked questions about paresthesia

Which doctor treats paresthesia?

It all depends on the cause of the sensitivity disorder. For your first consultation, you can contact a neurologist. If necessary, he will give a referral to the right specialist.

How to determine paresthesia?

The main symptom is tingling in the affected area. It is often accompanied by numbness and a crawling sensation.

Where is paresthesia most common?

In most cases, sensitivity is impaired in the legs and arms. But in certain cases, discomfort can occur in different parts of the body, including the face.

Diagnostics

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A therapist or neurologist is involved in identifying paresthesia.

Diagnosis is aimed at establishing the immediate cause that contributed to the development of paresthesia. During the conversation, the doctor finds out the onset of symptoms, their duration, and the presence of provoking factors. An important factor is to ensure that the workplace is designed to avoid exposure to chemicals.

After this, a neurological examination is performed, during which sensitivity impairment is determined.

The next stage is to search for the disease against which paresthesia developed. For this purpose the following studies are carried out:

• determination of blood sugar levels;
• blood test for toxins;
• blood chemistry;
• Ultrasound of the vessels of the lower extremities and brachiocephalic vessels;
• X-ray of the spine;
• CT, MRI of the brain and/or spinal cord.

An important research method is electroneuromyography, which shows the speed of excitation propagation along the nerve fiber, which makes it possible to identify disturbances in nerve conduction.

When paresthesia is caused by filling material entering the tooth canal, the dentist is involved in the diagnosis. Numbness develops in the chin, tongue, cheeks, lips, symptoms disappear after a few days or 2-3 months. In this case, there are no problems with diagnosis; the person independently associates the development of symptoms with a recent visit to the dentist.

Paresthesia is not a separate disease; it is always associated with concomitant pathology. Therefore, it is extremely important to carry out a full examination in order to prescribe the necessary treatment in a timely manner and prevent the development of complications.

Before treating limb paresthesia

It is very important, before starting to treat paresthesia of the extremities, to conduct a differential diagnosis and exclude the possibility of developing dangerous infections and malignant neoplasms that compress the nerve fiber. To diagnose a disease that causes paresthesia of the limbs as a clinical symptom of its course, the following examination methods are used:

• X-ray image of the spine (in case of paresthesia of the upper extremities, you need to take an image of the cervical and cervicothoracic region, in case of damage to the lower extremities - lumbar and lumbosacral);
• angiography and neuromyography - allow you to evaluate the conductivity of the nerve impulse and the condition of sensory axons;
• Dopplerography of blood vessels allows us to exclude atherosclerosis, narrowing of the lumen due to diabetes mellitus and the development of varicose veins;
• Ultrasound of soft tissues to exclude the risk of developing focal infections and tumors;
• MRI and CT if it is difficult to make an accurate diagnosis.

You can start diagnosing by visiting a neurologist. In Moscow, this doctor conducts initial free consultations with patients in our manual therapy clinic. Make an appointment at a time convenient for your visit.

Treatment

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Treatment is aimed at eliminating the cause of paresthesia and alleviating symptoms.

Blood sugar levels should be constantly monitored if you have diabetes. Careful monitoring will help prevent the development of complications such as diabetic polyneuropathy, which, in turn, is accompanied by paresthesia.

It is recommended to stop drinking alcohol, since prolonged use of alcoholic beverages provokes the development of paresthesia.

In case of poisoning by chemical substances, detoxification therapy is performed, aimed at removing toxins from the body.

Surgical treatment is used in cases where there is a tumor process that compresses the nerve.

Symptomatic treatment is aimed at reducing the manifestation of unpleasant sensations.

Physiotherapeutic treatment has a good effect. It is aimed at eliminating the subjective sensations of paresthesia. This treatment method includes:

• diadynamic currents;
• electrophoresis;
• magnetic therapy;
• mud therapy;
• massage;
• acupuncture.

Medicines are also prescribed to help eliminate the symptoms of paresthesia.

In cases where the mechanism of formation of paresthesia is associated with a violation of the conduction of excitation along the nerve fiber, the administration of B vitamins will have a good effect.

In addition, to eliminate the feeling of numbness, medications that improve blood circulation are prescribed. To achieve this effect, antiplatelet agents are used.

Groups of drugs such as antioxidants and antihypoxants are also used. They help improve metabolic processes in nervous tissue.

To prescribe a treatment regimen, you should consult a doctor who, individually, taking into account the cause of paresthesia and the presence of concomitant pathology, will prescribe the necessary medications. You should not wait for the symptoms to resolve spontaneously, but immediately make an appointment with a doctor to prevent the development of complications.

Facial paresthesia secondary to endodontic treatment

Paresthesia is a disorder of neurosensitivity caused by damage to the nervous tissue, which is characterized by subjective sensations of burning, numbness or attacks of pain, as well as partial loss of sensitivity. It is important to differentiate between paresthesia, dysesthesia and anesthesia. Dysesthesia manifests itself in the form of unpleasant abnormal sensations that occur spontaneously or as a result of the action of a provoking factor. Special cases of dysesthesia include hyperalgesia and allodynia. Dysesthesia is always accompanied by unpleasant sensations, unlike paresthesia. From a practical point of view, paresthesia refers to a case of abnormal sensation and, therefore, can be classified as a separate variant of dysesthesia. Anesthesia is characterized by sensory loss of perception caused by drug exposure or neural dysfunction.

Endodontically provoked paresthesias require careful examination due to the close anatomical proximity of the root apex and the neurovascular bundle of the jaw. In addition, if the damage is severe, irreversible nerve pathologies may occur. The purpose of our study was to analyze the literature data concerning paresthesia as a complication of endodontic treatment, as well as its causes, diagnostic features, the most severe complications and treatment options.

Paresthesia as a complication of endodontic treatment

Paresthesias associated with endodontic treatment are most characteristic of the inferior alveolar nerve (IN) and its mental branch. However, the prevalence of paresthesia associated with specific endodontic problems in individual teeth has not yet been established. A retrospective study of paresthesia cases associated with treatment of mandibular premolars found the incidence to be 0.96% (8/832). However, in many cases, paresthesia may go unnoticed by the endodontist and, therefore, such cases are not reported.

Some studies examining the relationship between paresthesia and endodontic infection have found both problems predominantly in teeth with extensive periradicular lesions (Figure 1). This type of nervous disorder is mainly of a compressive nature, but the possible migration of inflammatory mediators and bacterial products from the affected area to the nerve formations also remains an equally important etiological factor. In particular, inflammatory mediators such as interleukin 1, tumor necrosis factor and nitric oxide have inherent neurotoxic activity, and bacterial endotoxins such as lipopolysaccharides can also cause damage to nerve tissue.

Photo 1. Periapical radiograph of the mandibular second molar: visualizes the anatomical proximity between the root apex and the mandibular canal.

Regarding endodontic treatment as a possible cause of paresthesia, Rowe suggested that the nerve may be damaged directly during root canal treatment due to overtreatment (Figure 1). However, Rowe also argued that mechanical damage to the nerve from an endodontic instrument is easily repaired, so this form of paresthesia is temporary.

The possibility of paresthesia occurring as a result of direct contamination by microorganisms requires detailed consideration, taking into account the possibilities of their biological aggression, since this particular pathogenetic mechanism has not yet been studied in detail in the literature. Cytotoxicity and mechanical pressure of sealers in areas close to the mandibular canal are also potential mechanisms for possible nerve injury due to endodontic manipulation. In this case, the already mentioned inferior alveolar nerve and its mental branch are the most frequently damaged structures. Materials that can initiate such complications contain paraformaldehyde.

For this systematic review, the PubMed database was searched using the keyword combination “endodontic and paresthesia” to select all case reports of paresthesia associated with endodontic complications published within the last 10 years (January 2002 to December 2012). A total of 40 cases were found. Some clinical cases published earlier than this period will also be discussed in this article.

Several cases of paresthesia associated with endodontic complications in the maxilla have also been found in the literature. Orr described 2 cases of paresthesia of the maxillary nerve caused by apical extension of N2 paste (Indrag-Agsa, Bologna, Italy). Orr emphasized that N2 paste contains paraformaldehyde, which fully explains the pathology. Ree and Messer described paresthesia that occurred during retreatment of the maxillary central incisor. Perforation of the root apex resulted in transudation of sodium hypochlorite (NaOCl) into the periradicular tissues. The consequences of this incident were not long in coming, so pain, swelling and paresthesia immediately appeared in the areas of the lower orbit and nose. Pelka and Petschelt presented another case of paresthesia caused by accidental passage of NaOCl beyond the apical foramen in the upper left lateral incisor. This resulted in paresthesia of the left facial and infraorbital nerves. During in vitro studies, Schwarze et al observed that sealers/pastes containing paraformaldehyde, such as Endomethasone (Endomethasone, Septodont, Saint-Maur, France) and N2, were more toxic and mutagenic than sealers containing calcium hydroxide.

Overpreparation of the root canal often results in widening of the apical foramen and leveling of the apical constriction, which promotes the removal of irrigation solutions or filling material beyond the root apex. This, in turn, can cause chemical or mechanical damage to the nerve bundle. The diameter of bone lesions of endodontic origin may also influence the onset of paresthesia, especially in cases of premolars and mandibular molars.

Anatomical relationship of the inferior alveolar nerve and root apexes

Tilotta-Yasukawa et al determined the proximity of the apices of premolars and molars in relation to the mandibular canal, as well as the relationship between the inferior alveolar nerve and its corresponding artery, to understand how endodontic material spreads through bone before entering the mandibular canal. They noted that the distance between the root apex and the mandibular canal was more variable (and generally larger) for the first molar compared to the second and third molars (1-4 mm and less than 1 mm, respectively, in 35 of 40 cases studied on the mandibular jaws). The authors concluded that in its posterior region, the mandible is less dense and has a greater amount of cancellous bone. It should be noted that the inferior alveolar artery itself may be associated with the occurrence of paresthesia, as it can act as a router for the distribution of materials, microorganisms and irrigation solutions to the nerve structures.

Littner et al studied 22 jaws and found that the superior portion of the mandibular canal may be located 3.5 to 5.4 mm below the apices of the first and second molars. The apices of the third molars are located very close to the alveolar nerve. Denio et al studied that the apices of the roots of second molars are located at an average distance of 3.7 mm from the mandibular canal, and the apices of the mesial roots of first molars are located up to 6.9 mm. Other authors have confirmed the symmetry of the mandibular hemiarches in relation to the distance between the root apices and the mandibular canal.

The presence of numerous spaces in the thickness of the lower jaw in the area of ​​the molars promotes the spread of irrigation solutions and filling material towards the inferior alveolar neurovascular bundle (photo 2). This diffusion is facilitated by the presence of periradicular infections, which weaken the bony barrier between the apex and the neurovascular formation. In addition, it should be noted that the mandibular canal is not always surrounded by a dense cortical plate. In most cases, the neurovascular bundle passes through the cancellous bone without any additional bone barrier, which makes it more vulnerable to various mechanical or chemical agents from the root canal area.

Photo 2. Schematic representation of the various causes of paresthesia due to endodontic problems. In the region from the second premolar to the third molar, typical causes of paresthesia include apical extrusion or spread of endodontic drugs, apical surgery, excessive canal preparation beyond the apex, and apical periodontitis.

Diagnosis of facial paresthesia

Diagnosis of paresthesia or nervous anesthesia is based on medical history and assessment of the associated symptoms. Reactions of the affected area to thermal stimuli, mechanical stimuli, electrical or chemical tests all also contribute to the diagnostic process, although such reactions are purely subjective. Periapical radiographs are key to verifying the relationship between the root apex and nerve endings, especially in the mandible (Figure 3).

Photo 3. a) Bone in the area of ​​the molars of the lower jaw. b) Visual increase in the structure of the alveolar bone in the area of ​​the third molar; noteworthy is the presence of numerous spaces in the thickness of the bone tissue. c) Illustration of possible migration of bacteria or endodontic materials through marked spaces in the jaw structure to the area of ​​the inferior alveolar nerve (shown in red).

De Beukelaer et al described the use of sensitivity tests to determine the extent and severity of paresthesia. Mechanical, thermal and taste tests were carried out at certain time intervals, thus accompanying the course of treatment. According to these authors, clinical examination of patients with damage to the lingual nerve should begin with determining the function of the nerve, in particular by assessing pronunciation and swallowing. It is also necessary to palpate the affected area.

Two types of clinical neurosensitivity studies can be conducted according to the specific receptors that exist (mechanoceptors and nociceptors) that are stimulated by skin contact. Testing of mechanoceptive sensitivity is based on responses to light static touch and directed stroking with a brush, while nociceptive sensitivity is determined by the response to temperature stimuli, which stimulate certain groups of sensory nerve fibers in addition to the sensory sensations caused by the action of sharp instruments.

Paresthesia caused by the removal of materials beyond the apex and subsequent compression of the inferior alveolar neurovascular bundle is also described in the literature. However, given that most endodontic materials have a certain chemical effect, in cases of material extrusion beyond the apex, it is difficult to determine the pathogenesis of the neural disorder: whether it is mechanical, due to compression, or chemical, caused by the cytotoxicity of the material. Photo 4 illustrates a case of apical extension in which the sealer was deposited in the area adjacent to the cortical part of the mandibular canal. Depending on the cytotoxicity of the sealer, paresthesia in this case may be a complication. To minimize the risk of such situations, it is necessary to more carefully conduct a preliminary assessment of the initial radiograph to determine the relationship of the anatomical structures.

Photo 4. Removing the sealer beyond the apex at the border with the cortical part of the mandibular canal.

Cone beam computed tomography is an important additional option for the prevention, diagnosis and treatment of paresthesia of endodontic origin. The ability to preview sections up to 1 mm thick in three dimensions allows for detailed study of the relationship of root apices and bony lesions to neural structures.

Treatment of facial paresthesia

Since paresthesia associated with endodontic problems are polyetiological pathologies, a universal protocol cannot be used to treat all cases. Treatment options for paresthesia are described below depending on the cause.

If paresthesia is caused by the removal of endodontic sealers or treatment pastes beyond the root apex, then, according to some studies, surgical removal of them shows a high success rate with the return of normal sensitivity in the causative area. However, it should be taken into account that the time that has passed since the material was removed beyond the apex, as well as its volume and topography, affect the success of such treatment.

Cases of paresthesia caused by infection and inflammation are resolved by endodontic treatment, apical surgery, antibiotic therapy or tooth extraction, while paresthesia caused by local anesthesia or overdevelopment of the canal usually resolves within a few days without any treatment. Cases of prolonged or persistent paresthesia are usually due to rupture of nerve fibers, prolonged pressure, or extrusion of toxic endodontic materials. In these cases, it is necessary to remove the causative factor.

Surgery involves removal of the cortical plate followed by apical resection. This approach is the most common for removing top sealers and pastes. Sagittal osteotomy is also a treatment option, especially when compression of the alveolar nerve occurs in the area of ​​the second or third molars.

In nerve decompression, favorable results have been achieved by first performing a sagittal mandibulectomy to better visualize the mandibular canal and then removing foreign material, with or without apical resection. Microneurosurgical treatment techniques, which involve the use of microinstruments and magnifying equipment, are used to restore the function of certain sensory or motor endings. Indications and contraindications for microneurosurgical intervention are given in the Table.

Pogrel suggested performing exploratory surgery immediately after diagnosis because radiographic examination and other diagnostic tests cannot determine the extent of nerve damage. Pogrel also suggested that waiting time before intervention is a controversial issue, but that restorative procedures performed soon after injury are subsequently more successful than those performed after waiting some time. However, it has been noted that some interventions performed 12 months post-injury have also been shown to be equally successful.

Although some authors prefer more radical treatment of paresthesia, it should not be forgotten that in cases of extravasation, the cytotoxicity of sealers tends to decrease over time.

Another treatment option is the use of lasers. This method can accelerate the repair process of injured biological tissues by initiating angioneogenesis, which is an important aspect for neural regeneration. According to Schultze-Mosgau and Reich, spontaneous recovery from paresthesia is possible within 3 to 6 months, but this period is too long. These authors suggested that patients with paresthesia should be prescribed a vitamin B complex to promote the development of the myelin sheath of nerves.

Prevention of facial paresthesia

Precautions to prevent paresthesia associated with endodontic problems include careful radiographic examination, verification of the relationship of root apices and/or periapical lesions to neural structures, use of instruments of appropriate working length, avoidance of overpreparation of canals and apical foramen enlargement, and irrigation with chlorhexidine only in In cases of a very wide or incompletely formed apex, take vitamins immediately after extruding the filling material or irrigant solution near the nerve fiber.

In general, if paresthesia occurs soon after endodontic treatment, it is necessary for the dentist to monitor the patient for symptoms during the first 24 hours. This approach will allow for early diagnosis of paresthesia, and thus will contribute to more effective treatment.

conclusions

The inferior alveolar and mental nerves, which are most often affected by paresthesia, are located in the thickness of the jaw. To diagnose paresthesia, the dentist must take a medical history, evaluate the results of nociceptive and mechanoceptive tests of the affected area, periapical and panoramic radiography, and in some cases, cone beam computed tomography. The choice of treatment should take into account the cause of paresthesia, the degree of injury, the time elapsed since the onset of symptoms, and the patient's response to systemic drug administration. To prevent paresthesia, the dentist should not forget about the proximity of the root apexes to the nerve structures, and remember this even before starting endodontic procedures.

Authors: Flavio R. Alves, PHD Mariana S. Coutinho, DDS Lucio S. Goncalves, PHD

Medicines

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Of the B vitamins, preference is given to thiamine (B1) and cyanocobalamin (B12). It is better to use it as intramuscular injections to achieve the required concentration of the vitamin in the blood.

If there is a concomitant disease that increases the risk of developing blood clots, antiplatelet drugs (for example, aspirin) are prescribed. The action of this drug is aimed at preventing the formation of a primary blood clot by inhibiting the process of platelet adhesion. This helps improve blood circulation, as a result, eliminating the feeling of numbness.

Of the antihypoxants, Actovegin has a good effect. This drug consists exclusively of physiological components that are normally present in the human body. The active substance is a deproteinized hemoderivative of calf blood. Every cell in the body needs oxygen, which is used as energy. Actovegin stimulates oxygen consumption by the cell, thus exhibiting its antihypoxic effect.

One of the representatives of antioxidants is vitamin E. It is the main fat-soluble antioxidant that protects fatty acids in and around cells from free radicals and lipid oxidation. Often used in combination with another antioxidant, vitamin C. This vitamin protects muscle and nerve tissue from the effects of free radicals.

Folk remedies

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Folk remedies will not eliminate the cause of the development of paresthesia, but will help alleviate the symptoms and, thereby, improve the general condition of the person.

First of all, you should carefully monitor your lifestyle and diet. It is recommended to stop smoking and drinking alcohol, and not to abuse hot and spicy foods. Jerusalem artichoke has a good effect (helps eliminate numbness due to its beneficial effect on nerves and blood vessels).

Medicinal baths and contrast baths are also used. To prepare a medicinal bath, you can use herbs such as sage, chamomile, and string. The water temperature should not be hot, but comfortable for humans. Reception time is no more than 15 minutes. You can complement the effect with a massage with warming cream, which is performed immediately after taking a bath.

Contrast baths will help improve blood circulation and increase muscle tone. To carry out the procedure, you should prepare 2 basins with hot and cold water. The essence of the procedure is to alternately lower the feet into one and then into the other basin.

You can purchase a massage roller or brush for daily use. This kind of massage helps improve blood circulation and reduce the symptoms of paresthesia. But you should not massage areas of the body for too long and actively, so as not to injure the skin and cause irritation.

Soothing infusions of medicinal herbs have a good effect, since one of the reasons for the development of paresthesia is psycho-emotional stress. Herbs such as motherwort, mint, chamomile, adonis, and lemon balm are suitable for this. Decoctions are taken during the day in 3-4 doses. The course of herbal treatment lasts no more than 1 month, then a break is taken for several weeks, after which, if necessary, the course is repeated.

The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.

Providing medical care

At the first symptoms of dysesthesia, you should definitely see a doctor. The onset of the disease may be an indicator of the presence of serious problems in the body. Doctors will determine the cause and prescribe effective therapy. And to make your well-being easier, you can use the following tips:

• move a lot , taking walks before bed, since it is walking that enhances chemical reactions, freeing the brain from endorphins, promoting overall restful and sound sleep;
• If you experience discomfort in the lower extremities, you can get up and walk around the room ;
• don't overeat before bed;
• take multivitamins - according to research, the cause of this disease lies precisely in the lack of folic acid or iron;
• taking Aspirin - doctors could not explain exactly how it works, but in some patients, after taking it, their general condition improved significantly;
• avoid stressful situations;
• alcohol should not be taken as a sedative or pain reliever.

Fans of traditional methods of treatment claim that foods enriched with magnesium help improve well-being for various types of dysesthesia: soy, milk, wheat bran, almonds, nuts, pumpkin seeds.