(TC33) Inferior Alveolar Nerve Injuries for Dummies: Assessment and Management

Objectives: The aim of this table clinic is to suggest a protocol for managing inferior alveolar nerve injuries in the endodontic office. Recommendations for best practices recommendations will be reviewed and common allegations of nerve injury-related dental malpractice discussed.

Description: A patient presents with paresthesia after incision and drainage of an abscess adjacent to tooth #20. Inferior alveolar nerve injuries are a risk in endodontics, especially when instrumenting or medicating mandibular posterior teeth, incising an abscess near the mental foramen, or performing apical surgery. Quick identification and management of a nerve injury is crucial. Since 2010, the National Practitioner Data Bank has received 16,712 reports of dental malpractice claims. A portion of those claims are nerve injury related. Of those claims most are from third molar extractions, but some are from endodontic procedures. Common allegations include failing to take proper precautions to prevent trauma to the patient, failing to place the patient immediately on a steroid, failing to map the neurological deficit or failing to refer the patient to another provider who could perform a neurosensory examination, and failing to refer the patient in a timely manner to an oral and maxillofacial surgeon specializing in nerve repair surgery.

Conclusion: Learning proper assessment and management of nerve injuries is critical, and this table clinic provides best practice guidelines for the endodontic specialist.