Nerve Injury in Dentistry: From Red Flags to Resolution (IODCPC25 Resources)

Speaker: Dr. S. M. Kotrashetti — Professor of Oral & Maxillofacial Surgery, KLE VK Institute of Dental Sciences, Belagavi

We turned this video from IODCPC25 into a high‑impact resource on one of the most essential chairside challenges: recognizing, preventing, and managing dental nerve injury. This post distills the session into a clinic‑first summary for general dental practice—with quick tests you can apply at the chairside and clear steps for timely referral.

Watch the replay: 

Coverage includes: inferior alveolar nerve (IAN) and lingual nerve injuries after local anesthesia, third molar surgery, and dental implant procedures; chairside neurosensory testing; prevention; and referral guidance for general dental practice.

Why this matters

Nerve injuries—most commonly involving the inferior alveolar nerve (IAN), lingual nerve, or mental nerve—can follow local anesthesia (LA) blocks, third molar surgery, or implant placement. ^[1][2] Quick recognition, structured neurosensory testing, and timely referral improve outcomes and patient trust.

Common clinical scenarios

• IAN block anesthesia with persistent altered sensation
• Third molar surgery (especially mandibular impactions)
• Implant placement in the posterior mandible or near the mental foramen
• Trauma or periapical surgery close to the neurovascular bundles

Red flags you shouldn’t miss

• Anesthesia, hypoesthesia, paresthesia, dysesthesia, or allodynia
• Altered taste or tongue bite marks (lingual nerve)
• Burning, electric, or shock‑like pain patterns
• Deficits persisting beyond the expected anesthesia duration

Chairside neurosensory testing (quick screen)

Start with light touch and two‑point discrimination; add pin‑prick, brush directional testing, and thermal discrimination when available. Map and document borders with a diagram and repeat the same tests serially to track recovery.

Immediate steps when you suspect injury

• Document onset, site, type of sensation, and precipitating procedure
• Explain your plan and set expectations; provide written after‑care
• Baseline photos/diagram of the sensory map; consider pulpal tests for IAN involvement
• Medications (case‑dependent): simple analgesia; consider neuropathic agents with specialist input; avoid polypharmacy

When to refer & to whom

• Refer early to Oral & Maxillofacial Surgery / Orofacial Pain as soon as a significant neurosensory deficit is recognized or is progressing. ^[1][3]
• Implant impingement/breach of the IAN canal or mental foramen: prompt implant removal and specialist management are advised. ^[1][3]
• Persistent deficits (functionally disabling or beyond expected healing) warrant specialist evaluation and possible microsurgical opinion.

Prevention pearls

• Pre‑op imaging and planning (CBCT where indicated) ^[4][5]
• Respect safety zones near the IAN canal and mental foramen; use shorter drills/stops
• For third molars, assess radiographic risk signs; consider coronectomy in high-risk cases to reduce IAN injury ^[6][7]
• For LA blocks, aspirate, avoid repeated traumatic passes, and note unusual pain on injection

Communication, consent & follow‑up

Discuss risks in plain language before treatment, document informed consent, and give written post‑op instructions. If an injury is suspected, communicate early, schedule structured follow‑ups (e.g., 1, 2, 4, 8 weeks), and provide a pathway to specialist care.

When to suspect post‑traumatic trigeminal neuropathic pain (PTNP)

Consider PTNP when dysesthesia/allodynia persist beyond expected healing, pain is disproportionate, or symptoms occur without a clear peripheral mechanical stimulus. Early specialist assessment is recommended. ^[8]

Key takeaways

1. Recognize: altered sensation is not “normal.” Screen, map, and document.
2. Reassure & explain: a clear plan reduces anxiety and builds trust.
3. Review serially: same tests, same areas, same documentation.
4. Refer on time: severe pain, canal breach, or persistent deficit → specialist.
5. Prevent: imaging, planning, safety zones, careful technique.

About the speaker

Dr. S. M. Kotrashetti is Professor of Oral & Maxillofacial Surgery at KLE VK Institute of Dental Sciences, Belagavi, and a consultant with the KLE Smile Train program. His work focuses on facial deformities, trauma, cleft care, and implant surgery.

Watch next: The full IODCPC25 replay on nerve injury in dentistry 

Also check out: Our quick 1‑page handout — Dental Nerve Injury — Quick Chairside Guide (PDF).

Save the date: IODCPC26 — May 8–10, 2026. Get early updates & special discounts: tinyurl.com/IODCPC26Info.

Note: Adapted from an auto‑generated transcript; lightly edited for clarity.