Endodontic-related paresthesia: a case report and literature review

Endodontic-related paresthesia is a potential complication despite the development of endodontic materials and techniques. We describe a case of periapical lesion-induced paresthesia that was successfully treated endodontically. The literature review of endodontic-related paresthesia is also presented.

The patient sought treatment from a general practitioner for lower lip paresthesia as the only symptom. Paresthesia was present on the left side of the lower lip extending from the mandibular midline to the second premolar both extraorally and intraorally in the area of mental nerve stem. Apical lesion of an endodontically treated second premolar with short obturation was observed radiographically. Retreatment was unsuccessful at reaching the apex; instead, swelling, pain, and extension of numbness on the region resulted, and the patient was referred to an endodontist.

The root canal chemomechanical debridement was completed, and calcium hydroxide was placed for the follow-up. Two months later the symptoms had significantly improved, the radiograph indicated partial healing, and the tooth was obturated. The healing progressed so that the symptoms completely resolved within a year after the treatment.

Periapical pathosis might cause paresthesia with a good potential for healing after appropriate endodontic treatment. Complications might be prevented by careful preoperative examination, good quality radiographs, and good instrumentation, irrigation, and obturation techniques. However, according to the literature paresthesia might still occur. In case of treatment-related paresthesia in which apical extrusion of endodontic materials is observed, the need for surgical debridement (especially in cases of extrusion of obturation materials) should be considered within 48 hours.