Dental injection and nerve damage: how rare is it really?

Lasting nerve injury from a dental injection is rare. A dental shot normally leaves your mouth numb for a few hours, but you may have heard the words “nerve damage” or “paresthesia” and felt worried. This article explains what paresthesia is, why it may happen and what you can expect if it occurs. 

What you will learn in this article: 

• Lasting nerve injury from a dental injection is documented but rare. 

• If numbness or tingling lasts more than a day after your appointment, tell your dental provider right away. 

• The type and concentration of anesthetic may affect risk, and you can ask your dental provider about this before your procedure. 

• Most cases of paresthesia improve over time as the nerve heals. 

If anything about your mouth feels off after a dental visit, it’s worth talking to a dental provider. You can schedule an appointment with an Aspen Dental provider to get answers and peace of mind. 

What is paresthesia? 

Paresthesia is numbness, tingling or another change in feeling that lasts longer than expected. In dental care, it refers to altered feeling that continues beyond the normal window of a local anesthetic. Routine numbness lasts a few hours. Paresthesia may last for days, weeks or longer. 

The areas most likely to be affected are the lower lip, tongue or chin. These areas are supplied by nerves that dental providers often block during procedures on the lower jaw. 

What is the difference between routine numbness and paresthesia? 

Routine numbness fades within a few hours, while paresthesia lasts longer. 

After a dental injection, your lip or cheek may feel numb. That is the anesthetic doing its job. The numbness usually fades on its own within two to four hours. 

Paresthesia is numbness or altered feeling that remains. If your lip still feels strange days after your appointment, tell your dental provider. It does not mean the worst has happened, but it does mean your dental provider should check the area. 

How rare is lasting nerve injury? 

Lasting nerve injury from a dental injection appears to be rare, but the available research does not provide one exact rate. 

Altered sensation may clear within days, weeks or months. According to one study, only a few rare cases lasted longer than six months.¹

Put plainly: Local anesthetic injections are generally considered safe when performed properly, and lasting loss of sensation is uncommon. 

What can cause paresthesia? 

Paresthesia may be related to needle contact, the anesthetic being used or pressure near a nerve. These events are uncommon, but understanding them may help you know what to expect. 

How can needle contact affect a nerve? 

Needle contact can sometimes affect a nerve during a lower-jaw nerve block. A needle may contact or enter a nerve during an injection. However, not every case of paresthesia shows signs of needle trauma.¹ 

One study reviewed 248 paresthesia reports submitted to a federal adverse-event database. Of those reports, 94.5% involved a lower-jaw nerve block, and the lingual nerve was affected in 89% of cases. These percentages describe the reported cases, not the risk from every injection.² 

That same review also cites an earlier study in which 31 of 134 patients with paresthesia recalled an electric-shock feeling during the injection. That feeling may point to physical nerve contact, but it does not prove lasting damage.¹ 

How can the anesthetic affect a nerve? 

The anesthetic and its concentration may also play a role in paresthesia. 

Higher concentrations of 4% articaine and 3% to 4% prilocaine have been studied because they may affect nerve tissue. However, cell and animal studies did not find articaine more toxic than other anesthetics. 

These reports involving 4% prilocaine and 4% articaine occurred more often than expected based on U.S. sales data. Because the study analyzed voluntarily submitted adverse-event reports, the findings show an association but do not establish an individual patient’s risk or prove that the anesthetic caused each case.²

The evidence is not fully settled. Your dental provider will choose an anesthetic based on your health, treatment and individual needs. 

How can pressure or bleeding affect a nerve? 

Pressure or bleeding near a nerve may temporarily change how the area feels. A small bleed or pocket of pressure can compress the nerve rather than cut it. This type of injury may improve as the area heals. 

What happens when paresthesia occurs? 

Most cases of paresthesia after a dental injection improve over time. The nerve may heal on its own, although recovery can take weeks or months. In a smaller number of cases, some altered feeling may last longer. 

If your dental provider suspects paresthesia, they may monitor your symptoms. They may ask you to return for follow-up visits to track how the feeling is returning. In some cases, they may refer you to a specialist, such as an oral and maxillofacial surgeon or neurologist. 

There is no single treatment that speeds nerve recovery. Watchful waiting and follow-up care are commonly used to monitor healing. 

What should you do if something feels wrong? 

Call your dental provider if numbness or tingling in your lip, tongue or chin lasts more than a day after a dental appointment. Explain what you feel and when it started. The sooner your care team knows, the sooner they can begin tracking your symptoms. 

Your dental provider may ask about your symptoms, check the area and decide whether a referral is needed. Most cases do not require one, but your dental provider will make that decision based on what they find. If something doesn't feel right, contact your local dental provider to have it checked. 

Dental injection and nerve damage: How rare is it really? FAQs 

These answers cover practical questions that may come up before or after a dental injection. 

Can I ask my dental provider about using a different anesthetic? 

Yes. If you are concerned, talk with your dental provider before the procedure. They can explain which anesthetic they plan to use, why they recommend it and whether another option may be appropriate for you. 

Does paresthesia affect eating or speaking? 

Yes, paresthesia can sometimes affect eating or speaking. Numbness or tingling in the lip or tongue may make it harder to feel hot foods, chew or speak clearly. These effects usually improve as sensation returns. If difficulty eating or speaking is significant, let your dental provider know so they can track your recovery. 

Sources 

¹ The Open Dentistry Journal: “The Anatomical Nature of Dental Paresthesia: A Quick Review.” https://www.opendentistryjournal.com/VOLUME/12/PAGE/155/FULLTEXT/ 

² National Institutes of Health, The Journal of the American Dental Association: "Occurrence of Paresthesia After Dental Local Anesthetic Administration in the United States.” https://pubmed.ncbi.nlm.nih.gov/20592403/