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This article presents a case of temporary right-sided numbness of the lower lip during orthodontic treatment to upright an impacted lower right second molar (LR7) in a 15-year-old male. Following cone beam computed tomography (CBCT) this was revealed to be a result of deficient bone between the roots of LR7 and close intimacy to the mandibular canal. Traction to LR7 was discontinued and the patient's orthodontic treatment was completed uneventfully, with full recovery of normal sensation in the lower lip.
CPD/Clinical Relevance: Sensory nerve symptoms initiated by orthodontic treatment are rare, and the presentations, diagnostic tools, management and outcomes of these cases have been reviewed to devise and recommend an appropriate management plan for the treating clinician.
Article
Sensory nerve symptoms initiated by orthodontic treatment are rare, and have been more frequently described in dentistry associated with third molar extractions,1 administration of local anaesthetic,2 placement of dental implants and endodontics.3,4 Temporary altered sensation of the lower lip is more frequently observed in orthognathic surgery and after internal fixation of mandibular fractures.5,6 Other factors to consider include neoplasia and peri-apical pathology.7,8
Symptoms of sensory nerve injury can be classified into several types and have been described by the International Association for the Study of Pain:9
These symptoms are rarely experienced by patients undergoing orthodontic treatment and usually overlooked in discussions at consultation. Unexpected symptoms may have a negative impact on the patient's quality of life, which emphasizes the importance, in appropriate cases, of warning the patient about the potential risk of sensory nerve symptoms as a part of informed consent.
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