Prevention and diagnosis of neuropathy during dental treatment

Abstract

Peripheral nerves are often subjected to various forces such as surgical invasion, trauma, disease infiltration, and drug action. These attacks cause the peripheral nerve fibers to be pulled, pressed, damaged, or ruptured, resulting in a decline in peripheral function or loss of function. This symptom is often expressed in various ways such as numbness, palsy, paralysis, neuropathy, and nerve abnormality. Paralysis in the oral and facial areas includes motor palsy associated with efferent peripheral neuropathy such as the facial and hypoglossal nerves and sensory palsy associated with afferent peripheral neuropathy such as the inferior alveolar nerve and the lingual nerve. In addition, dysgeusia, taste disorders, dysfunction of autonomic nerves, and autonomic neuropathy may occur in the oral cavity and the facial region as one of paralysis. If these symptoms or disorders recover within days to weeks, it is temporary loss of motor and sensory function due to blockage of nerve conduction, and the diagnosis is neurapraxia. On the other hand, if the symptoms of paralysis persist and the aftereffects remain, or if the function does not recover at all, it can be diagnosed as axonotmesis or neurotmesis. Paralysis is exceedingly difficult to diagnose the prognosis and degree of disability only by the initial symptoms. In particular, the sensory function is more difficult to evaluate than the motor function because the sensory cannot be visualized, and therefore the diagnostic criteria cannot be determined, and inaccurate diagnosis causes confusion in the course of treatment. As a result, despite the definitive diagnosis being Neurapraxia, there is the possibility of giving unnecessary medication, surgical treatment, or wrong physical therapy. Not only that, but for axonotmesis and neurotmesis, which must be treated early, there is a possibility that the start of treatment will be delayed. A quantitative and objective, reproducible and accurate diagnosis is needed to determine the prognosis of paralysis and to make treatment decisions. Accurately grasping the cause of external force applied to the peripheral nerves and the timing of damage, it is possible to cure peripheral functions if the amount and duration of drug therapy and physical therapy and the timing of surgical treatment can be correctly determined. The purpose of this review is to explore preventive and diagnostic methods for peripheral neuropathy during dental treatment. Therefore, we considered the need for a Precision tactile function test for painful trigeminal neuropathy and neuropathic pain, considering the time to fix the symptoms of neuropathy. In addition, we discussed the treatment experience of hyperalgesia and allodynia caused by disorders of the somatosensory nervous system.