Predicting the prognosis of abnormal sensation after dental treatment - Using self-reported symptoms -

Sometimes patients complain of abnormal sensations after dental treatment. In some cases, pain and dysesthesia persist for a long time. These neurological complications are due to nerve and tissue injury during the procedure. We examined the question of whether we can predict prolonged abnormal sensation from the patient's initial self-reported symptoms. Sixty patients who visited the orofacial pain and neurofunction clinic in Kyushu Dental College Hospital with complaints of abnormal sensation after dental treatment were enrolled in this study (Table 1). Forty patients visited us within one month after injury (fresh cases), and twenty visited over one month after injury (advanced cases). Self-reported symptoms were categorized as combinations of spontaneous pain, hypoesthesia, hyperalgesia, allodynia, and dysesthesia (Table 2). Self-reported symptoms were assessed again twelve months later, and the prognosis of prolonged abnormal sensation was analyzed (Table 3). Nine fresh and eight advanced cases complained of spontaneous pain. Seven of the former and three of the latter were completely relieved. Dysesthesia was associated with spontaneous pain in other cases (Fig. 1). Twenty-two patients showed complete sensory recovery, and the other thirty- eight patients still complained of abnormal sensation twelve months after their first visit (Fig. 2). All patients with hypoesthesia but no other symptoms recovered satisfactorily (Table 4). Those who completely recovered had usually visited us earlier than those who showed sequellae. In fresh cases, those who had nothing but hypoesthesia in the affected region showed good response to treatment. Regeneration is associated with dysesthesia, allodynia and hyperalgesia. Hypoesthesia without any other symptoms in fresh cases represents mild degeneration and well-conserved damaged fibers. Prolonged abnormal sensation was observed in cases with severe nerve damage. Severe dysesthesia, allodynia, and hyperalgesia appeared to be more clearly observed in severely damaged cases. Prolonged abnormal sensation seemed to depend on how severely the case had suffered from dysesthesia and allodynia/hyperalgesia within the first month after injury. We can roughly predict prolonged abnormal sensation from the initially self-reported symptoms in fresh cases. Patients with hypoesthesia but no other symptoms tend to recover satisfactorily. The prognosis of abnormal sensation both in fresh cases with dysesthesia, allodynia, and hyperalgesia, and in advanced cases needs further investigation.