Modern pharmacology, combined with medical and dental advancements, has brought us pain-free medical and dental procedures through the use of local anesthetics. While this is a remarkable achievement, there are drawbacks. One significant issue in dentistry is “residual soft-tissue anesthesia”, which can result in self-induced injury post-procedure. This is not only the most common complication following dental anesthesia, but it also affects both adult and pediatric patients. Residual numbness can result in the biting of the lips, cheeks and tongue, with rates of injury as high as 7% for adults and 18-21% for children (1 in 5) following dental procedures [1]. The overall incidence for all age groups was found to be 13-14% (1 in 7) [1,2]. A separate study of special needs pediatric patients found that the incidence of self-induced injury was 24% (1 in 4) for children ≤ 6 years of age and 16% (1 in 6) for children > 6 years of age, with an overall incidence for special needs children of 19% (1 in 5) and a surprising incidence of 35% (1 in 3) following IANB (Inferior Alveolar Nerve Block), versus 9% (1 in 11) for maxillary infiltrations for children with special needs [3].

Despite the frequency of this issue, it has long been under recognized and under-addressed within the profession. Historically, the dental community has focused more on rare systemic or local complications, such as allergic reactions or infections (after injection), while largely accepting post-procedure numbness as an inevitable side effect. In fact, the profession has typically defaulted to advising patients to “be careful until the numbness wears off”, as famously illustrated in Stanley Malamed’s Handbook of Local Anesthesia, a stance that has remained unchanged in his book since the first edition in 1980 [4,5].

While the cautionary advice may be mildly effective for adult patients familiar with the sensation of anesthesia, it is grossly inadequate for pediatric patients, who are at a higher risk for injury due to their inability to fully control their behavior. It is clear that residual soft-tissue anesthesia poses a preventable risk, particularly when it comes to children.

However, the situation has changed. New options are now available to specifically address this long-standing issue. Two distinct solutions—agents that reverse anesthesia (through pharmacological or photobiomodulation means) and physical barrier devices, like BiteBuoy™, have emerged, offering dental professionals viable methods to prevent these injuries [6,7,8].

1. College C., et. al. Bilateral versus unilateral mandibular block anesthesia in a pediatric population. Pediatric Dentistry, 2000 Nov-Dec;22(6):453-7  Click here for link to full article.

2. Adewumi A., et. al. The Incidence of Adverse Reactions Following 4% Septocaine (Articaine) in Children. Pediatric Dentistry, 2008 Sep-Oct; 30(5):424-8  Click here for link to full article.

3. Bagattoni S, et. al. Self-induced soft-tissue injuries following dental anesthesia in children with and without intellectual disability. A prospective study. European Archives of Paediatric Dentistry, 2020; 21:617-22 Click here for link to full article.

4. Malamed SF. Handbook of Local Anesthesia. St Louis: Mosby 1980.

5. Malamed SF. Handbook of Local Anesthesia. St Louis: Mosby 2020.

6. Tavares M., et. al. Reversal of Soft-Tissue Local Anesthesia with Phentolamine Mesylate in Pediatric Patients. Journal of the American Dental Association, 2008 Aug; 139(8):1095-104. Used with permission of the author.

7. Hersh, E. V., Lindemeyer, R., Berg, J. H., Casamassimo, P. S., Chin, J., Marberger, A., Lin, B. P., Hutcheson, M. C., Moore, P. A., & Group, P. S. (2017). Phase Four, Randomized, Double-Blinded, Controlled Trial of Phentolamine Mesylate in Two- to Five-year-old Dental Patients. Pediatric dentistry, 39(1), 39–45. Click here for link to full article.

8. Annu A., et. al. Comparative Evaluation of Photobiomodulation Therapy at 660 and 810 nm Wavelengths on the Soft Tissue Local Anesthesia Reversal in Pediatric Dentistry: An In-Vivo Study. Journal of Dental Anesthesia & Pain Medicine, 2023 Aug; 23(4):229-36. Click here for link to full article.

9. Chi D., et. al. Lip Biting in a Pediatric Dental Patient After Local Anesthesia: A Case Report. Journal of Pediatric Nursing, 2008 Dec; 23(6):490-3. Click here for link to full article.

10. Bendgude V, et. al. An Unusual Pattern of Self-inflicted Injury after Dental Local Anesthesia: A Report of 2 Cases. The Journal of Contemporary Dental Practice, 2011 Sep-Oct; 12(5):404-7. Click here for link to full article.

11. Vempaty S and Robbins J, Self-Inflicted Trauma Secondary to Local Anesthesia in Children. Case Reports in Dentistry, 2017 Jan; 2017:4969484. Click here for link to full article.

12. Tiwari A A Traumatic Ulcer Caused by Accidental Lip Biting Following Topical Anesthesia: A Case Report. Cureus, Apr 2023; 15(4): e38316. Click here for link to full article.