Delayed Paresthesia: any thoughts?

Doubtful of dental origin did you notify her MD? I would be suspicious of a central lesion.

Thank you for your reply. I did in fact refer her to her treating oncologist and await results of investigations on his part. I was also doubtful of dental origin as numbness would have occurred immediately post surgery and we were in constant communication with the patient. Would any one have any thoughts on which central pathway could be disturbed? I cannot find anything in the literature regarding mental nerve paresthesia from a central origin.

80% of patients with osteosarcoma of a long bone have metastases at the time of first diagnosis, although they may not be clinically apparent. Usually pulmonary but this history of progressive mental nerve paraesthesia sounds worrying. Probably a candidate for radionuclide scintiscan +/- MRI. Please keep us posted

I had a case with delayed altered sensation a number of years ago that I published. This is uncommon. My pt had no systemic except diabetes. The breakdown products of porphyryn, ferric free radicals can cause neuropathy. Was there a mental block given for the implant placement? Was there an intraosseous V-3 block? Dennis Flanagan DDS MSc

My case the altered sensation lasted only about 2 months.Flanagan D. Delayed onset of altered sensation following dental implant placement and mental block local anesthesia: a case report. Implant Dent. 2002;11(4):324-30. PubMed PMID: 12518698.

I had a case which I completed over twenty years ago. It was a three unit bridge on two implants in the lower right quadrant. After twenty years the patient started reporting pain. She was well into her 70's when she reported the pain in "her jaw" at that location. I did not know what the problems was. She went to an oral surgeon who came to the conclusion that the implant treatment was done all wrong and that they should be removed and replaced ( despite the fact that there was no bone loss around the implants and implants and prosthesis had functioned without discomfort for over twenty years). She reported this discussion with the oral surgeon to me and I took a day or two to think it over. After some thought I connected these "dots." She was in her mid 70's. She had osteoporosis. She was taking oral bisphosphonates and the implants were placed virtually as close to the inferior alveolar canal as could be without causing numbness. These dots led me to a theory: Heavy occlusion on the implant prosthesis was causing micro-strain and micro-movement on the supporting bone over the canal, enough to cause pain when functioning. Over the twenty years since the prosthesis had been placed, the rest of her dentition had worn much more than the implant prosthesis causing an ever increasingly heavy load on the implants year by year. Her bone density on the other hand, had decreased. She came back, I checked her occlusion and it was indeed very heavy on the implant bridge. I adjusted the occlusion, lightened the load and the pain disappeared and never came back. These are a lot of dots to connect and very anecdotal. Take it for what it is worth. It did save my patient a lot of pain, expense and grief.

Very interesting...it could very well be that a combination of bone altering medication and occlusal load combine to stimulate previously unaffected neural areas.