Chronic apical periodontitis (tooth abscess) of mandibular premolars and molar teeth is quite common. What can occur is paresthesia - a sensory disturbance with clinical manifestations such as burning, prickling, tingling, numbness or itching. A common area for nerve damage to occur is the mental foramen region due to its more superior position in the jaw compared with the rest of the inferior dental canal. Therefore, it is important for dentists to be aware of the position of the mental foramen which studies report to be situated apical to the second mandibular premolar or between the apices of the premolars. Dentists should be aware of the fact that severe chronic apical periodontitis of mandibular premolars can lead to mental nerve neurological complications. Radiographs, a detailed history of the patient and clinical evaluation are critical to reaching the correct diagnosis when evaluating for the necessity of a root canal procedure. With proper care the patient’s neurologic symptoms can be completely resolved. Failure to perform conventional endodontic therapy with appropriate antibiotics can cause mental nerve injury to the patient.
- John O. Winter, DDS