The management will depend on the mechanism (Table 22.2) and the duration of the nerve injury and the patients’ complaints. Many injuries have limited benefit from surgical intervention and should be managed symptomatically. Earlier intervention is required for endodontic, implant and third molar-related nerve injuries as discussed.

If there is a persistent large neuropathic area (>40 % dermatome) then a severe nerve injury is present. If pain and/or hypersensitivity are present these will often be the main precipitating factors of difficulty with daily function. These symptoms may not be best treated using surgical intervention, however the patient’s inability to cope with disability and pain, is often the driving factor.

Prevention is the key as no management strategy guarantees resolution of nerve injury in relation to implants. Timing of intervention is summarised in Table 22.2.

Management of LA, orthognathic surgery and trauma-related injuries is essentially by counselling and medication for pain if present; however, prevention is better than cure. Valid consent will ensure that the patient understands the surgical risks and consequences when nerve injury occurs. Reassurance of the patient and giving them realistic expectations of recovery is suggested. Iatrogenic nerve injuries will require treatment in the

None of these interventions ‘fix’ the patient, but the aim is to manage their symptoms as best as possible, often not very satisfactorily. The prospect of lifelong neuropathic pain combined with functional difficulties and the psychological impact of the iatrogenesis is often a significant challenge for any patient and clinician to manage.

Burning mouth syndrome is a rare but impactful condition affecting mainly post-menopausal women resulting in constant pain and significant daily difficulty with eating, drinking and daily function. The aetiology of BMS remains an enigma. Recent evidence suggests a likely neuropathic pain, the cause of which remains unknown. There is no cure for this condition and the unfortunate patients remain managed on a variety of neuropathic pain analgesics, salivary substitutes and other non-medical interventions that help the patient ‘get through the day’.

Burning sensations in the mouth can result from a variety of causes including oral candidiasis, lichen planus, allergies, oral galvanism, xerostomia, systemic diseases like diabetes, deficiencies in vitamin B12, folic acid or iron, hormonal changes and autoimmune disease. In these cases, the term secondary burning mouth syndrome is used [9, 42]. The burning sensations may then subside if the primary cause is managed successfully. Primary Burning Mouth Syndrome (BMS), in which none of these potential etiological factors are present, is considered a neuropathic pain condition.