Volume 9 • 2022 • Issue 6

socket can damage the fascial spaces, inducing stretching and inflammation of the facial nerve. Similarly, a local anesthetic needle can damage the blood vessels around the epineurium of the facial nerve, causing hemorrhage, fibrosis and consequent compression of the nerve. The inferior alveolar nerve block (IANB) can damage the facial nerve via direct trauma from the needle as well as anesthetic infiltrating the peripheral branches of the facial nerve. Incorrect IANB technique (too far posterior insertion of the needle) and anatomic variability of the facial nerve have been associated with immediate-onset BP. Delayed-onset BP occurs days after the dental procedure and the recovery is prolonged. Viral reactivation, ischemia, and inflammatory theories have all been explored as possible etiologies for delayed-onset BP.Stress and local trauma in dental procedures may result in viral reactivation, particularly in patients with a prior history of HSV infection. Excessive stretching of the facial nerve can also lead to direct damage of the nerve or ischemia. Lastly, intravascular injection of local anesthetic may cause retrograde flow of the anesthetic, spreading distally and resulting in facial nerve paralysis. Other dental-related BP cases cited in the literature include acute infection of a tooth resulting in inflammation and compression of the facial nerve, neuropraxia caused by abscess or cellulitis, and orthognathic surgery. In patients with BP, oral hygiene is significantly affected due to the lack of self-cleansing associated with the function of orbicularis oris. This phenomenon results in increased food debris in the vestibular pouch, leading to increased periodontal disease and tooth decay. Regular dental recalls are mandatory for such patients in order to maintain their oral health. Additionally, edentulous patients suffer from cheek biting, mandible deviation to the non-affected side, and difficulty in pronunciation of various sounds including labiodental, bilabial, and fricatives. Conclusion It is important for health care professionals to recognize BP, diagnose it early, and differentiate it from other underlying causes. Although most cases resolve spontaneously, early diagnosis and prompt management contribute to a favourable prognosis. In a small subset of patients, permanent complications may arise, requiring a multi-disciplinary approach involving neurologists, ophthalmologists and physicians. Therefore, it is crucial for clinicians to understand the etiology, signs and symptoms, and the correct management of BP patients. Figure 1. Illustration representing an acute unilateral facial paralysis. Dr. Danesh is a periodontics resident at Nova Southeastern University. He completed his DDS at University of Toronto. Dr. Ouanounou is an associate professor, department of clinical sciences (pharmacology & preventive dentistry), faculty of dentistry, University of Toronto. He is corresponding author of the original article, which includes the full reference list, available at: jcda.ca/m8 34 | 2022 | Issue 6 SupportingYour Practice