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Dental Anesthesia

Mandibular block reaction

05/13/2008

Question:

I never had any prior reaction to any caine medication or ever had any problem being numbed with miminal anesthetic. (i.e. lidociane or novacaine). Septocaine Mandibular block used for lower back tooth filing. Following injection, had sudden rushing of gushing fluid with acute pressure in the upper roof of the mouth. This felt like someone had a hose behind the roof of my mouth turned on full blast. This was followed by an intense fluid pouring sensation through the entire side of the face (injection side), then profound numbness in the entire side of the head with a throat tightening sensation. Can you tell me what caused this? New dentists are afraid to use any anesthetic due to prior reaction, as they are thinking this was some type of allergic response. After the initial reaction, had non-abating oral and facial numbness, paresthesias, pain, numb leg, and pulling sensation to the corner of the injection side eye. Tongue muscle weakness (back of tongue). Can you please provide your input on what would cause a mandibular block in lower jaw to cause rushing fluid against upper roof of the mouth? Thank you very much.

Answer:

I am sorry, but I do not fully understand your question. I can say that I do not know what would cause the sensation you describe. There are many patients who describe unusual sensations from local anesthesia around the mouth when nerves other than those going to the jaws are anesthetized. There are several approaches to anesthetizing the lower jaw. If the Gow-Gates approach was used, perhaps this sensation you describe might occur but even then, I am hard pressed to understand the relationship. You may wish to ask you dentist if that was the approach.

In any case, this does not sound like an allergic reaction. I would recommend that you have your dentist use a small test dose of local anesthetic for upper tooth anesthesia and see if there is a reaction. If not, proceed with normal procedures. Another alternative is to have a dentist anesthesiologist come to the office and be there with you when treatment is rendered. These are dentists who have completed full general anesthesia residencies and can manage any complication. A list can be found at http://www.asdahq.org/.

I hope this helps.

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Response by:

Steven I Ganzberg, SB, DMD, MS Steven I Ganzberg, SB, DMD, MS
Formerly, Clinical Professor of Dentistry
College of Dentistry
The Ohio State University