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Dental Anesthesia

Why would local anesthetic not work?

06/16/2008

Question:

My daughter had a tooth extracted and after 3 times the normal dose of local anesthetic still felt the procedure 100% and walked away with none of the normal numb face or lips and could talk normally. As we all know we usually walk away looking somewhat like a stroke victim (for use of better descriptive) and talking is a struggle to say the least. My daughter has been through chemotherapy and 3 surgeries to remove astrocytoma from her spinal chord, so she is no stranger to pain. When she tells me she felt pain I believe her. Are there any other cases where locals had no effect or anything else that could be related suggesting why my daughter had to be subjected to this pain due to disbelief anything could be felt after such a high dose was administered?

Answer:

Sorry for the delay in replying, but I was out of the country giving general anesthesia for Healing the Children.

There are a number of reasons local anesthesia may not work. Especially in the lower jaw, the anatomy is variable for the place the anesthetic needs to be deposited. Sometimes, the solution does not go where it should. At times, there are extra nerves that go to the tooth, again, especially in the lower jaw. And lastly, a tooth that is abscessed may not be adequately anesthetized due to changes in nerve conduction by the tooth and even in the central nervous system. It is unlikely the astrocytoma has any connection to this.

Also, the dentist probably did not give three times the normal dose but three injections. Three times the normal dose may lead to local anesthetic toxicity.

I also believe you daughter was in pain based on your report. It may be that the next time, the anesthetic will be in exactly the right place. If this was the lower jaw and your daughter does not have lip and tongue numbness, then the procedure should be cancelled and I suggest you consult with a pediatric dentist who specialized in treating children.

I wish you daughter good health with all of her concerns.

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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