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Dental Anesthesia

Novocaine Injections- Choices for Anesthesia

09/27/2011

Question:

I just had the worst experience ever..went to the dentist just to get antibiotic for a swollen jaw& cheek, (from a wisdom tooth that needs surgical extraction because its triple impacted i believe) anyhow while i was there the dentist noticed that i had a couple teeth that becuae of being weak, has a spot opened on each, close to my gumline and decided he wanted to fill/restore them. the bad part is they had to numb me 6 times because after the first couple i still felt pain in the teeth when the air from the drilling hit them even though my entire right side of my face was completely numb! after the drilling came the hygenist to fill them, (more air to dry) and wow the pain was horrible, So, back again he came to hit me up with another round of novocaine #7 I believe. is this normal or should I try something else next time around? I have been told I have very sensitive teeth, and I always have to be numbed with topical anestic just to ease the pain of a cleaning and make it bearable. I know for the surgery I am requesting to be put to sleep. but what if anything can be done for pain during fillings and afterward when I get home?nothing i have tried is taking the pain away..im on 800 mg of motrin but ive been having to do 1200mg every 6 hours and still in pain!!cant wait to call this dentist in am, maybe the can give me soemthing else for pain?

Answer:

First of all, prevention of tooth decay is greatly preferred compared to drilling out the decay and patching decayed teeth with filling material. Cavities near the gum line are usually the result of ineffective or too infrequent tooth brushing which allows food and sticky plaque to accumulate at the gum line that leads to proliferation of cariogneic bacteria that cause tooth decay.

This same process also typically leads to chronic infection that over time destroys the periodontal ligament that binds the tooth to the supporting bone. This periodontal disease, called "periodontitis" will eventually cause severe bone loss and the teeth become loose and even fall out later in life.

Additionally, poor oral hygiene leads to increased amount of calculus, the hard substance that the dental hygienist has to scrape off the teeth. If the gums are swollen and painful as a result poor oral hygiene, the hygiene scraping procedure will be painful. So brush and floss at least twice a day and prevent the need for uncomfortable dental treatment.

As far as getting the teeth numb, some patients are more difficult to numb because their nerve to that tooth or teeth is in a different location from the usual position and therefore not enough local anesthetic gets to the nerve if the dentist gives it in the usual location where it is supposed to be.

Also the tooth may be connected to a different nerve than normal, so numbing the usual nerve is inadequate. In such cases, some dentists give supplemental injections of local anesthetic in a different place from normal. The "periodontal ligament injection" (injection into the periodontal ligament) and the
"intraosseous injection" (injection into a small hole in the bone) are alternative injections that can be done if the usual injections are ineffective. They usually work.

There is primarily anecdotal (word of mouth) evidence is that the local anesthetic 4% Articaine with epinephrine may be somewhat more effective than the usual anesthetic that most dentists use, especially in teeth in the upper jaw. Some dentists do not use it in the lower jaw due to possible increased risk of permanent numbness of the lower lip and teeth.
 
In the worst case scenario, there is always general anesthesia if the general dentist has access to a dentist anesthesiologist or at greater expense general anesthesia in a surgicenter or hospital.

The pain from the infected teeth can make the entire pain system wind up and make it much more difficult to control pain from other sources such as cavity repair. Getting the infection under control and then removing these painful wisdom teeth as soon as possible should make you more comfortable

Finally, be careful of overdosing on ibuprofen. If you are healthy, you should absolutely take no more than 3200 mg in a day (800 mg every 6 hours which is 4 times a day) if the usual recommended dose to 2400 mg/day is ineffective.

Having a clean healthy mouth will decrease the baseline pain will make the ibuprofen much more effective in treating pain only from dental work.

For more information:

Go to the Dental Anesthesia health topic, where you can:

Response by:

Joel M Weaver, II, DDS, PhD
Faculty Emeritus
Dentistry Administration
College of Dentistry
The Ohio State University