The Cosmetic Dentistry Blog

August 28, 2012

Why couldn’t my dentist get me numb?

Dear Dr Hall,
I have a peculiar problem which my dentist could not solve even after 11 sittings. My front lower teeth (two of them, I think they are called central incisors) are partially dead (injury from football during college) now half of it is infected and half of the nerves are still alive. I have got 5 injections and a paste on the tooth to numb it, it simply does not numb enough for a root canal. My dentist returned my fee, I am virtually living on ultraset since last 2 weeks now. your view and guidance would be a blessing.
Best regards,
Ankur from India.

Dear Ankur,
I’m confident I know precisely the answer to your problem, because the same thing has happened to me, when I had a root canal treatment done.

There is always a certain amount of anxiety when you’re having dental work done. And especially after trying and failing to get a tooth numb for dental work (you said 11 times), the amount of anxiety is going to increase dramatically. A lot of dentists don’t understand the connection between this anxiety and the novocain that they depend on to get you numb, but the anxiety counteracts the novocain and can even make it impossible to get you completely numb.

This happens with me, and once I understood this, I saw this in many of my patients who were difficult to get numb. What you need is some type of anti-anxiety medication. Taking 10 or 20 milligrams of Valium could do the job. Or, if you can find a dentist who uses nitrous oxide gas, that could do it also. If it’s Valium, take that at least 30 or 40 minutes prior to your appointment. But be sure you have someone who can take you to the appointment and take you home, as you will not be fit to drive probably the rest of the day. There are other good anti-anxiety medications that are useful for dentistry also, such as Halcion.

For more perspective on this, please see my article on dental fear that was published in Dental Economics.

Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

January 25, 2012

Followup on: Twelve shots of novocain to get me numb

Filed under: Dental fear,Extractions — Tags: , , — mesasmiles @ 4:51 pm

Earlier this week, I fielded a question from Gail from California who told me that it took twelve shots of novocain to get her numb for her tooth extraction. I explained some about dental anxiety, and she followed up with these comments and a question:

Dr. Hall,
1st let me say I “liked” you on Facebook and wrote a comment recommending your site.

Thanks for responding so quickly. Sorry I wasn’t more detailed.

As for the 12 shots of novacaine – all but one tiny spot was very numb. Everytime the dentist would apply pressure to the area pain would shot up the side of my face. The dentist said she was having a hard time getting that tiny area numb. When I went back for the removal of the bone spur, the dentist said the spur was probably the reason for the sensitivity experienced during the extraction done the previous week. This time 3 shots numbed the area great. The dentist said that one of her other patients had been in the morning with the same problem (bone spur) from her extraction the previous week too. The dentist said she couldn’t figure out what would have caused the spur to work itself to the surface.

Now the area where the bone spur was removed is VERY sensitive and this is the area where the ridge of bone is sticking thru the gum line. Whenever my tongue hits a spot on this “boney” ridge, pain shots thru my entire left side of my gum line. It also feels like the outside of my face is bruised along the same location. The dentist and her staff are very kind and caring. I just don’t know if I should go back to give them a chance to get it right.

Have a great one,
Gail from California

Gail,
Thanks for your kind comments.

There’s nothing really unusual about your experience, and it sounds like your dentist is doing a good enough job. And this will heal by itself given time, it’s just a matter of whether or not you’re comfortable in the meantime. I think you’d be fine going back to her for help.

But this idea that it was the dentist that just had trouble getting one spot numb – that is the anxiety, totally. This tooth that was extracted was a lower left second molar. There is one nerve that goes to the entire lower jaw on that entire left side, and it’s either completely numb or it’s not completely numb. It’s not possible to get one spot numb without numbing the entire side. It will FEEL like that, but it’s the anxiety. I know. As I said, not only did I treat a lot of patients with this problem, but I myself am one of those patients. The dentist pokes the tissue all around the tooth and you can’t feel it because it’s numb, but they go to extract the tooth and try to separate the tooth from its socket and it hurts. That’s how this works. The novocain is strong enough to block the very mild pain of poking the gum but because of the anxiety it isn’t strong enough to block the intense pain of the extraction.

You were fine for the loose bone spur because that requires a less profound anesthesia than the extraction.

And if a bone spur is loose, it will likely work its way to the surface. But, as I implied, this is no big deal and it just needs to be removed – if not by the dentist then by the patient at home – either way is fine.

Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

July 23, 2011

I have a high resistance to novocain

Dr. Hall
I am a fairly young female who has extensive dental problems mainly due to having a high tolerance for novacine. Therefore, making every trip to the dentist horrifyingly painful. After a while I just got discouraged and stopped going. Now I am older and what to take full control of my dental hygenie. I have 5 or more teeth that need to be extracted but haven’t done so cause I immediately want them replaced with preferably implants. My goal is to have heathly teeth with a beautiful smile. Since I live in New York, do you recommend I out-source to another state to keep the cost as low as possible?
- Nina from New York

Nina,
Manhattan has some of the best cosmetic dentists in the country, but it is also a very high fee area. Yes, if you want to save money and don’t mind travelling, there are excellent cosmetic dentists in either New Jersey, or on Long Island.

Interestingly, over the years when I have looked, I haven’t found a cosmetic dentist I wanted to recommend in any other boroughs of New York City except Queens. So apparently really good cosmetic dentists have no interest in locating in Brooklyn, for example.

But I wanted to address your high tolerance for novocain. This is nothing more than a higher level of anxiety when you’re getting dental work, and what you need is not more novocain but some type of relaxant. I know this subject very well, because I had a special interest in treating this type of patient, and the question I asked to find out if people needed a little nitrous oxide or possibly an oral sedative was, “How does novocain work for you?” In every case, where a patient had what they felt was a high resistance to novocain, using a little nitrous oxide, or perhaps an oral sedative before the appointment took care of the problem, and the novocain worked fine.

I also know this subject well because I am one of these patients also. I’ve had some very stressful experiences in the dental chair as a patient, so I tend to get anxious when I have any work done and the novocain wears off very quickly on me, unless I have some nitrous oxide. You can read about this in an article I wrote for Dental Economics about dental fear.

So look for a dentist who has nitrous oxide available. That could mean a world of difference to you for your future dental care.
- Dr. Hall

 

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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