Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

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.

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.

January 23, 2012

Took twelve shots of novocain to get me numb

Filed under: Dental fear,Extractions — Tags: , , , — mesasmiles @ 4:31 pm

Dr. Hall,
I recently had tooth #18 extracted. It took 12 shots of novacaine before the area was numb enough. About 5 days after the extraction a bone spur appeared at the extraction site. Everytime my tongue hit the spur it sent exteme pain thru the whole left side of my face. It took about 30 minutes to remove the spur as it was hard to reach. It has now been 8 days and the entire left side of the extraction site appears to have a ridge like sharp bone-like thing sticking out. It is very uncomfortable to swallow, eat, smile, etc. Is this just part of the healing process? I’m not real confident with this particular Dentist so I want to get some idea before I return. Thanks.
– Gail from California

Gail,
Requiring twelve shots of novocain before your tooth was numb enough to be able to take it out could be a problem with the dentist in missing the injection. But far more likely, it was your anxiety that was fighting against the novocain.

Most dentists aren’t aware that anxiety can cause novocain to either not be fully effective or to wear off very quickly. I’m quite an expert at that because that is the type of patient I am. I get fairly anxious in the dental chair and when I had to have some teeth extracted about twenty years ago, the dentist couldn’t get me completely numb for more than a couple of minutes.

And you say this bone spur appeared five days after the extraction, and that it took half an hour to remove it. You didn’t say whether you did this yourself or if you made a return trip to the dentist, and I’m not sure whether this was a loose piece of bone or a sharp edge that was firmly attached to the underlying bone. Dentists should try to remove any loose pieces of bone that result from an extraction, though if they don’t, it isn’t really a serious situation. Sharp edges can surface during the healing process, and that is quite normal. When the tooth is removed, the socket will have a sharp edge to it. You don’t notice it because the gum tissue is over it, but as it heals, the gum can shrink down and the sharp edge can then be on the surface. If it is enough of a problem, the dentist can smooth it over or clip it.

I’m not convinced that your dentist did anything wrong here. But having said that, it doesn’t look like you are a good match for this dentist. When you had such a problem getting numb, that indicates to me that you need some type of relaxant – nitrous oxide gas or an oral sedative. It appears that this dentist didn’t have this at his or her disposal to offer you. You could be better served by a dentist who has these additional tools available.

Dr. Hall

Note: Gail sent me a follow-up e-mail with some more details about her experience and another question. See the follow-up post to Twelve shots of novocain to get me numb.

 

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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.

August 13, 2011

Dental Accidents: My dentist cut my tongue and my lip, so I want a refund

Dr. Hall
I’m 31, and had my first bad experience at the dentist this past week.

I was 2 hours laying in the chair flat on my back for a crown and 3 fillings. Opted for the gas. I didn’t feel like it did much, but whatever. Here’s what went wrong.

During this visit the dentist nicked the outside of my upper lip with a utensil which caused me to bleed a little because he kept puting his finger on it.

Then a drop of some kind of chemical splashed out of my mouth and into my right eye. (It burned quite a bit. I also wear contacts.) I thought maybe it might have been an antiseptic of some kind.

And then after all that he is drilling on one of my back molars and slips off the tooth into the left under side of my tongue. Both him and his assistant jumped and gasped when it happened and I also jumped saying “Well I felt THAT!”

He never once apologized for any of it and when I told him I was in a lot of pain a couple of days later because of the drill slipping off of my tooth into the bottom of my tongue he denied he did anything and said a lot of patients bite their tongue when they are numb. I have a picture of the cut under my tongue and a voicemail of him calling after the dental work was done to check on me since I had had “A lot of dental work done.”

I only wanted an apology and maybe some sort of a discount since this was such an unpleasant experience. What do you think is fair in this situation? I would really appreciate your input. Thanks,
– Stephanie from Arkansas

Stephanie,
Well, it sounds like you certainly deserve an apology, but it doesn’t look like you’re going to get it, or get a discount. It sounds like he is in a defensive posture and not admitting anything you’re saying. So you’re going to be in a position where you will have to force the issue or just accept the outcome. And I don’t think you’d be able to demonstrate damages enough to make a lawsuit worthwhile, so I think the best thing for you to do is just put it behind you and find another dentist.

My recommendation would be to find a dentist who offers sedation dentistry. From what you are telling me, I’m just reading between the lines and it’s just a guess that maybe you were moving around a lot. If these types of dental accidents were habitual with this dentist, I think he would have a hard time keeping patients. So that’s part of what I’m using as reason for my wondering if you were a little jumpy in the chair. Plus the nature of these dental accidents are things you would expect with a jumpy dental patient. And you said that the nitrous oxide gas didn’t do much for you, which implies that you were uncomfortable during the procedure. Just look up “sedation dentist” for your city on Google, see what you find, and call a few offices to see what they could do for you.
– 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 novocain. 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 hygiene. 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.

September 20, 2010

Follow-up from Kenneth – Novocain doesn’t work for him.

Filed under: Dental fear,Sedation dentistry — Tags: , , — mesasmiles @ 4:59 pm

This is the a response to my posting of Sept. 16, “Novocain doesn’t work for me.”

Absolutely fascinating Doctor! You are the first who has actually made that connection even when I did not mention it in my email. It is an unfortunate fact that as a child I was a ward of the county and subject to the welfare medical care available at the time. My siblings and I were removed from our natural parents custody and sent to different homes. I was particularly fortunate in that the people who took me in were fine Christians who gave me an outstanding start in life. It is also true that the dentist I had as a child was (I truly believe) a sadist. As I have reviewed the experiences I had as a child in the dental chair, I now know that this sadly disturbed individual derived some sort of perverted pleasure from inflicting pain on helpless children. Of course, when I told my parents that “I don’t like the dentist!” they dismissed it as normal childhood anxiety and did not give it any weight. I do not blame them at all. I hold no bitterness toward anyone. Not even the dentist himself. My Christian heart still hopes he found a healing somehow. I do believe that it is a combination of anxiety and the conviction that failure is inevitable because of a long string of dentists who have promised painless procedures and failed, each in their turn to deliver. I will take the advice you gave and seek out an appropriate dentist who might help me end one of my life’s greatest embarrassments. Thank you for your thoughtful reply to my email. Are you at liberty to recommend such a dentist in the greater Cleveland Ohio area? I would be very interested in any thoughts you may have along this line. Thanks again for your help and understanding.
– Kenneth from Ohio

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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.

September 16, 2010

Novocain doesn’t work for me.

Filed under: Dental fear,Sedation dentistry — Tags: , , , — mesasmiles @ 5:36 pm

I have an extreme sensitivity to “all” of the numbing drugs commonly used by dentists. This is not a biological reaction, I am not allergic to anything at all, the drugs simply do not work as they normally do with most other people. I have, through hideous experiences come to the realization that I cannot tolerate dental procedures unless I am unconscious. Have you had experience with persons with my situation? I must emphasize that this is not simply a case of inability to handle pain or discomfort. I was the victim of a pilanidal cyst of considerable dimensions and endured the surgical procedure necessary for its’ removal. That really stung a lot! That is nothing compared to what I experience when undergoing dental procedures. Please let me know if I have any hope of improving a less than dazzling smile. Thank you in advance for your time and help.
– Kenneth from Ohio
PS – by the way… well designed for visually impaired persons. Great job!

Kenneth,
Yes, I have had a lot of experience with patients like you, and I understand this problem particularly well because I have had times when I have had so much anxiety that the novocain hasn’t worked for me, either. For me, usually nitrous oxide will calm me enough that the novocain will work. But I have treated a number of patients that had to be deeply sedated in order to become numb.

Few dentists really understand this phenomenon, so I wrote about it a few years ago for a dental journal. There’s something in your body chemistry that if you are stressed or anxious enough, it prevents the complete action of the novocain or causes it to wear off exceptionally quickly. Here is a scenario that I often had in my office. A person comes in for treatment and doesn’t want to admit that they have had past traumatic dental experiences. I give the patient the injection of novocain. They begin to feel numb right away, so I know I have “hit the target.” I begin to work, and they feel pain. So I tell them I think they need nitrous oxide gas. Now here comes the interesting part. If I just give the nitrous oxide gas, they will still feel pain when I start working again. I learned that I had to wait until they were sufficiently relaxed and then RE-ADMINISTER the novocain, and then they were fine. Or if they needed stronger sedation, then I would give that and then I would need to do a new injection after they are fully sedated.

My experience is that this happens when people have had past traumatic experiences in the dental chair. In my case, it was a children’s dentist who didn’t use novocain, and then later painful experiences with other dentists.

I don’t know if you have a dentist, but my suggestion would be to look for a sedation dentist or a dentist who practices sleep dentistry. Conscious sedation rather than general anesthesia is much less expensive, safer, and more convenient than going with complete general anesthesia. And most people will not remember the appointment. But if that isn’t strong enough for you, then you will need to go to the general anesthesia.

Dr. Hall

Click here to read Kenneth’s follow-up e-mail, Novocain doesn’t work.

links:
click here to ask Dr. Hall a question.

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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.

September 3, 2009

Dental treatment for someone in addiction recovery

Filed under: Dental fear,Pain in teeth — mesasmiles @ 12:48 pm

I am currently on methadone maintenance for opiate addiction and I am in desperate need for extensive repair on my teeth. The last time I needed dental work the dentist refused to give me any pain medication after I had informed him that I was on Methadone. I even gave him the name and number of the clinic I attend and permission to speak to the clinic’s doctor and my counselor. I was in need of dental care and in quite a bit of pain and concerned about pain after the procedure. I already have anxiety issues about going to the dentist and my teeth are in great need of dental care. What would be the best way to go about talking to the dentist about my needs. I do not want to continue to suffer with the pain I have been nor do I want to suffer through pain after. If you could offer me any suggestions or know of a compassionate dentist in my area that would be willing to work with me, I would greatly appreciate it.
– Cheryl from California

Cheryl,
Dentists and medical doctors are afraid of the Drug Enforcement Administration, and many of them simply prefer not to deal with any issue that could raise questions from the DEA. Some dentists have gotten in trouble simply because they were trying to be compassionate, and as these stories circulate, it’s the patient that suffers.

You just need to find a dentist for whom the compassion will be a ruling factor and not fear of the DEA. I would start by looking for dentists who do sedation dentistry, and then ask them up front if they can help you with your treatment and post-operative pain control, given that you are in addiction recovery. My advice would be to just keep asking around until you find a dentist willing to help you. Dentists tend to be compassionate, but they also tend to be timid. But I’m confident you could find someone who would be a match for you.
– Dr. Hall

Related links:
Read about toothache pain

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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.

April 7, 2008

Sensitive to novocain

Filed under: Dental fear,Porcelain veneers — mesasmiles @ 7:36 pm

Dear Dr. Hall,
I am going to have porcelain veneers done in a few days. I am very sensitive to novocaine and any other drug that can make my heart race. Is there any drug ingredient in the process (such as a caine or epinephrine) of porcelain veneers that you are aware of? A friend told me that she got very shaky during the beginning process of being fitted. She was not at all nervous, but her hands started to tremble just after a green topical agent was used prior to the impressions. Her heart started to race and her hands continued to tremble for 15 minutes. Is this possible?
Thank you.
Alison in Rhode Island

Dear Alison,
I have several points to make in answer to your question.

First, the shaking reaction wouldn’t be to the novocain, but could conceivably be due to the epinephrine that is usually present in the novocain. Epinephrine restricts the blood flow in the area of the novocain injection and thus keeps blood from carrying it away and makes it stronger.

Second, the shaking reaction, in my opinion, is more likely to be due to dental fear. Even when there is epinephrine in the novocain, that is less significant than the epinephrine your own body will produce if you have any dental fear, which most people have to some degree at least.

About your friend’s experience, I have some personal experiences as a patient that help me understand that. There were times when I would tell myself that I wasn’t nervous when I began being treated, but what happened during the appointment definitely revealed that I really was nervous. This dental fear can be a strange thing, and part of the way many people try to prepare is to convince themselves that they aren’t nervous. I think that’s what happened to your friend, because there is nothing in the topical ointment that dentists use that would cause shaking or trembling.

My advice? The best way to reduce the ephinephrine in your system is to use nitrous oxide gas or a pill with relaxant medication. Doing that has done wonders for me and for many patients I have treated that have had this sort of thing happen to them. The dentist could use a form of novocain with no epinephrine, but in my experience in treating people who have had reactions like yours, it’s more important that they are thoroughly numb, which is the purpose of that small amount of epinephrine, and a mild relaxant usually takes care of this reaction completely.
– Dr. Hall

Related topics:
sedation dentistry
sleep dentistry

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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.

April 3, 2007

I’m getting dentures. Do I go to a general dentist or oral surgeon first?

Filed under: Dental fear,Dentures — mesasmiles @ 12:39 am

Dr. Hall:
I am a 50 year old man who grew up with a fear of dentist. At an early age I was “freaked out” by a dentist and never really wanted to go to them – unless it was to have a tooth pulled.

Now that I am older most of my teeth are broken or missing. I need to get dentures – my question is how do I know if I need a dentist or an oral surgeon to remove what teeth I have left? This is rather embarassing for me and it keeps me from a lot of activities involving my daughter because of the embarrassment.

Can you tell me which I should look for so I can have my teeth fixed and once again be able to smile in public?

Thanks in advance – I would appreciate the help.
Robert from Ohio

Robert,
I would go to a dentist who can do the tooth extractions – the surgery AND do the dentures. Doing pre-denture surgery isn’t complicated, and there are many general dentists who do it. Just call the dentist’s office and ask what the dentist USUALLY does. Don’t give any hint as to your preference before you ask the question. You just want to find out how the dentist usually handles cases like that. A dentist who usually does the surgery, too, will have plenty of experience at that.

And since you have this dental fear you talk about, you’ll also want a dentist who offers sleep dentistry. In Ohio that shouldn’t be a problem, as there are a number of dentists there who do sleep dentistry.

The reason is that there is a certain amount of coordination that is needed between the surgery and the denture. You may, for example, choose to have the denture placed the same day as the teeth are coming out. This is called an immediate denture. This eliminates the embarrassment of going for six weeks or more without any teeth. Even if you don’t do that, there are certain things the dentist can do during the surgery to help the dentures fit better and be more comfortable, and general dentists are more familiar with those things than oral surgeons.

But even if you did have an oral surgeon take out the teeth, you’d still want to go to the general dentist first, because the general dentist will coordinate the procedures.

Good luck,
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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