Do you have trouble getting numb for dental treatment?

 

When it comes to getting numb, people are truly unique.  One patient that I have been treating for more than 25 years takes less than half of my weakest anesthetic (Citanest Plain, which has no vasoconstrictor) and will get numb in 1 minute in her lower teeth and be totally numb for an hour. For a dentist, this is wonderful.

 

Here is a little bit of information on dental anesthetics: on the upper teeth, the way anesthetic usually works is through injection outside the jaw so that the anesthetic will go through the bone, known as an infiltration injection. This works fine as long as the bone is thin enough for the anesthetic to penetrate it. On the lower teeth, we use a block, which means that the anesthetic blocks the nerve before it goes into the jaw. The lower jaw is not very porous, and the anesthetic doesn’t infiltrate it very well except for the lower front teeth.

In terms of the choices for anesthetic, there are several in the dental arsenal. The normal one is lidocaine with epinephrine. It works well, has few side effects, and has been the work horse for most dentists for many, many years. But, some people have other situations which would lead the dentist to use something else. Citanest Plain is an anesthetic without the epinephrine (epinephrine is a vasoconstrictor which helps to keep the anesthetic in the area); some patients experience a prolonged period of heart racing with this, and that is a reason to use something else. Some people don’t get numb well with either of these products, so we have Septocaine and Marcaine as 2 other choices. Surgeons tend to be particularly fond of these.

So what happens if this doesn’t work? One choice is doing an interligamental injection which goes down along the side of the tooth. (this is in addition to one of the above injections). There is also an intrabony injection where a small hole is drilled into the bone for injection just past the outside wall of bone (both upper and lower jaw are rather hollow!). Root canal specialists who are trying to treat a tooth that has a throbbing toothache frequently rely on this adjunct to their anesthetic options.

The above list of choices is pretty much what a dentist has to choose from. If these don’t work, then the patient may need general anesthesia.