Anesthetic Resistance, 56 /F

[KittysKid]

I have a history of difficulty achieving adequate numbness during dental procedures, despite treatment by different providers. This issue has also occurred outside of dentistry—during a vaginal biopsy. At that time, my primary care physician suggested that my body chemistry or tissue pH might require a different type of local anesthetic. Based on that guidance, I informed my dentist, and articaine was used successfully.

When I changed dentists, I explained my anesthetic history. A crown replacement on my upper arch was completed without issue. However, during two separate appointments for crown replacement on my lower arch, I was unable to achieve sufficient numbness. The most recent appointment had 2 injections into mandible & 2 at the gumline , it still didn’t work & was particularly unpleasant, and I became concerned that articaine was no longer effective for me.

At a recent wellness visit, my new primary care physician attributed the problem to the dental technique and questioned why I allowed the procedure to continue. I explained that once a crown had been partially cut, the remainder had to be removed. I disagreed about the dentist technique & asked whether a sedative might be appropriate & if further evaluation could rule out/ clarify an underlying issue, especially since I have been having same side eye ice pick headaches & jaw & neck pain-very limited ROM, but was told there was nothing & he could not help me-take it back to the dentist. I already know that many things can cause this-like my h/o fibromyalgia as well as genetic mutations, but it wasn’t worth any more effort. I have to find a better doctor.

I subsequently contacted my dentist’s office to express my apprehension and request consideration of sedation. Just to be sure I asked what was used & he informed me lidocaine. Well that may be the issue. I reiterated my prior difficulty with lidocaine and explained that, due to fibromyalgia and associated hypersensitivity, I sometimes require an alternative anesthetic. I am hopeful that this clarification resolves the problem. My only remaining concern is that lidocaine was effective in the upper arch but not the lower, which I understand may be due to the greater difficulty of achieving anesthesia in the mandible.

We are going to try articaine & forego any sedative. I wasn’t crazy about that. I will take any advice /recommendations , so I can be the best patient & everything goes smoothly.

 

[Gordon]

Not sure what the question is? You seem to have things under control.

Articaine diffuses better through bone than lidocaine, so in theory it will be more effective if not deposited closely enough to the inferior dental nerve before it disappears into the inferior dental canal.

Physicians also seem to be fond of using 1% lidocaine, without adrenaline, which is less effective than the standard 2% stuff with adrenaline that's used in dentistry.