Failure to numb lower jaw

[Anna]

I have always had problems with my lower jaw not getting numb, which (quite naturally!), has made me very anxious.

In the past I have been referred to a dental hospital for a root canal, and was told there that I had unusual anatomy of the nerves - dual innervation possibly?

Anyway, fast forward to this week - I needed a filling in a lower molar, and my lovely dentist who I'm usually totally relaxed with, had his first experience of me acting as a hyped up anxious patient! Sure enough, after 2 nerve blocks (one slightly higher than the other) and a wait of about 30 mins, I was still not completely numb (lip was still tingly) and I didn't want him to start drilling. He then did a pdl injection (gave me some LA into the gum first) down the side of the tooth, and that did the trick! I've not seen much discussion on this board about this type of injection for 'hard to numb' patients? Is it often used?

When I was having treatment at the dental hospital they tried using Articaine, as a last resort, but when I mentioned that to my dentist this week, he said it shouldn't be used on the bottom jaw. Is that correct, and if so, why?

Just curious!

Thanks

 

[Zzzdentist]

Re: Question for dentists please (failure to numb)

PDL injections are common and definitely can help with difficult to numb situations. Remember to remind the dental staff that you may require it the next time you need any work if they don't have it noted down already.

For some reason certain people are extremely difficult to freeze, possibly due to variances in nerve location or accessory nerves. Dentists rely on certain landmarks to pinpoint where to numb, and when the nerves aren't where they are typically located or when there are additional nerves that can be a problem.

It can be very frustrating for both dentist and patient, and understandably it can make the patient more dental phobic because of the difficulty in achieving complete anesthesia. Remember the dentist is trying their best to get you 100% numb, and it might be just due to something not entirely in their control.

I've used Articaine (Ultracaine) for years without any problem. I have read that some don't recommend it due to possible problems with parasthesia (lingering numbness).

 

[Anna]

Re: Question for dentists please (failure to numb)

Thank you so much for the reply. I love to know all the technical details!

Yes, my dentist has noted down that I needed a PDL injection. He owns the practice, so I hope I will be with him for a very long time, as it's one of my biggest fears having to explain to a new dentist that I have a problem. That is where my phobia started, having to try and persuade disbelieving dentists that I really do have a problem getting numb!! Some unfortunately seem to take it as a slur on their abilities.....

One other question - if I had just had a PDL injection and not a nerve block, would that have just numbed the tooth, and not half of the lower jaw? If so, why don't dentists use that method more often?

I really appreciate your speedy reply. Thanks

 

[Zzzdentist]

Re: Question for dentists please (failure to numb)

Don't quote me here since I don't do them that often, but I believe that PDL (intraligamentary) injections provide deep pulpal anesthesia for a shorter period of time depending on the amount of anesthetic deposited so it might be enough to "get over the hill" when doing a procedure, but it may not be enough from start to finish.

Also, for a lot of dental procedures, it's nice to have an entire area numbed up rather than a localized area if you're doing a fair bit of work, using rubber dam or say extractions. PDL injections are more localized to the area that they are given so it might take a few injections to cover an area adequately. The injections themselves can be more sensitive since you are injecting into a ligament space which is not that accomodating to having liquid injected into it.

Another alternative that some people use is intraosseous anesthesia where a small access opening is made directly into the alveolar bone and anesthetic is injected into it.

 

[Anna]

Re: Question for dentists please (failure to numb)

Thanks once again for the speedy reply and info

 

[Gordon]

Re: Question for dentists please (failure to numb)

I've had some PDL injections (I quite like to try stuff out on myself!), the other disadvantage of them is that if they're not done slowly and really carefully, you can have terrible sensitivity to biting pressure for about a week afterwards, not a problem with extractions but no fun at all after fillings.

 

[Anna]

Re: Question for dentists please (failure to numb)

My dentist is the best at injections He did warn me that I may have some pain afterwards, but not a thing. He must have been really really careful!

I can't believe you give yourself injections just to try them out. That really is dedication to your job!

 

[harper]

Re: Question for dentists please (failure to numb)

once gordon gave himself his own injection in the car

 

[Issy]

Re: Question for dentists please (failure to numb)

once gordon gave himself his own injection in the car

 

[harper]

Re: Question for dentists please (failure to numb)

think he said it was easy

 

[scaredstiff]

Re: Question for dentists please (failure to numb)

Like your humour Harper.

 

[brit]

Re: Question for dentists please (failure to numb)

It's not just humour SS..it's true..there's an old thread on it somewhere...even dentists get toothache sometimes you know...he was doing his own anaesthesia before going in....makes perfect sense don't you think ?

 

[harper]

Re: Question for dentists please (failure to numb)

think he would have done the rct as well if he could!

 

[Gordon]

Re: Question for dentists please (failure to numb)

I'm not very good at RCT, so I thought it best to let a friend do that bit

Basically if I gave myself the local, I could save my friend having to work through her coffee break to do my emergency endo, so it was the least I could do.

Back on topic... the painful bit of PDL injection isn't really the injection itself, it's the "bruising" that can happen to the little ligament that holds the tooth in, the PDL indeed and that makes it painful to chew on the tooth for days afterwards.

 

[puppypusher]

Re: Question for dentists please (failure to numb)

I'm not a real needle phobic thank goodness but giving myself one especially in the mouth...Wellll that's pushing the envelope.I do however admire anyone who can

 

[mikey]

Re: Question for dentists please (failure to numb)

Giving myself my own shot. ....hmm it seems like i must have over dosed on the crack before i did that!
so good for you gordon.

 

[harper]

Re: Question for dentists please (failure to numb)

when i was having probs with a tooth c got out the thing they give you the la with and the tool for extracting teeth and said get hubby to do it! and yes he was joking