Incomplete numbing

[Deblomas]

Hi, this is my first post here. I have been treated for dental phobia over the last two years after feeling pain of varying degrees at almost every treatment for quite a while. I had been getting on well, every 3 months I have a check up so it doesn't become too big a deal, and I have had quite a few small repair jobs done without issues, also my dentist changed anaesthetic too which helped. But today I have had a filling in the place where it all started and despite the new anaesthetic, and plenty of it, I was in a lot of discomfort. I'm usually ok after the drilling but today pushing the filling in made me yelp. I feel I have gone back a few years and will never be able to have work done in this area (lower left) again. My dentist thinks my nerves not in the usual positions in this area, but my question is is there a way to find this out? Scans or similar maybe. I don't want to swap dentist as he is really patient with me. If I can find how my nerves run surely it will make dental work a lot easier. Any ideas gratefully received.

 

[grumpybear]

Perhaps a CT scan or a MRI scan? I'm not a doctor or a dentist but I had to get a MRI scan of my spine done so my orthopaedic surgeon could see my nerves so maybe it could work for the mouth as well. Perhaps you could ask your dentist about this.

 

[letsconnect]

Hi there

Sorry to hear about your problem. We have a page on the causes of incomplete numbing here: https://www.dentalfearcentral.org/fears/not-numb/

I'd be really interested as well in finding out whether nowadays, Cone Beam CT scans or MRI scans are ever used for this purpose? Maybe our resident dentists will be able to shed some light on this matter !

 

[Gordon]

You couldn't justify the cost and radiation exposure for either of them for a fairly "benign" issue (not that it's not important to the patient concerned, but it's not life threatening in any way).

Pain on putting the filling in is unusual, was it a very deep filling?

Alternative techniques of delivering the local might be useful, such as intraligamental with a Wand or similar to top up the local.

 

[Deblomas]

You couldn't justify the cost and radiation exposure for either of them for a fairly "benign" issue (not that it's not important to the patient concerned, but it's not life threatening in any way).

Pain on putting the filling in is unusual, was it a very deep filling?

Alternative techniques of delivering the local might be useful, such as intraligamental with a Wand or similar to top up the local.

Hi thanks for your replies. It wasn't a deep filling, but I found it almost intolerable. I have quite a high pain threshold normally too. Having just calmed down about treatment with the help of CBT I don't want to go back to worrying about my teeth 24/7 so would pay for any tests if they'd be of use.

 

[Gordon]

They wouldn't be any practical use.

 

[comfortdentist]

They wouldn't be any practical use.

I agree. I see far more hard to get numb patients than my colleagues. I will use other anesthetics and injection techniques but CBCT? Never.

 

[letsconnect]

Interesting discussion!

Can you explain a bit more as to why CBCT or MRI woudn't be of any practical use? Thanks !

 

[Gordon]

There's a few reasons.
1) It's impossible to accurately "hit" an object the size of the nerve foramen with a dental needle. They all deflect a bit as they pass through the muscles etc on the way in.
2) Fine, you've got a 3D model of the patient's jaw and you know where the nerve is lying. How are you going to translate that into the actual mouth when you're trying to get a needle near it? The soft tissues will change shape when you touch them, so you have no fixed landmarks to guide you
3) You're injecting 2ml of liquid into a very small space, the liquid will spread around a cm either side of the injection site, it's unlikely that the nerve will be 2cm away from the usual location

But mainly, the problem with patients not going numb is unlikely to be that the solution isn't reaching the nerve, it's probably either that they have a high resistance to that particular local or it's a secondary factor like infection that's the issue.

I daresay there's more reasons but that's all I can be bothered to type out