Lower nerve blocks

[mbc350]

Has anyone on here had a mandibular nerve block that numbs the entire side (either side) of the jaw? I've read those can be painful, so obviously I'm afraid to have one done, esp. since the needle has to go deep into the tissue, which looks scary. Are they as painful as they appear to be, or can the discomfort be minimized or tolerated well? Also, I'm worried about the frightening possibility of an electric shock sensation in the tongue, lower lip, chin, etc. if the needle touches the main nerve itself. Are such complications even avoidable, and what are the chances or how likely they will occur? If it does happen unfortunately, will the damage be temporary or permanent? I'd appreciate any help that can be provided by dentists and/or patients! Thank you all!

 

[Gordon]

Personally I've had several dozen, both for dentistry and from my student friends practicing on me (yes, folks, dental students practice on each other!).
They're really no worse than any other injection, assuming the usual precautions from the dentist, surface anaesthetic, slow careful injection of the fluid and so on.
The electric shock feeling is pretty rare, having given thousands of these injections over the years, I doubt it's happened more than a dozen times. I've never had a case where there was lasting damage.
It's not avoidable, unfortunately variations in human anatomy can't be predicted.

 

[mbc350]

@Gordon Hello. I recently came across a study done by the National Center for Biotechnology Information for the National Library of Medicine under the National Institutes of Health as part of the United States Department of Health and Human Services (HHS): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6318735/. It's a very detailed & technical scientific analysis (with extensive statistical data) of Computer-Controlled Local Anesthetic Devices (CCLADs). I won't attempt to elaborate the lengthy document here, so if you desire, you may read (or at least browse) it for yourself if you have the chance. (Even though it's based in the U.S., I'd assume it's also relevant in the UK.)

My main area of concern is the fact that over 60% of patients reported mild to moderate pain from needle placement (c. 75% of the time) as the most uncomfortable aspect of mandibular nerve blocks. Even though the article in question focused on computerized systems (e.g., the Wand), I assume the same could be said for manual syringes in the hands of caring & competent dentists. Everywhere I've read (including this forum) states that dental injections can initially pinch or sting for a few seconds but don't hurt too much overall, even for IANBs, which I've believed for several years now as a result of educating myself to overcome my phobias, anxieties, & fears from the past.

However, now I'm worried that, in fact, lower nerve blocks are as bad as I'd anticipated them to be, mostly owing to sharp needle insertion and deep penetration in sensitive areas as the main factor(s). Please understand I'm not dismissing or minimizing your kind & caring response (above) a few months ago, which I'd found to be reassuring at the time; but can you enlighten me on the apparent discrepancy between professional stances vs. popular perception and possibly show where maybe I'm mistaken? Thank you again for your help!

 

[Gordon]

I'll have a read and get back to you.

 

[Gordon]

A few thoughts, seeing as it's Saturday and I do have other things to get on with.
1) The study seems well thought through, I couldn't see any major biases in it.
2) Measuring pain is intensely subjective, there is some evidence that actually asking the question can increase the level of pain reported. Something to do with anticipation if I remember right.
3) I'd be interested in seeing a similar study comparing IDB with other infiltration injections, since I don't personally think there is much difference, given my experience.

 

[mbc350]

@Gordon Thank you so much for your time & thoughtful response. Sorry, I didn't mean to keep you busy on the weekend! I would've been glad to wait for your reply next week, so no rush.

I understand the points you made and can see how they make sense. Your expertise & experience show that pain perception can be kept in proper perspective w/ the right balanced info. That's not to dismiss people's fears; instead, their concerns are valid, as you've acknowledged. However, you've also repeatedly shown that phobias can be overcome over time; so everyone has hope and the potential to make gradual progress.

I want to modify the beginning of the last paragraph of my previous post as instead it should've read, "I'm concerned [not 'worried'] that lower nerve blocks may be [not 'will be'] as bad as I'd anticipated them," instead of stating that "in fact" they necessarily would be painful. Your insights helped keep me level-headed and did alleviate the anxiety & dread to a good extent, which I will strive to maintain peace of mind consistently (though not perfectly, as I'm still a faulty human). If I relapse temporarily, I ask for your pardon as I persist in moving on; and I'll continually remind myself of your advice and take advantage of the wonderful resources on this site. Again, I really appreciate your assistance & knowledge. I'm sure other patients on here are grateful to you as well.