White Lesion on Gumline

[Marsbars]

After avoiding the dentist for 8 years, I went when I had severe tooth pain last year that required an extraction (it was cracked!) I have been diligently going for cleanings every 4-6 months ever since. At my last Cleaning two weeks ago, the hygienist noticed a small white spot on my gum line. The dentist looked at it and said that he would like to remove the whole thing and it send for a biopsy. I am terrified. I can’t see it - it’s near my last bottom molar but can feel it when I rub my gums. Can you tell me what I should expect?

 

[NETWizz]

Not a dentist but a patient who has been on the receiving end and can relay my experience...

What you can expect is that the anxiety will be far worse than the procedure. You can expect to sit in a comfortable chair and to have a topical numbing gel gently massaged into a small place somewhere near the area. Sometimes it is covered with cotton for for about a minute.

Next you can expect the administration of a newer local anesthetic that is much more effective and safer than Novacaine ever was; in fact, they probably give local anesthetic half a dozen times daily and have been for likely a decade or more without a single incidence of problem beyond anxious patients who sometimes have minor panic attacks or feeling faint with anything involving a needle. Probably won’t happen to you, but if it does they have seen it before and it would surly pass in less than a minute. Generally the needles are tiny if you are curious.

Yet, you can expect that to be the worst part of the entire procedure. It really does not hurt any worse than a flu shot, but it generally takes a bit longer because going slow makes it virtually painless. Sometimes it has a slight burning and feels funny, but that’s really it. Maybe a 1 or 2 out of 10 on the pain scale if it hurts at all. The best thing to do is just relax and you can even close your eyes if you want.

The dentist generally walks out for a couple minutes to let the anesthetic take full effect. You can use this time to rest and briefly talk with the assistant who stays in the room. The rest of the procedure will be not worse than a cleaning.

When the doctor comes returns he will check you cannot feel anything before he begins. He will proceed removing the spot, and you can expect there will be zero pain. It might feel like they are working on someone else’s gums in that it won’t hurt anymore than getting a haircut.

It will be over with before you know it. You will likely be given some at-home care instructions and sent on your way. You will generally be able to carry on with your day, drive, etc.

The local anesthetic will continue to provide pain relief for likely a couple more hours before full feeling returns. When feeling returns you can expect to feel a sore or tender spot that rapidly improves and heals.

 

[Gordon]

Don't get all worked up over the phrase "biopsy" it doesn't mean that there's a chance of cancer. It's just a medical term meaning "WTF is this? Let's look at it in the lab".

 

[Marsbars]

Not a dentist but a patient who has been on the receiving end and can relay my experience...

What you can expect is that the anxiety will be far worse than the procedure. You can expect to sit in a comfortable chair and to have a topical numbing gel gently massaged into a small place somewhere near the area. Sometimes it is covered with cotton for for about a minute.

Next you can expect the administration of a newer local anesthetic that is much more effective and safer than Novacaine ever was; in fact, they probably give local anesthetic half a dozen times daily and have been for likely a decade or more without a single incidence of problem beyond anxious patients who sometimes have minor panic attacks or feeling faint with anything involving a needle. Probably won’t happen to you, but if it does they have seen it before and it would surly pass in less than a minute. Generally the needles are tiny if you are curious.

Yet, you can expect that to be the worst part of the entire procedure. It really does not hurt any worse than a flu shot, but it generally takes a bit longer because going slow makes it virtually painless. Sometimes it has a slight burning and feels funny, but that’s really it. Maybe a 1 or 2 out of 10 on the pain scale if it hurts at all. The best thing to do is just relax and you can even close your eyes if you want.

The dentist generally walks out for a couple minutes to let the anesthetic take full effect. You can use this time to rest and briefly talk with the assistant who stays in the room. The rest of the procedure will be not worse than a cleaning.

When the doctor comes returns he will check you cannot feel anything before he begins. He will proceed removing the spot, and you can expect there will be zero pain. It might feel like they are working on someone else’s gums in that it won’t hurt anymore than getting a haircut.

It will be over with before you know it. You will likely be given some at-home care instructions and sent on your way. You will generally be able to carry on with your day, drive, etc.

The local anesthetic will continue to provide pain relief for likely a couple more hours before full feeling returns. When feeling returns you can expect to feel a sore or tender spot that rapidly improves and heals.

Thank you for the detailed description! I had the area removed yesterday. It was smaller than I thought. No stitches and no discomfort this morning!

 

[Marsbars]

Don't get all worked up over the phrase "biopsy" it doesn't mean that there's a chance of cancer. It's just a medical term meaning "WTF is this? Let's look at it in the lab".

A-ha! Thank you, Gordon - you actually made me laugh! ...And that IS what is getting to me the most. The procedure was straight forward. I do have a question though - I get an adrenaline rush (my heart starts racing) after the freezing is injected. My dentist said it was expected - something to do with an ingredient that slows the bleeding. It freaks me out - In the moment, I feel like I’m having an allergic reaction. It always takes a few minutes to calm down. Is that common?

 

[Gordon]

You're getting an adrenaline rush because you're being injected with adrenaline The compound that slows the bleeding is adrenaline. Most people don't notice it, others are more sensitive to it, so I'm guessing you're one of the latter...

Tell you a slightly amusing anecdote, about a million years ago, I was working in the Oral Medicine department of a big hospital. My next patient was coming in to get the results of the biopsy that one of my more junior colleagues had done 2 weeks prior.
No big deal, it was a routine biopsy for something fairly trivial.

However, the patient came in looking like he was about to face a firing squad, complete with super anxious wife holding his hand like she wouldn't let it go.
Before I could open my mouth, he blurted out "Well doc, how long have I got?"
Blank look from me...
"Before the cancer gets me?"
Again blank look... "What cancer?"
"The one I got biopsied 2 weeks ago"
I honestly nearly laughed out loud before realising how upset the poor guy was, when I told him it was nothing to do with cancer he about jumped out his seat and started hugging me. So did the wife.

My young colleague was more interested in getting a good sample for the lab and hadn't really explained to the patient what was going on. Poor guy had been re-writing his will, sorting out his life insurance and goodness knows what else.

 

[NETWizz]

Thank you for the detailed description! I had the area removed yesterday. It was smaller than I thought. No stitches and no discomfort this morning!

Great. The procedure wasn’t any worse than I described either was it? Getting numbed and all that.

A-ha! Thank you, Gordon - you actually made me laugh! ...And that IS what is getting to me the most. The procedure was straight forward. I do have a question though - I get an adrenaline rush (my heart starts racing) after the freezing is injected. My dentist said it was expected - something to do with an ingredient that slows the bleeding. It freaks me out - In the moment, I feel like I’m having an allergic reaction. It always takes a few minutes to calm down. Is that common?

The ingredient is epinephrine for example last Monday I got a full carpule ... at or about 1.7 ml Articaine 4% with 1:100,000 epinephrine.

Honestly, I didn’t feel my heart beating after, but I used to years ago when I was more anxious. For some it is the medication. Its main use is making the medication last longer providing perhaps an hour of anesthesia for teeth pulp and a couple hours soft-tissue.

If you let your dentist know you think it was the medication, he or she might have some alternatives without it or with a reduced amount. For example there is Articaine / 1:200,000 offered by dental supplies. There is also Bupivcaine 1:200,000, but that would likely keep you numb too long.

Other dental anesthetics without epinephrine are Meprivicaine often called Carbocaine (brand name). I think there is also a Prilocsine (Citenest Plain), but Gordon would have to tell you their use cases.

I do think there are options now though if you are legitimately sensitive to the epinephrine.