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Dentistry/anesthesia failure

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Expert: - 12/22/2009


Question

#31HFS
I had a root canal procedure on #31 yesterday using "oral sedation" and a local nerve block. The inferior alveolar nerve on that side is really messed from a botched 3rd molar extraction 27 years ago, with constant "phantom tooth" pain and paresthesias in cheek, gums, and tongue. Nevertheless, I had a filling in that tooth with successful local anesthesia 2 weeks prior to the endodontic treatment, and I have had other successful local nerve blocks there in the past. Also, I had had oral sedation with triazolam and some other drug several years ago. This time, however, the sedative did nothing at all psychologically though it did lower my BP. And worse yet, despite numerous hideously painful deep injections all over the gum and cheek (probably about 6 of them), there was no anesthesia--not even lip numbing. I know he used Marcaine for some of them; I'm not sure what the other were, but they were also "-caines." Finally he switched to some other chemical family of anesthetic (maybe an ester rather than an amide??) which worked.
I am wondering why the first anesthetics failed. The pain was horrible--involuntary tears and uncontrollable whole-body shaking--and the wretchedly apologetic endodontist said it was the second-worst experience of anesthesia he had ever had (what about my experience???). Could it be that the anesthesia for the filling had induced Cyp3A4 in the area and so the stuff got immediately degraded? There wasn't much swelling in the area because we caught the problem early and I had several days of penicillin to calm the infection. We checked all my other meds, and nothing should have interacted with the drug and of course I have been on the same meds for years and had successful dental nerve blocks other times. Nor should the underlying nerve damage and neuralgia have affected these injections any more than they had the previous week when I had the successful anesthesia for the filling. I'm mystified, but I certainly want to know what is going on, since I'll need something when the permanent restoration is done and I don't want to go through this torment again!
Thanks!

Answer
Hi Helen,

I can certainly understand why you are concerned. I have had this happen in my office as well and it isn't fun for anyone involved...patient or dentist. When we give a lower injection, we are trying to inject into an area about the size of a nickle that is 1" into the lower jaw. If we are high, low, too deep or too shallow, we miss the block. We use external reference points to find the right spot. There are days when we just simply can't inject in the right spot no matter what we do. Luckily it doesn't happen often and there is a high likelihood you won't have a problem the next time. If you have gotten numb in the past, then there is nothing physiological or chemical that would prevent you from getting numb again.

I know this isn't very reassuring, but this happens to every dentist from time to time. I truly believe the next time won't be a repeat of this horrible experience!

Hope this helps some.

Gary Backlund DMD, MSD
    Questioner's Rating
    Rating(1-10)Knowledgeability = 8Clarity of Response = 10Politeness = 10
    CommentThank you for your prompt and reassuring reply. I am still skeptical that a highly experienced person could perform so many injections in so many areas and miss the right spot until (fortuitously) he hit the right one just after he changed drug families, but I suppose it is possible when the nerves are all misaligned and re-routed during regeneration from the previous mangled impacted third molar extraction. Even 3 days later, everything is too painful to touch or bite down or even to yawn, and I get little jarring paresthesias into the tongue once in a while. I hope they'll have better luck with the anesthesia for the crown. But I agree that there doesn't seem to be any other obvious explanation.


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Gary Backlund, DMD, MSD

Expertise

I am an Endodontist ( root canal specialist ) and can answer questions about root canals and their treatment. I cannot diagnose or treat online, but can answer general questions. I have been a specialist for 25 years and am Past President of the Washington State Association of Endodontists.

Experience

25 years practicing as a specialist

Organizations
American Association of Endodonists, Past President Washington State Association of Endodontists.

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