About Mark Bornfeld DDS Expertise I can respond to all questions dealing with the practice of dentistry, from both the dentist`s and patient`s perspective. I am knowledgeable about all dental disciplines, from cosmetic dentistry to surgery, from restorative dentistry to root canal treatment. I have strong opinions about controversial issues in dental practice, including those topics which directly impact on the reputation of the profession in the eyes of both the lay public and our health profession colleagues.
Experience
Past/Present Clients Editor, Queens County Academy of General Dentistry newsletter; contributor to Dentistry.com 29 years practicing general dentistry partnered with brother Steve as one-half of the DentalTwins®
Question I have had TMD since age 13. On 1/19/09, I had an old crown removed, a build-up for the new crown and a temp crown placed. After the anesthetic was injected, my hands began to shake and my heart rate increased. I had such bad chills, the dentist gave me a blanket to use for the entire procedure. When the anesthetic began to wear off a few hours later, I experienced terrible pain in my left jaw, same side as the dental work, requiring hydrocodone for relief. For 3+ weeks after, I was unable to open my mouth wider that one finger-width placed b/w my front teeth due to my left jaw feeling frozen. One of the dentist's staff told me this sometimes happens with the anesthetic used though the duration is usually much shorter. However, when I saw the dentist at the 3-week mark, he tried to blame the problem on psychological factors, stating he had never seen that kind of problem in his 25 yrs of dentistry. Coincidentally, in 50 yrs of receiving dental work (i.e., 2 root canals, fillings, various crowns and bridges, etc.), I have NEVER experienced this problem either, despite having lived in many parts of the country and using several different dentists. I'd like a neutral opinion on what may have happened. I should mention that now that I'm able to open my mouth as widely as usual, there is a lot of clicking and instability in my left mandible.
Answer Dear Sara,
I'm surprised that any dentist with 25 years of experience would not have encountered this phenomenon before, because it is not uncommon-- although you may have manifested more severe symptoms than are usual. Although psychological factors such as temperament do indeed influence how this kind of event is experienced, it is primarily based on known organic physical factors.
This kind of event is almost always associated with an injection for a lower molar tooth. The injection technique, formally known as an "inferior alveolar block", involves the use of a trajectory that takes the needle through some muscles that move the lower jaw, as well as some relatively large blood vessels. Normally, the injection is given in such a way as to reduce the risk of injecting the anesthetic into a regional vein, but it sometimes happens despite these precautions. This allows the anesthetic to rapidly enter the bloodstream. The increased heart rate and agitation is not the result of the anesthetic per se, but the epinephrine that is commonly a constituent of the anesthetic solution. The effects of the epinephrine, while unpleasant, are temporary and harmless.
The residual trismus (limitation of jaw opening) is due to muscle spasm, which may have been provoked either by the needle passing through one of the muscles, or perhaps by a hematoma (internal bleeding) in the vicinity of one of those muscles from minor injury to one of the regional blood vessels.
Be advised that although I don't particularly agree with the "blame the victim" approach used by your dentist, this event does not reflect badly on his injection technique. As I said, even the most skilled operators will see this happen every so often in their practices-- it is just a matter of probabilities and variation in patient's internal geometry.
Good luck!
Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY
