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Question
I can only use a small amount of EPI. MY DENTIST CAN NEVER GET THE AREA HE IS WORKING ON COMPLETELY NUMB. HOW CAN THIS BE RESOLVED. FO I CHANGE DENTIST

Answer
The epi is not really a problem. Apart from the "rush" and increased heart rate and so forth that occasionally accompanies the shot, there is little risk to anyone from the small amount of epi we use. In fact, Stan Malamed , the guru of dental anesthesia, says that in general, since epinephrine is a natural chemical that is produced by your own body in response to stress, you can actually get a higher dose and be at greater risk if you are stressed by the pain that comes with not being numb. Medical doctors tend to exaggerate the risk because they typically use epinephrine as a 1:1000 solution, which is 100 times as concentrated as what we typically use. In general, 2 carpules should be safe. There are also certain local anesthetics that come with epi 1:200,000 instead of 1:100,000 that is typical, and most studies suggest they are equally effective with half the dose. All that being said, if your dentist is injecting properly using a local anesthetic without vasoconstrictor, you should get numb, but it will wear off quickly. That doesn't work for me as an endodontist doing long procedures, but for short operative procedures it should be OK. Sometimes it can be an advantage when you don't want to risk drooling on yourself for four hours! If you are not getting numb (I am guessing that this is your lower jaw), then your dentist is simply not up to the task. Peoples' jaws come in all sorts of configurations and since we can't see what we are doing we sometimes miss. My jaw falls in that category and it is very rare that anyone can get me numb, which is a huge problem for me. Fortunately nowadays we have a number of techniques that can be used, so I never have to be in a position that I can't get somebody numb. If your dentist is not up to the task, you might mention some of these things to him/her, and if he/she just can't do it, try another dentist.

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Frederick R. Liewehr DDS, MS, FICD

Expertise

I can answer your questions about root canal therapy in general. PLEASE DO NOT ask me to diagnose your particular problems or recommend treatment as I cannot do this without examining you and seeing your x-rays.

Experience

I am a Board-certified endodontist, former university department Chairman, teach dental residents, and have a private practice.

Organizations
ADA, AAE, ICD, AAOM, FDI, AMSUS, AAOB

Publications
J of Endodontics, Endodontics and Dental Traumatology, O,O,O, Military Medicine, Medical Bulletin, J of Dental Education

Education/Credentials
DDS, MS (Oral Biology), certificate in Endodontics

Awards and Honors
Surgeon General's "A" Designator, Fellowship ICD, Order of Military Medical Merit

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