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Hello,

I am having a molar extracted next Friday with local anesthetic (the one directly in front of the wisdom teeth at the bottom on my right side) and I'm a bit stressed about it.

The molar is on an awful angle (I think it was done by my impacted wisdom teeth - all 4 were removed under general anesthetic about 4 years ago), has been filled many times, broke last year and was filled, the filling had to be redone late last year and was very sensitive for about 3 months afterwards and the dentist said that she was expecting it to explode when she was redoing the filling (she offered to take it out for free but it eventually settled down and I wasn't keen to go through an extraction) and then it broke again 4 days before Christmas (about 7 days ago). My normal dentist was on holiday already so another one looked at it and said that there was 2 options, 1 to smooth off the extremely rough edges because to do anything else he would have to take out the whole filling, there was also a little bit of decay under the filling. I got him to smooth the edges off so my tongue would heal and I would at least be-able to get through until my normal dentist could take it out (I wanted someone I could trust). I had already made up my mind if it broke again it was coming out.

I don't mind the jab for the local anesthetic  at all.

The background to my fear is:

I have had bad experiences with all fillings in the past relating to pain during fillings and it's left a permanent fear. The worst time of them all was a filling in one of my molars at the top on my right hand side. I was in a lot of pain and even though the dentist I was going to at the time gave me more anesthetic (I think it is what is called a palatal injection that really hurt) it didn't even touch the pain. Up until I started going to this new dentist I had pain with every filling that they attempted to do, my teeth are like my nana's and I have had an uncountable number of fillings during my lifetime. The only reason I persevere with going to dentists is I don't want to lose my teeth like she did (she lost all of them at a very early age).

When I started going to my current dentist I knew I had about 8 fillings needed some of which were very deep. She kindly agreed that we could do them them all in one day and in 2 sessions to give her a break between them. I went to my doctor before them and she gave me some lorazepam to help me through and I also took over the counter Paracetamol and Ibprofen. I got on really well that time but the next day and for 3 or so days afterwards I felt really gross, light headed, dizzy and spent days in bed. I put it down to being so many fillings done and some deep ones.

I recently had some more fillings done and repeated the same again in terms of the lorazepam and paracetamol and ibprofen and although the experience at the time was great I ended up spending days in bed again.

I don't want her changing the LA she is using (Xylestesin) as it is working great - maybe my previous dentists were using a different one. I like my dentist she is really nice and I trust her. She listened to my concern about not feeling pain but I still get really stressed about it.

The only prescription medication I take is 1 x Tramal 200 mg Slow Release once a day.

So I guess my questions are:

1) Why would she say that she was worried that the tooth might explode?
2) Would you have any suggestions of what would be causing me to be light headed and dizzy afterwards and how to manage the symptoms? (or is that a side effect of the Xylestesin?
3) What is the procedure / process for extracting a tooth?
4) I understand an local anesthetic may not work if there is an infection but in the case of my molar there was no outward sign of any infection. What other reasons are there that a local anesthetic may not work?
5) Should I visit a GP and get an antibotic to stop any infection forming?

Grateful for any help you can provide.

Answer
these are hard to answer in an internet reply. there is far too much to try to put in here. but i will try to give you some of your answers...
1) i have no idea what saying the tooth might explode means. i think she meant that she thought there were fractures in the tooth and when she started working on it, pieces of the tooth might break apart. this is the only idea i can come up with. teeth do not literally explode. they can break apart as they are worked on.
2) xylestesin is merely lidocaine. this is a local anesthetic like xylocaine. most of the time these do not cause lightheadedness. if anything, i think the lorazepam is what might cause the lightheadedness.  but maybe it is due to the combination of everything you took. how to manage this? just try to take as little medications as possible and stop as quickly as possible.
3) it is too much to try to describe how a tooth is extracted. it is done in many different ways depending on the tooth, the shape of the tooth, the location of the tooth, angulations, and dentist technique. everyone does things in a different way.
4) infections can make it tough for anesthetics to work. but to get around that, we do nerve blocks which numb the nerves before they get to the tooth. the tough part for some people is getting the anesthetic in the exact location for it to work. if the nerve is not where you place the anesthetic, it will not be effective. that is really the only other reason...if you put it in the exact location it is needed, it will work.
5) the need for antibiotics would be the call for the dentist removing the tooth. ask him/her about this. if there is no infection, it is usually not needed.

good luck

i hope i have given you some good info here that will help put your mind at ease.

jeff dalin, dds

Dentistry

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Jeff Dalin DDS

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general dentistry questions with topics ranging from cosmetic dentistry to dentistry for children

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Fellowships in American College of Dentists, the Academy of General Dentistry, and the International College of Dentists.

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