Oral Surgery/anesthesia


QUESTION: hello sir,
i feel helpless sometime when i am unable to anesthize tooth,i.e. my local anesthetic fail....what can be the reason sir....
today too...i have to extract mandibular right second molar...inferior alveolar block given..aspiration come positive so i retract slightly and change angulation.....give buccal block well...but the tooth is still tender on percussion and pain during probing occur too after 10 minutes ...i decided to give intraligamentry with 26 gauze needle...it fails too supraperiosteal is tried to...but no result...patient still complain of pain....
where can be my fault...
sometime it also happens in grade III mobile tooth!!!!!!!!
what is that....

ANSWER: Ritu -  you are experiencing a situation that many dentists experience.  The cause can be a simple inflammation of the nerve branch.  Unless depositing the local anesthetic at the canal opening, an inflamed nerve can be very resistant to an attempt anesthetize.  I know you gained access to the correct location, but the blood vessel forced you to retract.  As an oral and maxillofacial surgeon I have been very lucky, in this situation to sedate or even anesthetize the patient to allow them to be comfortable.  I wish there is a simple cure, but the only way to expedite the local anesthetic effectiveness is to quiet the inflamed tooth.  So in some, removing the nerve in the tooth by drilling into the nerve canal in the tooth and then making a direct injection, as painful as it is, may be the only cure.

Sorry there isn't something easier, but I have discovered that initiating root canal treatment may be the only way to anesthetize a tooth.

---------- FOLLOW-UP ----------

QUESTION: is it possible to know prior to treatment nerve is inflammed....and can antibiotic prescription can make it comfortable

Ritu -  There might be inflammation, but that does not mean infection.  Unless infection is present, an antibiotic will not help.  What you are experiencing is fortunately not very common, but every doctor with experience at least one of them in his practice.

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Joel S. Teig, DMD, Diplomate ABOMS, retired


I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.


Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.

American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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