“Numb and Number, Please?”

Posted by drgracesun on April 30, 2009 under Information | Be the First to Comment

“Doc, can I have more Novocaine? I don’t feel very numb.” Of course, it is nice to feel numb before dental surgeries! Have you ever been in a situation in which you had difficulty getting numb?

Local anesthetic is effective in most situations, however approximately 15% of dental patients experience a partial or total lack of numbness after receiving anesthesia injections. This phenomenon usually occurs in the lower jaw, when mandibular bone is too dense for infiltrated anesthetic injections to take, unlike the upper jaw which can receive the anesthetic solution easily. The dental nerve within the lower jaw is essentially buried within the dense bone itself,  so it requires a mandibular block injection for proper numbing (numbing which includes the teeth, tongue and lips in the same quadrant).

Variations in the anatomy of the “entry window location” (where the mandibular injection deposits its solution) makes it difficult for some people to receive proper numbing, even when the dentist follows the usual landmarks – don’t blame the dentist right away if your anesthesia doesn’t work! The physiology of each individual varies besides the anatomy, which will lead to different thresholds or reactions to various dental injections. Different dental injection solutions also gives different numbing effects – your dental professional should choose what is most applicable to your situation, usually epinephrine (the blood vessel constrictor) is added to give a better local numbing effect.

Speedy injections or anxious patients can cause a racy heart beat, which could be very uncomfortable. If you’ve had too many cups of coffee or if your blood sugar is low from having not eaten, you may feel uncomfortable after receive the dental injection. The wine from last night can also alter the effectiveness of the numbing. This all makes anesthesia a very delicate science. The technique of the operator (the dental professional) can occasionally be at fault for improper anesthesia, but more likely than not it is a complication with a patient variable. It is important for you to communicate with your dental professionals if you’ve had a history of difficulty with dental anesthetics.

Special oral local anesthetic techniques, such as intraosseous anesthesia, which can enhance deep pulpal anesthesia, may help to increase the numbing sensation. This process injects novocaine directly into the bone marrow – because the needle penetrates the hard cortex of the bone, it penetrates to the jaw’s deepest level and can adequately numb the site. It is important to remember that every mouth can be anesthetized, however because intraosseous anesthesia is considered a specialized procedure, it is important to find a dental professional who is experienced with such techniques.

“Do I Need Laughing Gas?”

Posted by drgracesun on April 27, 2009 under Information | Be the First to Comment

” May I have some laughing gas please?” is a popular request among the “high anxiety” or “wants to get away” group.

A patient is anesthetized with nitrous oxide.

Nitrous oxide gas (nitrous oxide and oxygen (N₂0-0₂)) is affectionately known as “laughing gas” due to its euphoric qualities when inhaled. Discovered in 1772 by Humphrey Davy, he had this to say about its effects: “On the day when the inflammation was the most troublesome, I breathed three large doses of nitrous oxide. The pain always diminished after the first four or five inspirations; the thrilling came on as usual, and uneasiness was for a few minutes swallowed up in pleasure.” When the gas is inhaled (at an approximately 50% nitrous oxide + 50% oxygen dilution), after several minutes nearly all pain dissipates from the body and a euphoric warmth spreads throughout the body. This pleasant feeling is not only pain-reducing, but can calm anxious nerves and relax all but the most fearsome patients. The calming, relaxing and euphoric qualities of nitrous oxide make it a prime candidate for anesthetizing patients who have irrational fears about dental procedures who are unable to get comfortable in the chair. Because laughing gas can be highly effective in treating moderate dental anxieties, nitrous oxide gas can also benefit the dental physician working on a patient – calm environments benefit everyone! Patients with high blood pressure, or who have had heart attacks in the past and are at risk from traditional IV anesthesia are prime candidates for nitrous oxide sedation.

The level of sedation and warmth felt in the body after inhaling nitrous oxide gas depends on the concentration of the dosage, and how long the gas is administered. Because the gas is administered into the lungs, it is saturated into the blood stream very quickly  and once the procedure is finished, there are no lingering “hangover” effects, meaning it is safe to drive home without an escort. Local anesthesia is still necessary for the treatment site, but needle-phobia will disappear with laughing gas. If you suffer from dental anxieties and have tried different techniques, seen different dentist and you still can not  face dental work with ease, it is worth while for you to try nitrous oxide during your next dental procedure. Have a discussion with your dental professional.