“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.

“Wisdom Teeth – Save or Extract?”

Posted by drgracesun on February 28, 2009 under Healthy Smile, Information, Smart Smile | Read the First Comment

Only one out of every 25 people get to keep all 32 teeth to chew our food; most of us end up with only 28, and a story to tell about our wisdom teeth!

Anthropologists and evolutionary biologists think the wisdom teeth have become non-functional due to evolution: we do not have the same diet of coarse, rough food that our ancestors did, who had larger active jaw muscles. Evolutionary history lead us to our smaller jaws which can no longer accommodate wisdom teeth.

Wisdom teeth are the third set of molars, which usually start forming around age 10, and emerge in a young adult’s mouth between the age of 17-25, but often they are impacted or blocked by the second molars. Also, if the tooth is partially erupted, food can get trapped in the gum without access to clean. This leads to infection and decay. Wisdom teeth which come in tilted or remain tucked away can also lead to crowding or other problems. Completely impacted wisdom teeth can potentially develop into a cyst, forming a sac of tissue around the tooth leading to bone destruction.

Impacted Wisdom Teeth

Impacted Wisdom Tooth

There are lucky big-jawed or small-toothed people who develop wisdom teeth that function properly, they do not need to see an oral surgeon for extraction, but most of us face the unavoidable trip to the oral surgeon to prevent or treat wisdom teeth complications.

Unfortunately, there are risk factors for removing your wisdom teeth as well. Besides common surgical complications (like swelling, pain and infection), paresthesia (numbness) of the lower jaw, lip, chin or tongue could be quite annoying. If the wisdom teeth are positioned very close to or are intertwined with nerves, the process of extraction can bruise or damage these nerves. Paresthesia is rare and usually temporary, but in some cases can be permanent. Dry socket, when blood of the socket of the extracted tooth fails to coagulate (or a blood clot becomes dislodged due to trauma like sneezing, or playing a musical instrument) can cause irritation, pain and inflammation, but generally heal within a few weeks on their own. To lower the risk factors of extraction, have your wisdom teeth removed at the appropriate time, when the root has formed two-thirds of the way (approximately age 18-24) for easier handling and fewer complications. Because bone density is less developed in teenage years than in later adulthood, it is less resistant, carrying fewer risks of extraction. With age, the jaw becomes dense and extraction becomes increasingly complicated.

So it is very important to have an examination and consultation with your dental professional regarding your specific situation. Clarify the elective removal of wisdom teeth, whether the potential risks associated with the procedure exceed the benefits, or whether it’s time to get them out – for a better environment for the rest of your teeth.