What to do if a patient seems to have anesthesia but still has pain when the dentist is drilling?

Parojet intraligamental syringe

Sometimes when a patient has what seems like appropriate anesthesia they still feel some pain when their cavity is cleaned out. When a lower tooth is involved, their lip and tongue may seem numb but they still feel pain when the drill touches  their tooth.  Sometimes,  instead of giving still another mandibular block injection, I opt for a more local intraligamental injection. I do  this by using a special syringe that places several drops of anesthetic into the ligament holding the tooth. I place a couple of drops in each corner of the tooth and usually this does the trick.

If an upper tooth is involved, sometimes more anesthetic needs to be infiltrated, both on the buccal and in the adjacent palate. For upper molars and bicuspids (that have palatal roots) sufficient palatal anesthetic is important. Also using Septocaine can be helpful since it  provides  profound anesthesia, but should not be used for a mandibular block, since it takes too long to wear off.

If a patient is having a root canal there are times when a patient has what seems like appropriate anesthesia but still has pain. The intraligamental injection often works well for this situation as well. If all else fails then sometimes the only thing that will make a tooth comfortable is an intrapulpal injection. This is an injection of anesthetic placed either into the pulp chamber or into the canals under a little pressure. This usually Quiets  any sensitive pulpal nerve fibers that are present.

Nitrous Oxide can also be a big help for "sensitive" patients. Some patients are extremely apprehensive and this can heighten there reaction to everything we dentists do. Laughing gas is a great option for "jumpy patients" who seem to react to our every touch.  Although nitrous oxide is not a great analgesic at the concentrations we use, it lessons a patients anxiety and even though they may feel some discomfort, they don't seem to mind it as much.




from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2019/06/what-to-do-if-patient-seems-to-have.html - http://lspindelnycdds.blogspot.com/

Comments

Post a Comment

Popular posts from this blog

Help! My Child is Terrified of the Dentist

Image
If you’re the parent of a young child, you know their brains are similar to sponges that soak up everything around them—especially in their first five years, which neuroscientists say is when they’ll do the most learning and developing in their entire life. At this formative time, your child may amaze you with what they notice: your facial expressions, the different tones of your voice, and your habits. If your habits include regular dental visits and an excellent oral hygiene routine, they’ll notice and want to emulate you. If you happen to feel anxious about your dental visits, or you groan when you’ve got to floss and brush, they may synchronize and feel your dread. This could lead to dental fears that stick with them for years—potentially a lifetime! Kids Can Be Courageous If you’re feeling guilty right now, go ahead and put that away as it won’t serve you or your little one. Everyone has some room for improvement, and Coastal Pediatric Dentistry® is here to help show you an
Read more

Going for the Gold?

Image
On the left is the older allow, on the right the new one that my lab has chosen to use The cost of a penny weight of pure gold is currently $79.53. The cost of a penny weight of pure palladium is $130.6. It used to be that palladium was added instead of gold to the precious metals often used for pfms, but now laboratories are finding that palladium is no longer affordable. The lab that I am using has just changed the formulation of the metal it's using to one that has more gold than palladium. I really do not mind, but metals with more gold are softer and often easier for a dentist to accidentally polish off delicate margins. It is important when polishing "higher gold" formulations to exert less hand pressure when performing the final polishing of the crown's margins. Other wise there should be no problem with this change. Traditionally labs have chosen alloys with higher gold percentages for optimal esthetics, since alloys with higher concentrations of
Read more

Tongue Ties: What Parents Need to Know

Image
For a long time, people just didn’t seem to know much about tongue ties. In the early years of my practice, few of my patients had ever heard of a tongue tie. When I pointed out that they or their children might be tongue tied, I was often the very first practitioner who’d mentioned it to them. When I told them that a tongue tie might actually be the root cause of their oral myofunctional issues, or even their sleep apnea , I’m sure that some of them thought I was crazy. But in the last few years, things have changed so much! Initially, there was a small increase in the number of patients who were contacting me specifically about tongue ties. Dentists and orthodontists also began reaching out more frequently to discuss the application of myofunctional therapy exercises to tongue tie treatment. But in the last year or so, that little bit of interest has become a surge of awareness. Tongue ties and their effects on health and craniofacial development are finally becoming mainstream.
Read more