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/

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