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Dental Anesthesia

Pain Even with Novacaine and Gas

04/09/2010

Question:

My 12 year old daughter is extremely afraid of the dentist and she requires valium on the way to the appointment, gas and novocaine. She still had a lot of pain with her treatment. Is it possible that she just doesn’t get numb? He stuck her about 5 times. I have to take her back next week. I am horrified that she is feeling it. What can I do?

Answer:

It is not uncommon for children (and adults for that matter) to have significant fear and anxiety for dental work, especially if local anesthesia is not completely effective.

It is possible that local anesthesia does not work completely for your daughter. Usually this affects the lower jaw teeth where the anesthetic technique is different than in the upper jaw.
 
There are other anesthetic techniques your dentist can use, and you should discuss this with him or her. Some options include traditional injection supplemented by intraosseous injection or local anesthetic next to the tooth with articaine local anesthetic.

Articaine can also be tried for the traditional injection if standard local anesthetics are not completely effective.

If you daughter is very anxious, and it sounds like she is, then this tends to magnify all sensations and even some non-painful sensations may be interpreted as painful.

This is not to say they are not real. They are to your daughter and should be taken at face value. Good sedation can help a great deal, but she may not have enough with what the dentist is doing.
Intravenous sedation may be a very good option or even having a dentist anesthesiologist come to your dentist's office to do general anesthesia in the office. These are dentists who have completed accredited anesthesiology residencies specifically for patients like your daughter. You may contact one at the American Society of Dentist Anesthesiologists.  

I hope this helps.

For more information:

Go to the Dental Anesthesia health topic, where you can:

Response by:

Steven I Ganzberg, SB, DMD, MS Steven I Ganzberg, SB, DMD, MS
Formerly, Clinical Professor of Dentistry
College of Dentistry
The Ohio State University