Shots or no shots at the dentist?

[Trekchick]

When you go to the dentist and he/she needs to replace a filling,
Does your dentist give you the option of shots to numb you?
Do you opt for the shot that numbs your face or do you tough it out?

What other options do you get at your dentist?


I have a reason for asking this question.

 

[GrilledSteezeSandwich]

3 years ago I had 3 fillings and there was no option..the dentist used Novacane..I was hoping for some Nitrous but apparently you only get that for Root Canals and at Hippie graduation parties..

I wonder what the reason for asking this??? Do you have a friend who is in dental school??

 

[Warp Daddy]

Novocane BUT once i went COLD TURKEY ------------------JUST ONCE

 

[Trekchick]

I had some dental work done a few years ago (overlay and crown) and I don't recall having a shot, but the dentist chart says I did. That is no big deal either way, but today I had two 30 year old fillings removed and replaced. I asked to not have a shot. The dentist was surprised and concerned.

I just wondered what your dentist thoughts are on pain control options.

 

[drjeff]

Since this thread is just ripe for me to chime in Here goes nothing.

First off, not all work that "my people" due to a tooth is uncomfortable depending on circumstances. Small, superficial areas of decay that need to be restored can very often be cleaned out and filled comfortably without being numb. Larger areas of decay on a tooth with a living nerve, will often provide a bit of sensation (generally sharp, pinching like) if restored without being numb, the variable is that as we age, basically the size of the nerve shrinks, so an equivalent sized area of decay may be a VERY intense restorative experience for an un-numbed 20 year old but may very well be completely painless for an un-numbed 65 year old.

For a tooth that has had a root canal and no longer contains a nerve, unless the anticipated area of work will go below the gumline OR if the adjacent, nerve containing teeth are sensitive to the cold air/water from the drill, then you shouldn't need to be numbed to be comfy.

Personally, I offer novacaine(there actuallly isn't a drug called novacaine anymore, but just like an iconic name such as Xerox for a copy, it's stuck around) to all my patients, even the root canaled ones(I'll tell them that they likely WON'T need it for the root canaled people), and probably 98 out of 100 I offer it to for teeth that I'd usally numb prior to working on them, will accept the anesthesia.

Roughly 2 out of 100 refuse for various reasons, and if they do, if I try and get them numb against their will, then technically I've committed battery on them Heck, twice in my career I've even had patients refuse anesthesia for extraction To each and every there own!

 

[RootDKJ]

Since this thread is just ripe for me to chime in Here goes nothing.

Personally, I offer novacaine(there actuallly isn't a drug called novacaine anymore, but just like an iconic name such as Xerox for a copy, it's stuck around) to all my patients, even the root canaled ones(I'll tell them that they likely WON'T need it for the root canaled people), and probably 98 out of 100 I offer it to for teeth that I'd usally numb prior to working on them, will accept the anesthesia.

Who knew?!? What do "you people" use these days?

 

[Hawkshot99]

Who knew?!? What do "you people" use these days?

A big hammer!

 

[deadheadskier]

Here's a question for Dr. Jeff. Have you ever had a patient that you needed to do a root canal on that no matter how much 'Xerox' :lol: you injected into them, it just didn't numb them; you couldn't put the nerve to sleep?

I had such an experience once and was basically told, there is nothing we can do for you other than just drill straight down through the never and eventually after a minute or so, it will be dead and you won't feel it. Horrendous experience clutching the arms of that chair and sweating through that minute of torture.

 

[drjeff]

Who knew?!? What do "you people" use these days?

Depends on if there's any underlying health issues that I need to be really careful with (i.e. un-controlled/ poorly controlled hypertension or known allergy to one of the components of the anesthethic) and/or how long I want to keep the patient numb for(quick easy visit vs. longer visit where I might the person to be numb for a few hours after the visit so they can get a dose of oral pain medication on board if applicable before the anesthesia wears off)

Currently in my office, my business partner and I have 5 types of "novacaine" that we use:

3% Mepivicaine - our short acting one (usually under an hour total duration)
2% Mepivicaine with 1:20,000 Neo Corbeferin (Lasts about 2 hours for those with hypertension issues)
2% Lidocaine with 1:100,000 epinephrine (Our "workhorse" - lasts about 2 hours)
4% Articaine with 1:100,000 epinephrine (The "I REALLY need this patient to be numb anesthetic - lasts about 4 hours)
0.5% Marcaine with 1:200,000 epinephrine (the long acting one - lasts 6 to 8 hours)

Often with the Articaine and Marcaine I'll use them combined as kind of a "novacaine cocktail" in situations where I'm doing a proceedure where I know that PROFOUND and LONG lasting anesthesia is needed - think RAGING abcess or TOUGH extraction.

 

[drjeff]

Here's a question for Dr. Jeff. Have you ever had a patient that you needed to do a root canal on that no matter how much 'Xerox' :lol: you injected into them, it just didn't numb them; you couldn't put the nerve to sleep?

I had such an experience once and was basically told, there is nothing we can do for you other than just drill straight down through the never and eventually after a minute or so, it will be dead and you won't feel it. Horrendous experience clutching the arms of that chair and sweating through that minute of torture.

Unfortunately, in certain circumstances, this is the case. Basically why this happens is because of good 'ol chemistry.

"Novacaine" is acidic and if you have a "hot" tooth (a tooth with an abcess), the bacterial waste (puss + various gases that the bacteria release) is very alkaline, and often no matter how much anesthesthic we put in the general area of the hot tooth, until we actually access the nerve space and essentially vent/drain the gases/puss to gain a favorable acid/base ratio, it's not a fun event for patient + dentist.

 

[RootDKJ]

Depends on if there's any underlying health issues that I need to be really careful with (i.e. un-controlled/ poorly controlled hypertension or known allergy to one of the components of the anesthethic) and/or how long I want to keep the patient numb for(quick easy visit vs. longer visit where I might the person to be numb for a few hours after the visit so they can get a dose of oral pain medication on board if applicable before the anesthesia wears off)

Currently in my office, my business partner and I have 5 types of "novacaine" that we use:

3% Mepivicaine - our short acting one (usually under an hour total duration)
2% Mepivicaine with 1:20,000 Neo Corbeferin (Lasts about 2 hours for those with hypertension issues)
2% Lidocaine with 1:100,000 epinephrine (Our "workhorse" - lasts about 2 hours)
4% Articaine with 1:100,000 epinephrine (The "I REALLY need this patient to be numb anesthetic - lasts about 4 hours)
0.5% Marcaine with 1:200,000 epinephrine (the long acting one - lasts 6 to 8 hours)

Often with the Articaine and Marcaine I'll use them combined as kind of a "novacaine cocktail" in situations where I'm doing a proceedure where I know that PROFOUND and LONG lasting anesthesia is needed - think RAGING abcess or TOUGH extraction.

WOW! Good info doc!

 

[SkiDork]

I'm one of the 2 out of 100.

I don;t use any pain numbing. I tough it out. I have this ability to go into a zone when the pain comes and I can hold still, its not hard for me.

I recently had a crown and she had to do a lot of drilling. Not a big deal for me.

Mind you, I've never had root canal. I'd prolly want novicaine for that.

I really like walking out of the office and not having to drool for the next 6 hours.

 

[Warp Daddy]

I'm one of the 2 out of 100.


I really like walking out of the office and not having to drool for the next 6 hours.

BOY i hear ya - BUT from what i HEAR DOC JEFF has some seriously GOOD looking hygenists who MIGHT cause one to DROOL -- EVEN those who opt to go commando as far as pain meds

 

[Trekchick]

<snip> but today I had two 30 year old fillings removed and replaced. I asked to not have a shot. The dentist was surprised and concerned.

I just wondered what your dentist thoughts are on pain control options.

<snip> so an equivalent sized area of decay may be a VERY intense restorative experience for an un-numbed 20 year old but may very well be completely painless for an un-numbed 65 year old.

<snip>
Roughly 2 out of 100 refuse for various reasons, and if they do, if I try and get them numb against their will, then technically I've committed battery on them Heck, twice in my career I've even had patients refuse anesthesia for extraction To each and every there own!

Well, I'm 42, so somewhere between 20 and 65 on the tough old bird chart.

The two teeth where the fillings were removed are the back teeth on the right side. The concern that the dentist shared was because the fillings being removed were rather large and he was confident that we'd be "hitting nerves".
I won't say that there were moments when it was extremely intense, but I'd rather go through those moments than a half day with my face half frozen.

The only tenderness I had after the fact was from the time spent with my mouth stretched open. That would happen with or without the shot.


Dr Jeff, thanks for the in depth explanation.

 

[severine]

Never without novocaine. And I've given birth without drugs. I have little tolerance for pain while drilling in my mouth. And I'd hate to think what would happen if I flinched at the wrong time during that procedure.

 

[drjeff]

Never without novocaine. And I've given birth without drugs. I have little tolerance for pain while drilling in my mouth. And I'd hate to think what would happen if I flinched at the wrong time during that procedure.

I would call that stitches in most cases

 

[portermisch]

When you go to the dentist and he/she needs to replace a filling,
Does your dentist give you the option of shots to numb you?
Do you opt for the shot that numbs your face or do you tough it out?

What other options do you get at your dentist?

I have a reason for asking this question.

Yes of course, they can give you shots so you won't feel any pain during dental procedures. Dentist practice sedation dentistry so there's no need to worry about feeling any pain. You can also request them to give you one.

 

[Johnskiismore]

Just one shot, I'd rather deal with the pain during the procedure and not having my face dead for the rest of the day

 

[Hawkshot99]

Anything that will make me not be able to drive(gas) or limit me for the rest of the day(dead face from shots) is to be avoided at all costs.

 

[severine]

Funny this was bumped up today. Had a cleaning this evening and discovered I have 2 small cavities forming that will need to be filled. Going back in 3 weeks and I WILL be going for the Novocaine!