Q: Tooth Pain
with extraction
"I had to have a tooth
pulled and they gave me
the maximum numbing
medicine they could. Why
then was everything in
my mouth numb but the
tooth itself was still
exquisitely tender? It
was the most painful,
traumatizing event I
have ever been through
and they would not
believe my tooth was
still painful."A:
Let us start by
telling you that we are
sorry you have had such
a bad experience. During
administration of dental
anesthesia the goal of
the dentist is to
deliver the medication
as close as possible to
the main nerve that
innervates the tooth or
the area of operation.
These are the most
common reasons a dental
anesthesia could be less
than effective:
- Presence of
infection in the
area that being
numbed. In some
cases antibiotic
therapy is indicated
before the surgery
(extraction).
- Anatomical
variations. On
occasion the anatomy
of the area and the
placement of the
nerve may be
unusual, therefore
the medication does
not reach the nerve
that is responsible
for the tooth
itself. That is why
you could be numb
all around but not
on the tooth itself.
There are techniques
that can be uses to
reach the main nerve
at a higher level.
- Cross
innervations.
Depending on the
location of the
tooth that is being
extracted, there
could be nerve
fibers crossing from
adjacent area to the
the tooth. This
anatomical
characteristic
requires
administration of
anesthesia to those
other nerve roots.
In general, while it
may be very challenging
to get a complete
anesthesia in some
cases, it is very rare
that a dentist has to
perform a surgery while
patient still is in
pain. If this is
predicted, general
anesthesia or conscious
sedation may be
indicated.
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