What does the phrase “going to the dentist” conjure up for you? For many it is a feeling of anxiety. At best, it may be an unpleasant experience, or at worst, a very painful one. However, it doesn’t have to be, nor should it ever be, something to dread.
Pain is personal, and everyone’s threshold for pain is different. Some patients require numbing for a simple cleaning, whereas a select few decline anesthetic altogether for even the most invasive procedures. Moreover, pain may also be perceived differently at any given time. If you’ve had a stressful day or if you’re expecting to feel pain, the anesthetic may be less effective than if you come into the appointment relaxed and calm.
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Weighing the Risks and Benefits of Local Anesthesia
It is always important to weigh the risk and benefits of any medication, and anesthesia is no exception. Before you decide to take anesthesia from your dentist, you must consider the potential side effects.
One review of 78 articles spanning from 1966 to 2019 noted that reported adverse events after dentist-administered, local anesthesia included:
- Visual disturbances
- Allergic reactions
- Nerve damage
- Hemorrhaging
- Needle breakage
- Tissue Necrosis
as the most frequent side effects. The review also said that adverse events happened among the reports anywhere from 4.5% to 26.2% of times. Overall, the study found that “adverse effects that are rarely encountered in real-world general practice are overrepresented in the literature.” With such a wide span of results in the reviewed studies, it is tough to say accurately what can be considered “rare.”
Why Oral Health Matters
For those seeking dental care, but who are too afraid to schedule an appointment, numbing agents may provide for enough pain alleviation to be proactive about their oral health. One 2019 study says that improvement of oral health “could have great systemic implications for [a person], for the prevention of pathologies, and therefore for society and for the quality of life in individuals” overall.
Oral health has been connected to overall health for decades. A link between oral health as contributing to a number of medical conditions have been made, including:
- Endocarditis
- Cardiovascular disease
- Pregnancy and birth complications
- Pneumonia
Conversely, your oral health can be affected by medical conditions, as well, including:
- Diabetes
- HIV/AIDS
- Osteoporosis
- Alzheimer’s disease
How Dental Anesthetic Can Provide Relief
Local anesthetic, delivered via an injection, is the most common tool dentists employ to numb areas in the mouth. Often referred to by the generic term “novocaine,” there are actually many types of local anesthetic that can be administered during a dental appointment. Dental anesthetics are differentiated by:
Additives – Epinephrine, or adrenaline, is typically added to anesthetics to prolong the effect of the medication. Epinephrine constricts the blood vessels in the surrounding area and keeps the anesthetic “local” – hence the name – and in the treatment area, so that it lasts longer in the affected area.
Although epinephrine is a naturally occurring substance in the body, some patients react as if they are allergic to it. Rather than a true “allergy,” what they’re feeling are the essential effects of epinephrine: a faster heartbeat, increased anxiety, or lightheadedness.
Side Effects – Should some of the anesthetic inadvertently enter a blood vessel, these effects may be magnified. If the anesthetic enters the blood vessel, you may be at risk for tachycardia (a heart rate faster than 100) or hypertension (raised blood pressure). General side effects of an overdose include hypertension, tachycardia, tachypnea, headache, and vertigo. If you experience hypersensitivity to the epinephrine, ask your dentist to use an anesthetic without this ingredient.
Duration – Some anesthetics are short-acting, lasting 30 minutes to an hour, just long enough for a quick procedure such as a simple filling. Others can last for six to eight hours after a procedure. These anesthetics are ideal at the completion of wisdom teeth extractions, for example. The duration of the anesthetic may also be related to any additives contained in the ingredients, in addition to ephedrine. Oftentimes such ingredients are needed to extend a product’s shelf life or to keep it in its intended state.
When Relief Doesn’t Come
Despite local anesthetics used in a dental office, sometimes patients don’t get completely numb. There are a number of factors that influence this:
- Anatomic variation – Certain areas of the mouth, specifically the lower jaw, may be more difficult to numb. The dentist must deposit the anesthetic close to where the nerve exits the jawbone, but he/she can’t actually see this spot because it’s underneath the gum. The dentist instead must use other anatomic landmarks to estimate where this location should be for the average patient. In certain people, the area might be higher or lower, resulting in that patient not getting numb. Depending on the dosage administered, your dentist may be able to add more anesthetic. Other times, you may be out of luck and in some pain, as providing more would increase your risk for an adverse reaction.
- Infection – Regardless of how much anesthetic is used, an infected area will not get completely numb. The infection must be addressed first before the dental procedure can proceed. Research has shown that this occurs due to both an increased acidity in the mouth during an infection, as well as the presence of inflammation.
- Accessory nerves – Occasionally there are tendrils from other nerves that supply feeling to an area. When that’s identified and anesthetized, the patient will be comfortable.
- Being a redhead – Less than two percent of the world’s population has naturally occurring red hair. But ask any dentist, and most will tell you, that redheads have difficulty getting numb – and staying numb with dental anesthetic. They generally require more anesthetic than their blonde or brunette counterparts. There is strong anecdotal evidence to indicate that redheads may have some genetic predisposition to their pain response.
Research has shown that nine in ten redheads have an “MC1R” gene mutation that requires them to need higher doses of anesthesia for relief.
- History of alcohol or substance use disorder – Similar to redheads, these patients seem to need more anesthetic for numbness and the effects are short-lived. They also require repeated injections during a procedure. It is unclear why this occurs, though some have speculated that a combination of an increased tolerance and/or a raised anxiety and stress level may cause these numbing agents to lose efficacy.
If any of these conditions apply to you, discuss it with your dentist. Together you can work to achieve maximum comfort during your visits.
Mitigating Pain
No one should feel pain at the dentist’s office. Here are some strategies to facilitate that:
- Be as relaxed as possible. Use relaxation techniques, such as deep breathing and mindfulness.
- Consider distraction techniques if you’re anxious. Listen to music, books, or podcasts. Some offices allow you to watch videos during your appointment.
- If you’re very anxious, discuss this with your dentist beforehand. He may prescribe some anxiety reducing medication or suggest nitrous oxide (laughing gas).
- If you’re needle phobic, definitely bring this to your dentist’s attention. Not only will you potentially require a longer appointment, but there are additional techniques the dentist can use to address this challenge.
Remember: Being Numb Can Help. Ask About Dental Anesthetic if You Need To
Speak up if you’re feeling any discomfort! When the local anesthetic works successfully, you are at ease. Your dentist, too, will be more relaxed, not bracing for the next time you flinch. He can focus on the procedure and work more effectively and efficiently. The entire environment will be much more tension free.
One last thing: Plan accordingly for after the procedure. Find out how long you’ll be numb, what symptoms to expect afterwards, and what precautions need to be taken.
Remember, going to the dentist should be pain free. Doing so regularly can help to improve your overall health, indicate medical conditions, and reduce occurrence of some diseases.
