feel no pain with anaesthesia during filling : truth or fiction?

[clifford slug]

Hi all!

Had a new filling installed yesterday due to old filling falling out. Its a back lower tooth with a deep cavity. When the drill was used briefly I felt sensitivity. It was uncomfortable but tolerable. My question is simply whether it is normal to feel some pain when having a deep cavity filled. The dentist waited a good five minutes at least after giving me the numbing medication.

I only ask because all the internet dental sites proclaim that you should feel no pain at all during any procedure and id like to know if my experience is unusual. Thinking about it I cant imagine that numbing agent injected into the gum could even penetrate through solid tooth to reach the nerve in the first place and its the nerve after all that feels the pain!

Would love an honest answer from a dentist.

Thanks in anticipation!

 

[MattKW]

Back lower teeth are sometimes difficult to fully numb up without adding extra anaesthetic or a different technique. It is thought that there are extra nerve fibres that enter from the transverse cervical nerve (TCN), or branches of the mylohyoid. You then have to weigh up if the pain of another injection (or 2 or 3) will be worse than just being brave for a little while. I get ready for administering an intraligamental injection for sore lower teeth that are likely to present this problem.

 

[honestdoc]

Many times sensitive teeth may still feel cold if not fully anesthetized. I would spray air & water blast on a tooth with my assistant's high suction. If you don't feel cold, I will proceed little by little. Years ago, I used to do full time root canals for a group practice (many inexperienced or restorative focused dentists don't like to do them). I had the luxury of repeated practice and observed certain patterns and tendencies of anesthetizing. A lot of my colleagues like to use a strong anesthetic called Septocaine (Articaine) 4%. They lost the accuracy of giving the lower nerve block. One 30 plus year dentist couldn't get a patient numb and asked me for help. I just used the standard 2% Lidocaine and within seconds, the patient was fully numb. With that note, I do have times when I couldn't get people numb. I put them on oral sedatives to relax the nerves and usually succeed.

 

[MattKW]

Yes, I don't see a significant better LA success with articaine, and don't stock it. Sometimes I wonder if struggling dentists have given lidocaine 1st, then when it hasn't worked, have reached for articaine. The 2nd shot works and they attribute it to articaine! For really hot pulps, I might clean out as much as they can bear, then close up with Ledermix/Odontopaste and a temp filling, then have them return later, pre-dosed with ibuprofen.

 

[honestdoc]

Past American Assoc of Endodontists President and residency director Dr. Ken Hargreaves gave a lecture where his research team found 10 pain receptors in the pulp. 8 of them are Lidocaine sensitive while 2 are resistant. The resistant ones are sensitive to Mepivicaine (3%). On a routine LA nerve block I give the 3% slightly lower about 1 cm above the occlusal plane and followup with Lido aiming for the ear hole (Gow Gates). Usually after the Lido, the patient is fully numb. On difficult anesthesia cases during RCTs, I get the patient numb enough to expose the pulp and inject and flood the canals with Lido and use a hand file down. Afterwards, no more anesth worries.
I don't drill through bone and PDLs doesn't work for me.

 

[clifford slug]

Thanks for the informative answers! I'm now better informed and a little more realistic about what's possible with pain management.

Thanks again from Clifford Slug.