We use local anesthesia at this office, which has a long history of safety and effectiveness. This anesthetic may be administered as a block, which affects the entire area and may numb the tongue and lip as well as the tooth, or with local infiltration, which numbs only the area around the tooth to be worked on. Below are descriptions of types of anesthesia used, along with evaluation of risks.
This is a definite possibility for shallow decay and tooth brush abrasion damage, since our air abrasion system of cavity preparation is much gentler than a traditional drill. With no anesthesia, there is no problem with after effects, but occasional discomfort during the procedure can occur.
Local anesthetic - Lidocaine with Epinephrine
This is a commonly used dental anesthetic. It is powerful and long lasting, (lasting 2 to 4 hours after administration), but cannot be used in some patients who have conditions that do not allow use of epinephrine, such as high blood pressure.
Local anesthetic - Articaine with Epinephrine
This is a newer dental anesthetic. It is powerful and long lasting, (lasting 2 to 4 hours after administration), but cannot be used in some patients who have conditions that do not allow use of epinephrine. The rapid onset and efficacy is a reason this anesthetic has become the most common dental anesthetic used in our office.
Local anesthetic - Mepivicaine without Epinephrine
This is used for patients with high blood pressure or glaucoma, pregnant women, patients taking medicines that interact with epinephrine, and patients with a known sensitivity to epinephrine. This anesthetic is not as long acting as that with epinephrine, but does not raise blood pressure or cause epinephrine side effects.
Local anesthetic - Marcaine
This is a very long lasting local anesthetic, used primarily to provide sustained pain relief after extractions or surgery. It may last about twelve hours after administration.
Possible Complications from Anesthesia
Complications from local anesthesia are very rare, and are usually only mild in effect. Below are some possible problems, along with the statistical chance of their occurrence.
Soreness at Injection Site
This is generally not serious, although it can be uncomfortable for a few days. Statistically, this is more likely to occur with an intraligmental injection rather than a block. This occurs about once in three hundred injections.
Reaction to Epinephrine
This involves dizziness, a jittery feeling, a feeling of cold, or elevated blood pressure. The reaction can vary from slight to severe. The reaction is generally not serious and goes away after the epinephrine change is to has dissipated, but can require medical attention if blood pressure is elevated. This reaction may be more likely with a person who experiences panic attacks. This reaction occurs about once in a thousand injections. Anyone who has had previous reactions (or suspected reactions) should report them to us, and any epinephrine reactions that do occur in the office should be reported as part of any future medical history.
When an injection is given, there are numerous bundles of blood vessels invisibly crisscrossing the area. Occasionally a blood vessel is affected, and a bruise may develop. This can cause facial swelling, which will go away as the injury heals, usually in about a week. This may occur about once in six thousand injections.
Occasionally a nerve is touched during an injection. This can result in a temporary jolt or the feeling of an electric shock. This occurs about once in five hundred injections.
Sometimes medicines are prescribed in advance of an appointment to help the patient relax. Valium is one example of an anxiolytic medication. The main disadvantage is that the patient must have someone drive him or her to the appointment after taking this medication.
Anxiolytic drugs can also be unpredictable in their effectiveness, especially in children. Although most patients react by being mildly relaxed, once in a while a person may react very strongly and be too fatigued to cooperate with the dental procedure. On the other hand, an occasional patient will show no effects from the medicine.
We offer nitrous oxide or “laughing gas” as a sedative option for our patients. Nitrous is a colorless, non-flammable gas that is mixed with oxygen and administered through a mask over the nasal area. There are very few side effects or contraindications in its usage, which makes it a useful tool in dentistry to help patients relax during a procedure. When inhaling a mixture of nitrous oxide and oxygen, patients become less anxious, and may feel light-headed or notice tingling or a heavy feeling in arms and legs. Patients remain awake and are able to respond to conversation with the dentist while receiving this anxiolytic. Patients still require local anesthesia if it would normally be administered for the procedure. Not everyone reacts the same way to nitrous oxide but in general we have found it to help most patients (both adults and children) enough to have them get through the procedure successfully and happily. Once the nitrous is shut off, the patient breathes in oxygen for a few minutes and is then able to return to normal activities