DENTAL ANESTHESIA: WHAT YOU NEED TO KNOW - Dr. Steven

Just like modern medical procedures rely on anesthesia, dental procedures performed today would not be possible without dental anesthesia. The structures in and around your mouth, including the lips, cheek, gums, tongue, and teeth, contain many extremely sensitive nerves. Because of the fear of experiencing severe pain, some people delay or avoid going to the dentist.

You need not let the fear of pain during a dental procedure prevent you from visiting your dentist. The ability to provide comfortable dental care exists today due to the advances made in dental anesthesia. It all began many years ago with the discovery of novocaine, which was a significant step forward. But the types of dental anesthesia available today are far superior to those used years ago.

Types of Dental Anesthesia

There are many options available to dentists to ensure your comfort during dental procedures, including:

- Topical anesthetics. Benzocaine and lidocaine are the two most common topical anesthetics and are available as a gel, liquid, spray, and patch. A topical anesthetic is frequently applied before a dental injection to numb the gum area for more comfortable needle penetration. Dental hygienists also use it occasionally when there is a need to clean deep beneath the gums. Applying these anesthetics to the gum will not numb your tooth, which requires the use of an injectable local anesthetic.

- Local anesthesia. Most people know this as the “shot of novocaine” you receive at the dentist for most dental procedures. Novocaine is rarely the anesthetic delivered with the needle. The anesthetics used today are far more advanced than novacaine. There are a few important things for you to know about local anesthetics.

• There are two broad categories: those with and those without a vasoconstrictor known as epinephrine. This can be particularly important if you have heart or blood pressure issues. You must inform your dentist if you have either condition. The advantage of using a vasoconstrictor is that the anesthesia lasts longer and minimizes bleeding during surgical procedures. The disadvantage is that it can affect your heart.
• Some local dental anesthetics last much longer than others. It is possible with certain ones used today to experience numbness for eight hours or longer. Numbness for this length of time can be helpful for specific procedures. Still, it can also present a challenge until your normal feeling occurs. If you receive one of these anesthetics, it is crucial that you not chew on your tongue or cheek and cause an injury while the numbness persists.
• Your medical history is important to your dentist. Some people believe they are allergic to a particular local anesthetic because it caused their heart to race or felt sleepy after the injection. Your medical history may help determine if you are allergic or if the cause is another medical condition. If you suspect you have a drug allergy, you must discuss this with your dentist and get tested to confirm or rule out the allergy.

- Sedation. Completion of most dental procedures is possible using topical and local anesthetics. However, to alleviate anxiety and reduce pain, your dentist might use sedation also. The two most common methods of providing sedation are nitrous oxide inhalation (also known as “laughing gas) and orally in the form of a pill. The intravenous injection of certain drugs provides relief for more severe cases of anxiety.

- General anesthesia. The strongest form of dental anesthesia and involves the use of:

• Inhalation anesthesia
• Topical and local anesthetics
• Intravenous injection of drugs that put the patient asleep

Administering general anesthesia requires specialized training and comes with more risk to the patient.

Procedures Requiring Dental Anesthesia

No dental anesthesia is usually necessary for dental examinations and teeth cleaning. Most other procedures require the use of one or more types of dental anesthesia described above. These procedures include:

• Dental fillings
• Tooth extractionssuch as wisdom tooth removal
• Crowns and bridges
• Dental implants
• Gum surgery and deep periodontal cleaning
• Soft tissue biopsy
• Root canaltreatment
• Cosmetic dental procedures such as dental bonding
• Oral surgical procedures such as draining an oral infection

Side Effects of Dental Anesthesia

Dental anesthesia is safe and enables the delivery of many painless dental procedures. However, it is imperative that you inform your dentist of any past, or current medical conditions and medications received.  Pregnancy, breastfeeding, receiving chemotherapy, taking anti-anxiety or heart medications are just a few of the significant medical conditions that might affect the use of dental anesthesia for your treatment.

Although it is rare, there are some potential side effects of dental anesthesia, including:

• A rapid heart rate that goes away in a few minutes.
• Dizziness
• Fainting
• Hyperventilation
• Rash or itching
• Drowsiness
• Pain or swelling at the injection site.
• Nausea
• Prolonged numbness
• A feeling of increased anxiety

Today’s superior oral hygiene products such as fluoridated toothpaste and mouth rinse, floss and interdental cleaners, and electric and ultrasonic toothbrushes can help you maintain optimal oral health, enabling you to avoid many dental procedures. But when you need dental treatment, you can be confident that your dentist will be able to provide comfortable care with the use of modern dental anesthesia.

--- By Dr. Steven I Received his Doctor of Dental Medicine (DMD) from the Medical College of Georgia before practicing general dentistry in the United States Navy. He then completed a residency in endodontics at the Medical College of Georgia.