Nothing but the Tooth column: Relieving pain can leave patient numb
Columns share an author’s personal perspective.
Q: Whenever I go to the dentist and have to have a filling done, I think the worst part is the numbness. My dentist is really good at giving me the shot so that does not bother me too much. But, I always walk out of the office numb. Either I have a numb lip or a numb cheek or something like that and I often bite it and when the shot wears off, it really hurts for a few days. I hate that feeling. Isn’t there something that can be done to make it wear off much faster or even immediately?
- S.P., Burlington, Massachusetts
A: In a perfect world, that would be wonderful. It would be even better if you never needed a shot in the first place. The problem is that usually the teeth in your mouth are alive (unless they have had root canal therapy) and you have to realize that dental treatment is a surgical treatment. If the dentist has to cut into your tooth to remove disease and then restore your tooth, he/she has the responsibility of making the procedure as comfortable as possible. If a general medical surgeon cuts into a part of your body, they have to do the same and usually they do that with the help of another doctor (the anesthesiologist) who administers a drug to control the pain of that surgical procedure. In dentistry, pain control is usually done by the dentists themselves. There are however, some options you may discuss with your dentist.
There are multiple types of drugs that can be used to numb your tooth. Some of these are stronger than others and some take longer to wear off than others. You can definitely discuss these options with your dentist. Remember that pain is largely subjective. What one person feels does not mean that another will feel the same. In my practice years, I have had times where patients have asked if I could do the procedure without the need to numb. Often, they use the same reason as the one you stated in your question.
If the procedure is going to be very quick and I think the pain will be very minimal, I will give them that option. What I can do to control the discomfort is to make sure that I use a very light touch when I am handling the drill that cuts into your tooth. Also, if I use a very sharp and maybe new cutting tip or bur, it will be able to cut much faster and with much less force on my part. If I am very careful to make sure to use a good amount of cooling agent (water spray), then the amount of heat that might be generated will be under control and that will minimize the pain. What I am saying is that the pain associated with the surgical dental procedure can be minimized to some extent with how the dentist performs the surgery.
Another factor to consider is age. As we get older, the nerves in our teeth tend to shrink often just because of age. If a tooth has been drilled on before, the nerve will recede because of the irritation of that prior surgery. If the dentist can see on a radiograph that the nerve is much smaller than normal and you have asked whether the procedure can be done without a “shot,” he/she might consider that. Also, if a tooth has had prior root canal treatment and there is therefore no nerve in the tooth, then no numbing will be needed.
The type of local anesthetic that is used can also be discussed and you should let the dentist know what your concerns are about the numb feeling that remains after the procedure is complete. There are local anesthetics that wear off very quickly and some that last a long time (used if a procedure is going to take longer than usual). In addition, the location and type of injection given can have an affect on the time taken to wear off.
S.P., what I am saying is that all concerns can be discussed with your dentist before the procedure is begun. The most important part of what I am always trying to convey to my readers is that there is no question that should not be brought up to your dentist. If it is a thought or concern of yours then bring it up and you should get a very thorough and understandable answer. If you do not, then that alone says something negative about the clinician and should make you question whether the “doctor is always right” and should you maybe consider treatment elsewhere.
Last but not least is that if after all your questions, you and your dentist decide that you have to be numb, then be very careful to not chew anything at all until the numbness has totally worn off. For some that can be a long time and sometimes not under the control of the dentist or drug chosen. If that happens, be as careful as you can and be happy that your dentist made the surgery as comfy as he/she could.
Dr. Richard Greenberg of Ipswich, Massachusetts, practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question or comment about the column? Email him at email@example.com.