Dental MythBuster #4 – Dentists Still Use Novocaine

Dental MythBuster #4 – Dentists still use novocaine

There are some dental myths I hear quite frequently in my dental office in Orange, CT. The novocaine myth is one of the most common.  Invariably, as I am talking about a procedure with my patient in the chair, he/she will say something to the effect of:

“So you are going to give me a shot of novocaine, right?”

I usually do not correct the patient, unless he/she works in the medical or pharmaceutical field.  If I were to answer the question, I would say:

“No, I am not going to give you a shot of novocaine. Dentists stopped injecting novocaine over 30 years ago. We use local anesthetics that are more effective and have less potential for allergic reactions now.”

History of Local Anesthetics in Dentistry

Cocaine is still used as local anesthetic in certain medical fields

Cocaine as a local anesthetic

Local anesthetics have been used in dentistry for over 100 years. The first widely used local anesthetic was actually cocaine.  Cocaine was first used in a dental procedure in 1884.   Prior to that, many other techniques were used, with the most common being the consumption of large quantities of alcohol before a dental procedure.  Cocaine was certainly more effective than no local anesthetic (or drunkenness), but there were many drawbacks, most notably its high potential for addiction, its short duration of action, and its effects on the heart and entire cardiovascular system.

In 1905, procaine was synthesized, and it was immediately adopted as a replacement to cocaine.  One manufacturer came up with the brand name Novocaine (also called Novocain and misspelled as novacaine ).  Due to the marketing efforts of this manufacturer, Novocaine became immediately popular with dentists and it subsequently entered the vocabulary of most Americans.

Lidocaine is used by dentist as a local anesthetic instead of novocaine

Lidocaine – the most frequently used dental local anesthetic in the U.S.

Novocaine was widely used in dentistry in the early decades of the 1900s with great success. However, it was noticed that some patients suffered allergic reactions to Novocaine.  While some of the allergic reactions were mild, others were more serious (note that people are not allergic to novocaine; people can be allergic to PABA, a direct metabolite of novocaine). As a result, a new class of local anesthetics was developed in the 1940s that did not have the same incidence of allergic reactions. They became commercially available in the 1950s, and then the use of Novocaine began to decline in the 1960s. By the 1980s, nearly all dentists had stopped using Novocaine in the United States, and lidocaine (pictured above) became the most frequently used local anesthetic.

Why this dental myth persists…

One would think that I, as a practicing dentist, would know exactly why this myth has persisted for so long.  I am unsure. But here are some ideas:

  1. Many parents indoctrinate their kids with stories (and phobias) about dentistry.  If the parents use the term Novocaine, then kids get used to the term too.  Many of those kids are now grown up and pass along the “novocaine” myth to their kids.
  2. Procaine (the generic name of Novocaine) is still occasionally used in certain fields in medicine.  In addition, other local anesthetics in the same family as novocaine are used in dentistry as topical anesthetics.   This might be a reason.
  3. Dentistry is filled with many myths such as “the dentist who pulled my tooth put his knee on my chest” and “Diet soda is not bad for my teeth” and “When I was pregnant my baby stole calcium from my teeth“.  People may hate going to the dentist, but patients love to tell dental stories. Perhaps because so many patients seem to relish in recounting and exaggerating dental stories that we have so many dental myths, including the novocaine one.

Regardless of why this dental myth is still around, it needs to be busted, so I will summarize it by writing:

Dentists no longer use novocaine and haven’t used it routinely in over thirty years!

 

Comments

  1. I assumed that novocaine was what all dentists used all the time. It is puzzling why everybody keeps calling it novacaine.

  2. A.O.,
    Thank you for the input. This is the reason I chose to write about novocaine. Next time you go to the dentist, ask him or her what he/she uses for a local anesthetic. It won’t be novocaine!

  3. Hi
    When I visited my dentist she seems to have a choice between two anesthetics
    I’ve herd her say lidocaine but I do not know what the other one was
    when I had a tooth extracted once It hurt and when I went back to see her on the next appointment , I mentioned about the tooth hurting me when it was extracted
    and she said I gave you the wrong anesthetic ,because I thought your tooth would come out easy
    so jokingly when I have to have a tooth extracted I always say give me the strong stuff
    I thought it was novacane ,but it must have been lidocaine
    so what other anesthetic could she have given me, and what is the strongest

  4. Garry,
    That is an excellent question. I am assuming you live in the United States and this incident occurred within the last 20 years. I can assure you your dentist did not use novocaine.

    Lidocaine is the most popular dental anesthetic. There are more powerful ones out there. Sometimes for extractions I use marcaine (generic name is bupivicaine). Marcaine can last a long time – like 8 hours – but it helps to ensure my patients feel nothing during the extraction. Other times I will use septocaine (generic name is articaine). Those are both more powerful than lidocaine. In general, if I am doing a filling, I use lidocaine. But for extractions, I use either the marcaine or septocaine because you need to be more numb for a tooth extraction than for a filling.

    In the future, you could always ask for one of those two, or just ask for extra lidocaine. I hope that answers your question.

    Nicholas Calcaterra DDS

    • Dr i had a question, i was given up to 5 shots during a root canal. i think it was lidocaine. it might have been more but this was years ago. the tooth never went numb, infact this is the 3rd time its refused to go numb. after a while the dentist said my nerve was too deep, and i was in alot of pain, so he cleaned the inside with an antiseptic and filled it up.. why wont my tooth go numb? is there anything i can do to help it get numb easier? at this point the shots hurt more than the procedure.

      • If I had to guess this is probably a lower back tooth? Some teeth in that region are difficult to anesthetize because of the variations in the number of nerves supplying them. For lower back teeth, there can be as many as 5 different nerves supplying them, each one requiring a separate injection in a different location. Besides that, there are other factors, such as hair color (see this page: http://directionsindentistry.net/redheads-dread-dentist-part-2/), anxiety level, presence of an infection, and other variables. One or more of these factors are likely behind your tough tooth. Hope this helps.

    • Just three-four nights ago I had excruciating pain in my upper and lower left side of my mouth. The main tooth, which had a large cavity that was filled quite some time ago, was the source. The decay got behind the filling and I had a pinpoint exposure. He shot me 5 times with “Novocaine” i guess, 4 in front 1 behind the tooth because they couldnt numb me. Proceded to put a liner and medicated filling in. I’ve had the same procedure done on my lower left (where its also been hurting) but never have I had such intense pain in the days following. What should I do

      • Drew,
        Based upon your description, it sounds like the “medicated filling” and “liner” are very close to the nerve and that the nerve might be irritated. You may need a root canal. I would call your dentist and explain your symptoms. Your dentist may recommend a root canal.

  5. Hi
    Thanks for your reply I live in England
    when she extracted my tooth she gave me about six injections and I still felt pain
    and other times I don’t feel anything so I am assuming now she gave me lidocaine when it hurt
    also how long should you Waite before extracting the tooth, my dentist only waits about two minutes and tests to see if it hurts
    so next time I have a tooth out I will ask what anesthetic she is using
    also is the price of lidocaine cheaper than the other two anesthetics that you have mentioned
    because I am on the national heath and don’t pay for my treatment I am wondering if she gives me the cheapest to save money
    thanks
    by the way I am not a red head

    • Garry,
      I am sorry that you had to feel pain during the procedure. That is not the level of care that any dentist likes to deliver

      Besides the actual local anesthetic, there are other factors which affect how numb a patient is:
      1. Presence of an infection – a persistent infection changes the chemistry in the area and can make it more difficult to achieve profound numbness.
      2. Location – some teeth, most notably lower molars, can have multiple nerves, and sometimes you have to give multiple injections in many different areas to numb each nerve.
      3. Patient’s stress – being stressed can heighten your ability to sense pain, causing the patient to need more anesthesia.
      4. Other factors such as red hair, certain medical conditions, etc.

      Regarding your questions, lidocaine is slightly cheaper, but not my much. Using U.S. currency, a lidocaine shot is perhaps about $.20 less expensive than other types. And for an extraction, I typically wait at least 10 minutes, but usually more.

      I would talk to your dentist about this. He/she may be aware of other factors that I am not aware of.

      Nicholas Calcaterra DDS

  6. I wish dentists could get rid of it altogether or get needles that don’t look like they’re from some ancient horror film.

  7. Recently I had a filling done on a lower back tooth. I asked the dentist to give me the anesthetic without epinephrine because I had a bad case of very rapid heart rate and nervousness after one use of the regular drug. He said he would do this but it would wear off in 15-20 minutes, which would have been fine since it only took him about 5 min. to do the filling. However, it took a good 4 hours for the stuff to wear off. Can you tell me why the very big difference in what he said vs. what really happened?
    Thanks.

    • Nancy,

      Thanks for the post.

      It is common to use a local anesthetic without epinephrine in certain circumstances. In general, for most patients, in my experience local without epinephrine will last about an hour. So why did it last 4 hours in your case? There could be a lot of factors. These could include:

      1. Genetics: Some people are born with higher blood levels of the enzyme which breaks down the local anesthetic. You may have genetics where you have less of this enzyme.

      2. Location of the injection: if your dentist gets very close to the actual nerve, then the numbing will last longer. Conversely, if the local anesthetic is deposited farther away from the nerve, then the numbing effect will not last as long.

      3. Physical activity after the injection: if you engage in a lot of physical activity after the injection, your blood flow to the area will increase, and therefore the local anesthetic will wear off more quickly.

      4. Other factors which can include: subtle changes in blood pH, your head position during the procedure, your anxiety (or lack thereof) about the procedure, etc.

      If anything, the above should just tell you that we as humans are very complex and no two teeth (nor their owners) are the same! But rest assured, based on your description, it doesn’t look there is anything abnormal going on. But ask your dentist to be sure.

      Nicholas Calcaterra DDS

    • This is exactly what happened to me today Nancy. I hate the anesthetic my dentist uses. He goes to great lengths to shoot me full of it and today the tiny cavity I had filled took approx 15 minutes and the anesthetic he uses numbs the whole side of my jaw and face and ear and took 3 hours wear off. I’d almost rather have the pain. Is there anything, Dr Calcaterra, that you can recommend instead of using a novocaine type anesthetic? I have been with my dentist for 20 years but this whole anesthetic issue is making me want to look around at what other dentists are doing. Any suggestions? And my dentist is very good at what he does. I just don’t understand why I have to have so much anesthetic to the point of numbing the whole side of my face.

      • DebH,

        Thanks for your comments. For certain areas of the mouth, most notably lower back teeth, the only way to reliably get a tooth numb is to do a nerve block. For a lower back tooth, you have to block a specific nerve (called the inferior alveolar nerve), which just so happens to supply the chin and part of the cheek on that side of the face.

        I understand the frustration of being numb for so long. There are certain anesthetics that do not have epinephrine in them that do not last as long. You can ask your dentist if he/she can use them. Those include mepiviciaine as well as prilocaine. Both are structurally related to novocaine.

        You also asked about Oraverse. That would decrease the duration of the numbing feeling. But remember – that means ANOTHER INJECTION. I can assure you that your jaw muscles will be sore the next day if you received 2 injections.

        Sometimes, for very small fillings, I offer to try without any local anesthesia. About half the time, I am able to do it. It’s a win win situation!

        I hope this helps.

        Nicholas Calcaterra DDS

        • Thank you for your response. It was a very small filling and I feel I should have opted out of novocaine. I will ask my dentist next time. I think because he is also a friend he doesn’t want to take the chance of causing me pain. Probably better communication is in order. Thank you again for your response.

  8. Have you ever heard of http://www.oraverse.com/

  9. Yesterday, I had an upper wisdom extracted (which had a sharp edge). I informed my dentist that the last time he shot me up I had some heart pains that lead me to have to sit back upright. What I didn’t volunteer was telling him it took all the concentration I had to pray for it to languish. The shots were “pinchy”,too. Enough epinephrine to travel to my lower lip

  10. …And numb that,also. I’ve never been a fan of synthetics.(even though our bodies are made up of approx. 70% synthetic Nitrogen..thanks to German scientists @ Luena)
    So, he obviously used another numbing product because he didn’t use as much , he only gave me 2 shots, I barely felt the “pinch” , and was a mild wear-off effect. As opposed to the previous time where there was extreme numbness.
    During the extraction I felt the tools more, slight pain while the tooth was being ripped out, but it was all the while more worth the experience than to suffer from the anesthesia.. I don’t envy the guys in the civil war, I know that much.
    Lastly, I’d like to say Hi to the NSA for reading all our personal information. Jesus saves!

    • Vernon,
      Upper wisdom teeth usually don’t present issues to get numb. I do lots of extractions, including wisdom teeth, and the patients rarely complain. I am glad your experience with your extraction was not too bad.
      Nicholas Calcaterra DDS

  11. Irene Edmond says:

    When a person can take nothing with caine in it what can a dentist use or what type of dentist he can go to

    • Irene,
      True -caine allergies are exceedingly rare. Patients can sometimes experience an adverse reaction to lidocaine and perceive it as an allergy. Have you been tested by an allergist?

      Dipenhydramine (better known as its brand name Benadryl) can be injected as a local anesthetic. This has been used with moderate success. Dentists do not typically carry this in their offices so you should not assume your dentist has it. For more significant dental work, then sedation may be necessary. But first step is to verify what type of allergy, if any, you have to -caine anesthetics.

  12. I was researching online to try and figure out what happened to me at today’s dental appointment. I have a very bad toothache and found a nearby office opened on Sunday. After some X-rays, it was decided that I would probably need a root canal. I was given a shot of something for pain, and within minutes my body went crazy. I was dizzy, my heartbeat felt faint, my blood pressure was off, my vision was blurred, and I ended up in an ambulance. I’m okay now, just a mild headache, but my vitals are okay. My tooth still hurts, but I am a little nervous to go back. What happened?

    • Raven,
      I wasn’t there to observe you but based solely upon your description, it sounds like you passed out. The technical term is that you likely experienced an episode of vasovagal syncope (http://en.wikipedia.org/wiki/Vasovagal_response). It is also known commonly as fainting. I see episodes like this once over couple of months.

      Your dentist should have told you what happened. And certainly, the paramedics in the ambulance should have told you too. Did either of them tell you?

  13. Well THIS explains a lot. As a kid, the last time I had a regular dentist, my dentist used Novocain on me all the time. When I went abroad to England and then to Canada, the dentists there use Novocain. Novocain is not contraindicted in people with High Blood Pressure, hence even though I was diagnosed with HBP in 2003 by my then-doctor in San Francisco, I never had any problems with it from the dentists in England and then Canada, AFTER I was diagnosed with high blood pressure – and in 2005-2006 was still not “on” anything for it because she had not given me anything for it. Novocain is not contraindicted for people with high blood pressure – I’ve done all my research as I go to Johns Hopkins and have gone to law school so I’m used to doing research whenever I’m told something absurd which sounds like malpractice or just plain nonsense by the medical profession. Hell, the medical profession screwing with me was the reason why I went to law school in the first place. No lawyer I could afford would ever take my case.

    I’ve been wondering what’s wrong with dentists in this country as they’re all telling me that the anesthetic they use can’t be used on people with high blood pressure. If it IS still Novocain then I have a case for dental malpractice or negligence or just plain incompetence, because they should know better than that or they deserve to have their licenses to practice dentistry revoked. In Canada and England apparently it IS still Novocain that’s used because I’ve NEVER HAD ANY PROBLEMS WITH IT and in fact there they don’t even TAKE your blood pressure before dental procedures unless you SAY you’re allergic to Novocain – which, get this, they ASK YOU first.

    I was beginning to wonder why EVERY STATE I go to, the “free” dental clinics all say the same stupid moronic thing. That the anesthesia is contraindicted for not only high blood pressure patients but also reacts badly with Beta-Blockers used to LOWER the damn blood pressure.

    Well, off to Mexico or back to Canada I go, then, for dental treatment. Both of which are one HELLA long way to go to get “fixed” from domestic violence, don’t you think??!!

  14. Michael says:

    Hi, I had a root canal done today. They gave me two dosages of something and some gel. It’s been almost 7 hours and I still have numbness and no control over my cheek but I can feel my tooth, is this normal?

    • Michael,
      Based upon your description, this is most likely normal. Some commonly used anesthetics (marcaine as an example) can make a patient numb for up to 12 hours. I know that sounds like a lot, but sometimes that is the only way to reliably ensure that a patient will not feel anything during a procedure.

  15. I went to the dentist to have a tooth extracted. He gave me one shot and everything was fine when he started the second shot I had some kind of a reaction. The room was spinning so fast I had to hold on to the arms of the chair or I was sure I would fly out of it. I had to close my eyes so I couldn’t see the room spinning. While I had my eyes shut I realized the chair was moved with my head lower than my heart and heart monitors had been put on my chest. Next I got sick and vomited. The dentist said it was a panic attack but I am not sure that is what it was. I had no fear before I went in and the first shot was fine. Someone mentioned that maybe he hit a nerve and caused the reaction. Now I am afraid to get another shot. Do you think it was a panic attack, the needle hit a nerve or some kind of an allergic reaction?

    • Janice, I wasn’t there for the incident, so I am basing this upon your description only. It does not look like an allergic reaction because typically that will produce other symptoms such as redness, swelling, rashes or hives, possibly airway issues and difficulty breathing, etc. The fact your dentist arranged the chair so that your head was lower than your heart tells me he/she thought you were fainting. This is technically called vasovagal syncope (https://en.wikipedia.org/wiki/Vasovagal_response). People can get very nervous at the dentist, and I see this periodically. It is unlikely because of what was in the shot; it was more likely based on the concept of the shot as well as about to have a tooth pulled. That is what I think it is, based upon your description alone. Hope that helps!

  16. The last 3 dental visits when I needed work done and was given a shot I felt shaky and my heart raced. I wasn’t nervous so it wasn’t from that. It happened after the shot while I was waiting for the complete numbing to occur. Three times! Now I need to go back from a toothache and I am afraid of the shot. I didn’t want to say anything because I thought my dentist would say that I was nervous. What could this be?

    • Karen,
      Based upon your description, it appears that the epinephrine in the local anesthetic is getting into your bloodstream and causing your heart to race (among other things). This is quite common. At your next visit, you should ask your dentist to use a local anesthetic that does not contain epinephrine. Note that the local anesthesia will not last as long, so he/she may need to give you more halfway through the procedure.

  17. I have a question for you…I went to the dentist yesterday morning just for a cavity & still today I have swelling in my cheek & I can hear the liquid moving around when I pressed down on it & I saw liquid move up to my eye. I stopped touching it immediately & went to my dentist but they didn’t have much to say & they told me to give it a few days for the swelling to down. Is this normal? Will it go away? What causes this?
    Thank you

    • Melissa,
      This is a tough one to comment on without doing a proper exam. It sounds like there might be an accumulation of fluid in the tissue. While this is not normal, there is always that potential when injecting anything into the body. If this is the case, it should self resolve. But your dentist can probably answer it better, since he/she was there and was able to examine you.

  18. Why does the myth still exist?

    “I usually do not correct the patient, unless he/she works in the medical or pharmaceutical field.”

    There is the reason. Mystery solved.

    • Jonathan,
      Astute and concise observation there. That definitely is a factor, but not the only one. Since this post receives so much traffic, maybe I’ll do a follow-up post where I address your point more formally.
      Thanks

  19. Recently, I went to see my endodontist for a root canal. I am 58 years old. He did two previous root canals on me in the last 20 years. He sold his practice and is working only 2 or 3 days a week almost next door. They took my blood pressure with a ‘watch’ which had never been done before. I got all stressed out because he told me that I needed to be on high blood pressure medication? I went to see my internal medicine doctor and he said that I did not have to take medication and could go for the root canal. I trust this endodontist since he did two beautiful root canals before without any problem.
    What is going on here and how should I handle it? Some one told me that the ‘watch’ to measure the blood pressure is not accurate.

    Thank you very much for your time/expertise.

    • Taking blood pressure at your dentist’s office is not that uncommon. I will frequently do that on patients who are medically complex. If a patient has untreated high blood pressure, a stressful dental procedure can cause an increase in blood pressure, leading to an undesirable consequence.
      That being said, wrist style blood pressure monitors are not that accurate. In addition, the stress of being in the dental office can cause a leap in blood pressure (this is called white coat syndrome). However, your endodontist was only looking out for you. He has your overall safety in health in mind.
      If your primary care physician evaluated you and said your blood pressure is fine, then you shouldn’t worry about that. Have your primary fax a letter to the endodontist and then get the root canal procedure done.
      Hope that helps.

  20. I have been going to a dentist for a couple of years now. I needed a root canal on my back right molar. He gave me 3 shots of Articaine and I had pins and needles going down my arm for about 10minutes which had never happened before. He ignored the reaction and I left with a temporary filing. As I am now going to be 60, I feel afraid of anaesthesia and an allergy test did not show anything except nauseous and sick to my stomach from Lidocaine and Scandonest. Did the dentist damage a nerve as I have pain on the right gum at the back intermittently and not sure why in that area? For the permanent crown will I need a local anesthestic or will nitrous oxide suffice? I have lost trust in my dentist and I am going to a dental clinic at the hospital as I am worried about my age

    • Doreen,
      Your description of your experience doesn’t sound fun. Your description also paints a very complex picture, one so complex that I can’t figure out what really happened. Remember – I wasn’t there to see it! Hopefully the new dentist at the hospital can answer your questions.

  21. Italiabella91 says:

    Hello,

    I am, I guess you could call me a younger generation patient of the 90s who routinely has gone to the dentist since I was about 4. I had several filings done and my dentist did use novocaine every time. Originally, they just stuck the needle in the gums and numbed to root and nerve to the tooth so you didn’t feel the filing and the sensations of the procedure. Mind you, this was back in the early to mid 90s at a pediatric dentistry.Then, shortly after kids became petrified of going to the dentist to get cavities filled, they began using the topical gum solution that temporarily numbs the site so the shot is less painful, but you still received novocaine, regardless. Now, I’m in my early 20s and need a filing replaced.( the silver mercury ones were all they had then) and I’m so scared of that shot because most adult dentists don’t use a numbing solution before the inject.

    • Most adult dentists do use topical anesthetic (that is the numbing solution or numbing jelly). If your dentist doesn’t use it, ask for it! Before your appt you should call to ask if they have it. I use it on 100% of my patients – unless they specifically request that I don’t use it. Don’t let fear keep you away. Your problems will only get worse.

  22. Are dental assistants allowed to seat temporary crowns without direct supervision of the dentist? I had this happen recently for the first time. The dentist left the room, and the assistant fitted the temp crown on, jamming it on, and then using a drill to grind off rough spots at the bottom that were protruding. (Before that, she was pulling on it hard, as if she were trying to remove the already cemented temp crown, to where I feared the delicate tooth might break, as she worked she said nothing, contributing to my alarm) I don’t recall any of the other crowns I had, where the assistant did this portion of the work, alone. Is this something new? I am in Hawaii.

    • Victoria,
      That is a very good question. The laws concerning this vary from state to state. Where I practice in Connecticut, assistants are able to seat temporary crowns as long as a dentist is physically present. I do not the laws in Hawaii. This is a more recent trend seen in the past 5 years or so and is based on numerous factors (at least in New England and New York where I am most familiar). I hope that answers your question.

  23. John Doll Jr says:

    I was told by my uncle Dr Hoff DDS that the original novacaine was extracted from leaches. As you stated novacaine was a manufacturer’s name so I don’t know what it would have been called but the way the story went is that it was noticed that you can’t feel when the leach bites so they farm raised leaches to extract whatever and use it in dental procedures

  24. I finally got my first- and hopefully last- cavity at age 50. I learned the hard way during a minor surgical procedure that injectable lidocaine does not work on me unless it is ‘buffered’. I made an appointment for a filling today and I feel a little panicky just thinking about it. Is my dentist likely to use lidocaine? Have you ever heard of/encountered lidocaine resistant patients? I read an article about lidocaine resistance and it seems to be more common in redheads. I’m not a full-blown redhead, more like a strawberry blonde. :p

    Can my dentist buffer lidocaine shots?

    • Tami,
      Your dentist will likely use lidocaine or something very similar. There is documented resistance to lidocaine in individuals with red hair. I wrote a blog post about which is located here:
      http://directionsindentistry.net/redheads-dread-dentist-part-2/

      Buffering lidocaine is a new technique that is being used by few dentists. It requires special equipment. The company that sells it describes the product here:
      http://www.onpharma.com/MixingPen.html

      You could call your dentist and ask if he/she uses it. Chances are he/she does not because this is a relatively new product and not many dentists are using it yet.

      Hope this helps.

      • Thank you for your reply. Your blog post was very interesting! :).

        I have issues with that study too.

        The minor surgery I had was my first experience with lidocaine. It had little effect. I felt everything. It was a terrible experience and years later it still haunts me.

        A little while later I had a biopsy of a mole by my dermatologist. I was prepared for pain but I felt nothing. :). I asked the nurse if they used lidocaine and she said yes, but it was a buffered solution that they make themselves because some of their patients are lidocaine resistant.

        I have since had a liver biopsy (after 50 everything goes wrong ;) ). I requested buffered lidocaine and I felt nothing- not even the doctor pressing my side with his finger to see if the anesthetic was working.

        After all this I talked to my sister about it. It turns out she had a terribly painful biopsy and her doctor was baffled. She had used lidocaine so why was my sister in pain? My sister has dark brown hair, btw.

        Anyway, I’m glad you’re aware of this. It’s a real problem and not just anxiety about the minor ‘ouch’ of an initial shot of lidocaine. Not even close. :)

        I’m curious about why some specialists routinely prepare buffered lidocaine and others don’t. Maybe some have the equipment you mentioned. Either way, I’m going to call my dentist and ask if he can buffer his lidocaine. ;)

        • Tami,
          Your experiences, although infrequently observed, are not unique. Buffered local anesthetics are relatively new to dentistry. The company marketing the solution to dentists is less than 10 years old. It is unlikely your dentist has this solution. He/she may not even be aware of it. You could always call the company (Onpharma) and find out the closest dentist who has their product.

          Note that I have no connection to this company but I have been thinking about purchasing their system for quite some time.

          Do let us know what ends up happening.

  25. I had a lower molar extracted 18 days ago. It took 3 shots for me to be numbed (the shots were back where my upper and lower jaw meet) and one of the shots was terribly painful in a “hitting something wrong” sort of way. The extraction went fine. After 2 weeks I returned to the dentist with pain in the extraction site only. He saw no bruising or wound and had no suggestions. Another week has passed and I am aware of the injection site at every moment, can taste a metallic taste, and there is pain there off and on. What could be the cause? I am afraid to ever get another injection there.

    • Kit,
      Injections for lower molars can be very painful. That is because the nerve that needs to be anesthetized is under about 1 inch of tough muscle. Penetrating that muscle with a needle can lead to significant post-op pain in the injection site area.
      Your story is a bit perplexing. Injection site pain 3 weeks later is not typical. A metallic taste can come from a lot of different things. Without being able to examine you and take a detailed history, there is not much more I can add. But I would recommend seeing the dentist who removed the tooth again.

      • Thank you so very much for your reply. I have since gone to Urgent Care and they feel that there is infection at the injection site – so they swabbed the site, will culture it – and I am on a new antibiotic. I already feel better….

  26. What type of anesthetic do you recommend for extraction of #19…an anesthetic without epinephrine please. I have MVP and last time a dentist game me the kind with epinephrine I ended up in the ER. I told her to please not to use it because I’ve had issues before but she insisted. :( Thank you very much in advance.

    • The anesthetic I typically use that does not contain epinephrine is 3% mepivacaine (brand name carbocaine or polocaine). Some dentists also use 4% prilocaine but I do not find that to be as effective. You have to give extra because without epinephrine, the anesthesia feels less profound and does not last as long. Hope that helps.

  27. Dr. I read in another post that you wrote about injections for the bottom molars being a bit more difficult and have been seen by my dentist today but I’m still confused and thought maybe you could shed some light. One week ago I had #19 and #20 filled. She said that 19 looked bad as far as the root and recommended a root canal. I asked if I could have an extraction instead and a bridge in the future due to finances right now. She said yes. She said because she had to get so close to the nerve I could experience pain later. Because my jaw was open for so long I took ibuprofen later because I have occasional episodes of tmj. For the next 48 hours I took ibuprofen only ever 8 hours. Then it went to 12 hours and even one day so far as 24 hours without meds. Ibuprofen always helps. The pain is not excruciating but mostly reminds me of when my jaw was being held open, she even gave me extra shots when I told her my jaw hurts. Today she took another X-ray and said no infection but looks ‘suspicious’. I asked what that means and she said that an infection could be coming. She seemed doubtful that it was tmj but didn’t totally disregard. The pain goes from the center of my chin and can extend to my ear. I have my appointment for extraction in one week. If I may ask, what are your thoughts on this? Any info at all would be greatly appreciated. I’m concerned that I’m not getting it extracted soon enough. Thank you in advance.

    • Marnie,
      Without being able to examine you and see the x-rays, it is tough to assess whether the pain is coming from the nerve in the tooth or whether it is originating from the joint and/or musculature associated with the TMJ. Both can present with pain similar to what you are describing. As a general rule though, if the pain gets worse with temperature (hot or cold foods/drinks), the it is highly likely it is the tooth and not issues with the joint/muscles. Your dentist sounds like she knows what she is doing so I would rely on her for a definitive opinion.

      • Thank you so much for your response, it is greatly appreciated. I’m on antibiotic and am definitely getting the extraction. Thank you for your kindness and all of your time for answering my lengthy questions! :)

  28. On Friday I went to the dentist because I had some pain in the front of my mouth and the tooth next to my top front tooth was loose. I had a cavity in that tooth and was scheduled to get it filled two weeks ago but due to back/sciatic nerve issues I was unable to at that point. The dentist gave me a shot of lidocaine in the front of my mouth and over the next several minutes it started hurting worse then when I came in. So he gave me another shot in the roof of my mouth and again the front, and still lots of pain and it started to radiate to the back of my mouth. My mouth was numb (and so was my nose) but I still had lots of pain. He gave me another shot that felt like it was between the teeth and extremely painful and one in the back of my mouth. I was clenching the chair and had tears (first time I ever cried at the dentist). He decided to do a partial root canal to drain the abscess which gave me relief for about one minute and then back to extreme pain. He gave me another shot which felt like it was in the hole that he had drilled for the drainage. At some point, not sure when, he switched to a stronger injection but I am not sure what it was. After about one and half hours I had lost count as to how many shots he gave me. He finally pulled the tooth and there was instant relief. The assistant counted up the vials and there were nine total. Is this normal? I was taking oxycodone and a muscle relaxer for my back at the time, would this effect it in anyway? How did the abscess get that bad that quickly without feeling pain?

    • Michelle,
      You describe a lot of things. In general, in the presence of an abscess, it is more difficult to achieve profound anesthesia. This is because the abscess changes the chemistry of the tissue around the tooth, making the local anesthetic less effective. Also, a person with an abscess typically has anxiety (and rightly so), which can make them more sensitive. Lastly, chronic use of narcotics such as oxycodone can make people be more sensitive to pain. All of that together is likely why you felt so much pain. 9 vials is a lot for one area but not totally unheard of. An abscess can be chronic at one point and then become very acute and painful very rapidly. Overall, that is still an unfortunate situation and it is too bad you had to experience it. Good thing you are out of pain now!

  29. Yesterday I had a filling done on my bottom lower molar (farthest tooth back). It took approximately 3 hours for the numbing agent (not quite sure what the dentist used) to wear off. After it wore off, I noticed my ear started to hurt and feel like there was water pouring out of it. I tried to sleep, but the pain was just too intense. I took 800mg Ibuprofen and still, no relief. This morning I woke up and I feel light headed, dizzy, intense inner ear pain, throbbing, and swelling. Could this be a result from the numbing agent they used? I feel like I can barely function, my ear hurts SO bad. I made an appointment with my primary care doctor before I thought that maybe the ear pain would be related to my dentist visit. I spoke with my dentist and he said he needed to see me immediately. What could be going on? I am freaking out!

    • Sara,
      Based on your symptoms, it sounds like it is most likely pain from the injection. To numb a lower back tooth, the needle goes in quite deep – approximately 1 inch – and often that area can hurt for a couple of days afterwards. Pain can radiate to the ear. But you are correct to see your dentist who can determine definitely what is going on.

  30. I had a root canal on 19 and an inlay on 3 I’ve been back now a 3rd time for the Permenet crown on 19. The lab keeps missing the margin. Is this normal. Also the dentist missed a root canal on 3 instead performed a inlay soon after the permenant crown was seated I began having serious pain in that tooth. An endondontis performed a 4 root canal thru the permenant crow. As it turns out that crown needs to come out because interior to the crown between 2&3 food particles keep getting stuck. Is this all above normal or should I run like hell and find another dentist

    • Jerry,
      What you are describing happens to all dentists every now and then. The human body is unpredictable and unexpected things come up. However, I stress “every now and then” because if those issues are happening on a consistent basis, then the dentist probably is not doing as a good a job as he/she could. Without more clinical data, I can’t offer more details. It is too bad you are experiencing such poor outcomes. Hopefully things work out in the near future.

  31. Sharon Robinson says:

    Why on earth would you not correct people? Most of us don’t really want to be ignorant, and it doesn’t seem to require a DDS to process the information that the drugs have changed!

    • Sharon,
      You bring up a very interesting point.
      Earlier in my career, I used to correct people. I did it very diplomatically. For the majority of patients, I would see two types of responses:
      1. They would perceive me as being cocky and arrogant, despite me being very diplomatic and nonchalant in my correction.
      2. They would continue to insist that novocaine was being used despite my explanation. And if I pressed the issue, they would perceive me as being cocky and arrogant.
      After a while, it was clear to me that by attempting to correct patients, it was detrimental to the patient-dentist relationship, and I stopped.
      If you were in my chair Sharon I would be happy to talk with you about the history of local anesthetics and how each one works… assuming you wanted to hear my explanation! Thanks for the candid feedback.

      • Excellent comment, Dr.! I do believe most of us wish we could have such a kind, diplomatic dentist that is more than willing to educate!! I’ve always said ‘novocaine’ just as I’ve always said ‘Kleenex’ instead of tissue! In my opinion, it’s just a name like so many other brand names that we’ve clung to and as long as the dentist knows the difference…lol…than that’s all that truly matters!! :)

  32. First, thank you for taking the time out to educate us and answer our questions. I personally appreciate you input.

    My question is I went to the dentist and I got 2 filling done on the same side (upper right). This was done 48 hours ago and when I press my cheek it is still sensitive where I was injected. Is this normal? My local numbing agent did last a few hours as well.

    Thanks for sharing

  33. Hello Doctor,
    I need your advice/opinion once again. I recently had #19 removed and soon after it was removed I noticed #18 looks awful. It has much decay and a very big amalgam filling. The original thought was to have a bridge after #19 was taken, but now by the looks of it ill have to have #18 removed as well. I don’t know why my dentist wouldn’t have noticed that it was so bad, but I was wondering the most reasonable ways to correct the gaps that will be left from those teeth. A bridge wouldn’t be possible any more would it?

    Thank you in advance.

    • Marnie,
      I am assuming you don’t have #17 (your lower left wisdom tooth). If that is the case, a bridge would not be possible, because a bridge requires teeth on both ends for support. Your only option after #18 is gone would either be for dental implants or a removable partial denture.

  34. There is no mystery as to why people call it novocaine. Its just a brand-shorthand like Kleenex for tissues or the verb “to Hoover” for vacuuming. But it does make it seem like there is only one type of local anesthetic used and that is a problem. Now that I’ve read these posts, I will ask my dentist exactly what she uses on me and maybe participate a little more in the process. I would prefer a lighter one for small fillings, for example, since I am still sitting here at home 5 hours after the procedure and unable to eat – well at least to taste and chew.

    • Prisca,
      You are the first person to make that particular observation. And I do believe this is one of the MANY reasons why people still think novocaine is still used. This particular blog post gets over 200 hits a day which just shows you how ingrained the term “novocaine” is. Thank you for your comments.

  35. I asked my dentist to use an epinephrine free anesthetic because I do not react well when I am given this. (Racing heart, shakes etc.) However…on my last visit he assured me that he did not use it yet… Yet I shook and convulsed uncontrollably within about one minute after being injected. It was super scary and was by far the worst reaction I have ever had to any injection. ( It sure felt as though it had epinephrine in it. ) My question to you is…is it possible to react this way without the epi in the anesthetic
    ?

    • Tracy,
      It is certainly possible but less likely. I’ve seen patients react in the way you’re describing out of fear. Just the thought of an injection causes them to react this way. So it could be purely psychosomatic. Alternatively, one of the common local anesthetics is lidocaine which is also used in certain applications to adjust the rhythm of the heart. There is the possibility that some of the local anesthetic went into the bloodstream and traveled towards the heart where it exerted an effect. Possible, but less likely. I am more inclined to believe it is psychosomatic. Hope this helps.

  36. How long has epinephrine been in use in lidocaine? I ask because I had a couple fillings, a crown and a root canal (and crown) done on my teeth more than 5 years ago, I recently have had some work done (another crown, and in the process of a difficult root canal – instrument got stuck and sent to a specialist – Dr. West) and I notice both my Dentist and the specialist use epinephrine, which was a surprise to me, as it’s the first time in my life I’ve experienced this. I asked if the drug/formula was new, and the assistant seemed to think it was an odd question. I have recently moved from the Midwest to the Northwest so perhaps its a regional thing?

    • Daniel, the use of epinephrine with lidocaine is definitely not a regional thing. Most dental anesthetics have come with epinephrine for years. The epinephrine makes a big impact on both the duration and the profoundness of the anesthesia. There are some dental anesthetics that come without – but they are primarily used in those patients with heart conditions.

      I write a bit more about the use of epinephrine in another post – this one is Dental MythBuster #10 – I’m allergic to epinephrine

      Dr. John West treated you? I did my residency with his son Dr. Jordan West. Small world isn’t it?

      • Dr. Jason West treated me the first time. Dr. Jordan West treated me another time. I haven’t been treated by Dr. John West though. The Doctor that referred me said that they were internationally famous in the Dental community, so I thought that was cool. Small world indeed!

        Interesting to know about the epinephrine though. Maybe it’s an age thing for me, not noticing it until now. I was much more fit and 6 or so years younger so maybe I just didn’t notice the heart racing thing and attributed it entirely to nervousness and summarily forgot about it. I definately noticed it this time, but nothing major – no reactions other than very fast heart rate.

        • Whether you feel your heart racing also depends upon the site of the injection. Some areas of the oral cavity have larger blood vessels that can carry the epinephrine towards the heart and other organs.

          I’m sure you got excellent care with the Drs. West.

  37. I had a root canal performed where the DDS gave me 7 shots over the course of the procedure. After it was done (which incidentally had to be redone by another DDS 1 year later since he didn’t get all of the root), I went to the men’s room and had bright red blood in my urine. Have you ever heard of this side effect from anesthesia?

    • Andy,
      Your story sounds alarming. I truly wonder if the presence of blood in the urine is/was related to the administration of the local anesthetic. I would consult with your physician on this, as blood in the urine can potentially indicate serious issues completely unrelated to the local anesthetic and/or the root canal procedure.

      • Thanks for the fast reply doctor. I too was very concerned when I saw the blood in my urine. I had a complete exam by a urologist including CT scan, with and without dye, ultra sound and a scope of my bladder, all of which were fine. That’s why I was wondering if you had ever heard of blood in the urine from anything related to dentistry?

        Thanks again
        Andy

  38. Hi Dr,
    I am about 6 weeks pregnant and also have a broken (and very painful) tooth. It is the very back tooth on my upper left side. I have an OB appt in 13 days. My OB is only in my local office two days per week and is completely booked for a sooner appt. The dentist is refusing to touch me without a release and my OB office will not give me a release until my appt because I’m not technically a patient yet. I cant go to a different OB because it is the only one that takes my insurance. My question is: If I go to a different dentist and not tell them about my pregnancy so I can have this tooth pulled, is there any danger in that? I cant take this pain anymore and I’m scared of getting an infection. I have been told by many people that they had dental work done while pregnant. Help!

    • Ashley,
      It looks like you’re in a tight spot. But there is no way I can advise you to withhold information about your pregnancy from another dentist. I treat pregnant patients all the time, including extracting teeth in cases of pain and infection, but I always require a release from the OB. I wish I could tell you otherwise but I can’t. Sorry.

  39. dear doctor,

    My denstist did a root canal four days ago but the anesthesia doesn’t wear off completely, it wears off but really slow, is that normal? this RC was done in Amsterdam.
    thanks

  40. Hello Doc,
    I have a question that I’m pretty confused about. I have a tooth that had a root canal and crown about 20 years ago and I notice it has a dark blue line around the gum line of this tooth. Would could this mean?

    Thank you in advance.

    • Mamie,
      That is most likely normal but without examining your I can’t be sure. But after a root canal, the tooth can slowly turn a gray/blue color. This is very common. So that is what is most likely occurring.

      • Thanks as always doc. Just had a root canal in tooth 20. No problems whatsoever until I discovered I can’t open my mouth very far. Have a history of tmj but nothing too major as I only have problems maybe once a year. Doc prescribed me steroids but I hate taking medicine. Also advised to do warm compresses and mouth exercises. I do the exercises and compresses. There isn’t much pain just can’t open my mouth like normal. Any suggestions? Wondering if this will go away on its own. Thank you.

  41. I have had several crowns done over the last 10 years and seem to have some sort of reaction to the shots each time. I always get a canker sore at the injection sight. I usually get a sinus cold and my cheek hurts when the shot in in the upper jaw. Could this be an allergy to the injection and should I ask for something to go with the shot or a specific type of numbing drug? I do have HBP, have a history of sinus issues and am 60 years old.
    Thank you.

    • Eileen,
      That is a tough question to answer without examining you. Your dentist could give you a more thorough answer. However, some people do get sore spots that resemble canker sores at injection sites. That is from the trauma of the needle and is not a sign of an allergic reaction.

  42. I have had 2 2 hour sessions for root canal on far back lower molar. I had to have a great many shots to numb the area. Before each session, I took .50 mg of xanax. After each session, I was extremely tired, even after a great deal of sleep. The feeling of fatigue did not clear until the next day. Could the shots have caused this?

    • Laurie,
      Based on your description, that is most likely the Xanax! The half life is 11 hours, which means the xanax has an effect on most people for approximately 24 hours, depending upon how you metabolize the medication.

  43. sabrina says:

    I am now 26 but since I was 18 my dentist wanted my wisdom teeth pulled out. This time last year I finally saw a specialist to talk about the procedure. After he told me all of the possibilities of what could go wrong he told me he was going to use novacaine. I was so taken back that I said ” novacaine?” And started laughing. I guess he was serious because he looked confused/annoyed. I never went back and cancelled the operation.
    That’s the only place that accepts my insurance to have my teeth pulled so what do I do now? One of my wisdom is starting to periodically hurt.

    • Sabrina,
      Some dentists continue to use the term novocaine even though it hasn’t been used since the 1960s. Some dentists use it the way you might use “kleenex” or “scotch tape”. Most tissues are not kleenex, but many people still use the term since everyone is so familiar with it. So I doubt your dentist was going to use it. Regarding your insurance, that is a limitation a lot of people run into, and I don’t have any solutions for it.

  44. Kathleen Smith says:

    Hello,

    Every time I have dental work done and the dentist gives me the numbing agent shots, my heart races for a minute or so. I recently found out that I have an allergy to benzocaine. Are all of the “caines” related and could that be why I have the racing heart? I’m kind of worried and dreading the next time that I need dental work done.

  45. Hey there! I just noticed your web site: Dental MythBuster when I was exploring digg.com. It looks as though someone liked your blog so much they decided to bookmark it. I’ll positively be coming here more often.

  46. Joni Spaulding says:

    I’ve been having my silver/Mercury fillings removed. Upper right, then upper left, today, just the injection of the numbing agent, and my throat went numb, and when they reclined the chair, I couldn’t breathe! Not sure if that was just anxiety, or what happened, but, I refused to allow them to DO the lower removal, and 3 hrs. later I am still numb, swallowing makes me think I can’t breathe. Should I go to the ER, and is there anything to help this wear off, as my face and ear are also still numb! I told them, even my chest was feeling the effects. I had a HUGE Para Thyroid tumor removed 22 months ago, and didn’t have my throat numb like this, so I’m almost in a panic. Could my body not be handling these numbing medications? Or did he hit a nerve wrong?

  47. Joni,
    It is likely by now that the all the numbing effects have worn off. What most likely happened is a bit of anxiety along with some of the local anesthetic inadvertently making its way into the bloodstream. If you are still numb then you should definitely contact your dentist.

Trackbacks

  1. [...] out, it’s a pretty common misperception that novocaine is still at large in dentist offices. As Nicholas Calcaterra, DDS, explains, what the hygienist actually use on me was lidocaine, which has no known anti-aging benefits. And I [...]

  2. [...] “This shouldn’t be too bad.” The dental assistant said as she put a bib on me while the dentist prepared his first syringe full of whatever they use to numb you these days.  I was yelled at by a dentist, a “friend” not my personal dentist, when I called it Novocain.  Apparently Novocain went out with Tab Cola and non-cable television.  For more on that, read this. [...]

  3. [...] In 1905, a new local anesthetic, Procaine, was introduced. Procaine had all the desired effects of cocaine as a local anesthetic, but did not posses the addictive potential nor the other negative side effects. Procaine then quickly replaced cocaine as the local anesthetic of choice in dentistry.  One company then made the fateful decision to market procaine under a new brand name: Novocain. From that point on, the name Novocaine has become synonymous with “the shot you get at the dentist”, a phenomenon I documented in this Dental MythBuster post. [...]

  4. […] Dental Mythbusters: Dentists Still Use Novocaine Source: What has replaced Novocaine in a dentist's […]

  5. […] like the other dental myths that I have written about (dentists no longer use novocaine, the dentist put his knee on my chest to pull my tooth, etc.), let’s bust this myth! So the […]

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