Since starting this blog in October 2012, readers have posted hundreds of comments on all aspects of dentistry. While the comments vary significantly, there is one subject area that is consistently popular. And it also happens to be the most dreaded part of a dental visit: the numbing shot!
This is not surprising, given that over 1 million local anesthetic injections are administered in dental offices per year in the United States alone. And did I mention how everyone hates the shot? People love to Google things they hate!
This post covers two areas that readers on this blog have commented about as well as questions that I receive on an almost daily basis in my practice in Orange, CT.
Epinephrine in Local Anesthetic
Patients are always curious about epinephrine (a.k.a. adrenaline) used in local anesthetic. First off, there is no such thing as an epinephrine allergy, a myth I thoroughly debunked in Dental MythBuster #10 – I’m allergic to epinephrine.
Still don’t believe me? Dr. Stanley Malamed, considered the world’s foremost expert in local anesthesia in dentistry, writes “allergy to epinephrine cannot occur in a living person” in the textbook he authored.
Can you get an injection at the dentist that does not contain epinephrine? Of course! Nearly all dentists should carry at least one type of local anesthetic without epinephrine. The most common is either 3% mepivacaine (brand name is carbocaine) or 4% prilocaine (brand name is Citanest Plain). Keep in mind that if you do receive local without epinephrine, the numbing feeling will not last as long and will be less profound.
If your dentist does not have that type of anesthetic available, you may want to consider switching offices.
Occasionally, you may receive an injection at the dentist and your heart races. This occurs when some of the epinephrine from the local anesthetic enters the bloodstream. It may feel a bit unsettling, but for most people, this is temporary and completely harmless. But this does not mean you are allergic to ephinephrine! See this page for more on that dental myth.
No Novocaine While Drilling?
First off, dentists no longer use novocaine, something I wrote about here. Interestingly, prior to the invention of novocaine, cocaine was actually used as a local anesthetic. It was quite effective, but there were some undesirable side effects as you can probably imagine.
Many have commented on this blog asking if they can have dental work done without having local anesthetic administered. The answer is yes. Except in certain circumstances, the local anesthesia is for the comfort of the patient and is not required for the procedure. However, doing dentistry on a patient who is experiencing pain is not good for anyone involved!
In certain cases, I will however recommend that we attempt without any local anesthesia. These are circumstances when the cavity is very small and restricted to the outermost layer of the teeth. In these instances, little to no sensation is transmitted to the nerve of the tooth. Patients don’t feel anything except a little vibrations. They then leave happy because they didn’t receive a shot and therefore will not be numb for the next three hours.
However, if the prospect of potentially feeling a tiny bit of pain during the procedure scares you, do not ask your dentist to skip the local anesthetic.
What should you do?
For all the readers who have posted comments on these two subjects, keep in mind these two points:
- Epinephrine is found in most formulations of dental local anesthetics, but you can always get local anesthetic without it.
- It is possible to have dentistry done on you without local anesthetic. However, you should ask your dentist if the area to be worked on is small. If not, you will feel it!