Redhead Dread

Do redheads dread a trip to the dentist?

Redheads dread the dentist due to resistance to local anesthesia

Redheads. Image courtesy The New York Times

When I stumbled across this article in the New York Times back in 2009, the conclusions seemed eerily familiar.  In my own personal experiences as a dentist in Orange, CT and elsewhere, patients with red hair seemed to be more apprehensive regarding dental care, and also seemed to have the dreaded “well, it looks like you’re not quite numb enough with the first shot, let me give you a bit more” phenomenon occur to them with much greater frequency than patients with darker hair and complexions.

As much as I would like to delve into the true scientific details, those facts go beyond the scope of this post.  But to summarize, redheads have a mutation (basically a change in their genetic makeup) that produces red hair and fair skin.  But that same mutation also affects receptors in the brain that govern pain perception.  Although the exact mechanism is not quite fully understood, studies show that redheads have resistance to lidocaine.  Lidocaine is the most commonly used dental local anesthetic used in the United States. Chances are, when you visit the dentist, and get “The Shot”, you are receiving lidocaine.

So if redheads have resistance to lidocaine, then they are more likely to feel pain during a dental procedure.  But does that translate into more dental anxiety?  Of course.  You don’t need published research to reach that conclusion!   However, in medicine and dentistry, we do like to have our conclusions backed up by sold research.  A 2009 article by the Journal of the American Dental Association did confirm that redheads have “increased dental-care anxiety” and exhibit “avoidance of dental care.”

As a practicing dentist, I always look at research and then ask myself how the findings apply to my patients, either past, present, or future.  This is true not just with this specific research finding but with all the developments that are continuously occurring in dentistry.  A lot of research doesn’t immediately apply. However, this is one case in which the findings have immediately impacted how I approach my patients – specifically patients with red hair.

Lidocaine also known as xylocaine is a dental local anesthetic used in the United States

Dental Carpule of Lidocaine with epinephrine. Redheads have a documented resistance to Lidiocaine.

No dentist is perfect and can get 100% of the patients 100% numb with the first injection.  Any dentist that claims that is lying. There are too many factors that come into play.  As a dentist, it is tempting to find something or someone to blame when your patient does not get numb with the first injection.  Blame the assistant!  The anesthetic must be expired!  The patient moved!  The sun was in my eyes!  The sun was in the patient’s eyes!  It was a full moon last night!  This happens to all dentists and to all patients – independent of hair color.

However, upon thinking back on my own patients who were “tough” to get numb, a disproportionately large percentage had red hair and fair skin.  These patients seemed to require 2 to 3 injections to get numb.  Another observation is that these patients always knew they would need more.  They were the first ones to say “Hey doc, I always seem to need 2 or 3 shots every time I get a cavity filled.”  But they never knew why they needed more local anesthetic.

In my experience, if you know a patient is going to be a challenge to effectively anesthetize, administering extra local anesthetic right off the bat is the best solution. The patient appreciates it.  The second injection, if done properly, will rarely hurt, and will almost guarantee that the patient does not feel any part of the procedure. Since this article was published in the New York Times in 2009, I’ve told numerous redheads about it.  Upon telling them, they nearly universally have an expression of “Wow!! Now I finally understand why I’ve always felt pain and dreaded coming to the dentist.”  And from then on, their fears are reduced, permanently.

So how do we approach redheads who avoid care because of past negative experiences?  This is a lot more challenging! Most redheads are unaware that their genetics are pre-determining them to have more pain in the dental chair (unless more local anesthesia is administered).  So they must be informed of this. Simply informing anxious patients of this genetic phenomenon and how we address it is enough for many patients.  More severe cases of dental anxiety require different approaches.  I have training in sedation dentistry which has allowed me to treat patients who have moderate to severe dental phobias. This has allowed me to personally treat hundreds of patients too scared for “regular dentistry.”  But unfortunately, very few dentists have the training, equipment, and staff to do sedation dentistry safely. I will try to describe other techniques in a future blog post.

Many redheads still do dread the dentist, but now they don’t need to anymore.  There are many dentists out there equipped with this knowledge helping redheads overcome their anxieties, one patient at a time.

Comments

  1. I have red hair and this has been my experience with the dentist for over 20 years! I heard rumors of this relationship between red hair and pain with fillings but this finally confirms it. It seems like every time I need dental work I need like 3 or 4 shots! I wish all dentists were as informed as you on this. I will be telling my dentist this next time when I go for a cleaning. Thanks.

  2. Nicholas Calcaterra DDS says:

    Shauna, thank you for the input. As you can see from my post, you are not alone. The key is to be aware of the phenomenon and make sure your dentist is too. I am glad to have made you aware of this. Take care. Dr. Calcaterra.

  3. ANGRY!! That’s how I describe going to the dentist. Not toward the dentist personally, but due to the barbaric “Methods” which are still in use today. There HAS to be an alternative to the current method of local anesthesia. Long needles, multiple injections and 4 to 5 vials of medication is RIDICULOUS! As a patient… WE DON’T WANT TO BE INJECTED with long silver spikes that look as though they come from the dark ages. WHEN is there expected to be a simple way to turn nerves off, or block nerves vis-à-vis pain in a different way (electronically, technologically) without needles?! It’s been well over 60 years that this method has been in place… I mean, what gives?

  4. Frank,

    I understand your frustrations and I wish I had a better answer for you. Remember that the human body is a wonderfully complicated combination of billions of cells that vary from person to person. One person may only need 1/2 a vial of local anesthetic and not feel a pinch while another may need 3-4 injections. There are some dentists who are trained in hypnosis as an alternative but I haven’t heard of that technique working consistently. Maybe there will be another alternative in the future.

    Nicholas Calcaterra DDS

  5. Michele Hurd says:

    I had a DNA medication test done by my Dr. It fully backs up that this red head’s body ‘burns through’ Lidocaine, Marcaine, etc. My poor dentist has learned that when I tell him you need to start NOW (after 4 shots-and no additional time for it to ‘take effect’) he has 15 minutes to get a tooth done before I am completely ‘un-numb’. We just do one tooth a visit. Also Marcaine and ‘nerve blocks’ do not work on me.

  6. Rosemary says:

    This article was fascinating. I have always had such a hard time getting numb at the dentist office ad have always hated to go. The only times that it wasn’t as bad was when I had my wisdom teeth out and recently when I had an implant. In both cases, I had laughing gas, too. That seems to be a big help because neither of those procedures hurt nearly as bad as smaller things that have been done with the novacaine and I can’t tolerate anything with epinephrine because it gives me heart palpitations.

    • Rosemary,
      I am assuming you are a redhead? Being a redhead and not liking the epinephrine can make it so that you will be very difficult to numb. The key is that you are aware of it so that you can make sure you get extra amounts of local anesthetic when you need procedures done.

      • I want to thank you for this article and all the comments. I am a red head. I have severe dental phobia. 15 years ago I went to get a few teeth fixed and got an infection that was there for 13 years. I went to a different Dr 3 days ago to start having my teeth removed for dentures and when he got to the third tooth I almost came up out of the chair it hurt so bad. I was promptly told that there was no way that I could possibly feel the tooth being pulled and that I was just saying that because I was having a panic attack!!!! I have since been referred to an oral surgeon to be put out for the remaining 25 extractions. Thanks again for letting me know I’m not alone!!!!

  7. Melinda Williamson says:

    What a wonderful article! The first time I ever heard of such a thing was this past week when I had my first root canal. I was very nervous and made the endodontist promise me I would not feel anything. She told me she knows redheads require a lot more numbing agents and she was on top of it. That out me at ease immediately. Four shots later, I was good to go. She would tell her assistant the time she had left before the numbness wore off, which was interesting. When I heard her say, “I only have 25 minutes left” I thought that was fantastic. I had zero pain and was actually surprised that the root canal was less painful than a filling a few weeks before. I will be telling my dentist about this research and hopefully he will do his own, for the sake of all his redheaded patients. Up until now I just assumed I was a difficult patient. Thank you!!

  8. Dr. Steve Rowe, DMD. says:

    Great article Dr. Calcaterra, another point to make to redhead patients and all hard-to-numb patients is for them to eat an adequate meal before they come in; so many people suffer from hypoglycemia (full blown and borderline) without even realizing it, and in my 30+ years of practice I’ve found that so many times low blood sugar levels in these types patients will have an effect on the potency of the anesthetics.

    • Dr. Rowe. Thanks for the comments. That is very true regarding hypoglycemia. In severe cases, it makes your blood slightly more acidic. That could potentially convert some of the local anesthetic into the inactive protonated form. That could be a possible mechanism behind the decrease in potency. A good reminder!

  9. As a dentist, I can fully appreciate this article and was aware of 9/10 of the reasons you cited, but I had NO idea that redheads were resistant to local anesthetics… Fascinating… Could you point out bibliography on the subject? That would be great!

    Thanks for your great site, Dr. Calcaterra.

    • Kristen,
      Thanks for the feedback. I elected to avoid publishing an “official” Bibliography because in many cases those turn off the average reader, in my opinion.
      However, all of the information in this article and the follow-up article (http://directionsindentistry.net/redheads-dread-dentist-part-2/) was based on research I did. I cite all those papers within the body of each post. For example, this article here from the Journal of Endodontics talks about IAN efficacy in redheads vs. non redheads. In both posts, Redhead Dread and Redhead Dread Part II you’ll see me citing research papers. Hope this helps!

  10. I just found out tonight that red heads may need more anesthesia for dental work. I have always had this problem and my dentists have always commented on how I needed more shots and they were surprised I wasn’t numb yet, etc. The strange thing is, I am only “sort of” red headed. My hair is somewhere between light brown, dark blonde, and red. I wonder if this means I have some of the mutation that produces red hair? Is having a “partial mutation” even possible? In any case, I have experienced this phenomenon and never know why!

    • Stephen G. Rowe, DMD says:

      I have found that many people light-skinned (freckles) and of European (Northern) descent can carry this gene that resists anesthesia…..this has been found to be true for general anesthesia also; I was an Operating Room Scrub Technician before dental school and can always remember the nurse anesthetists dreading red-heads because they were so hard to put under, then were somewhat unstable once they were under. You don’t have to be a “carrot-top” (or a “ginger” as the Brits say) to have this gene.

      • Stephen,
        Thanks for the comment and for replying directly to Miranda. After learning of this phenomenon, I too have noticed that some light skinned individuals who do not have the classic red hair appear to be resistant. I’ll have to do more research. I always mention this to my patients who are either anesthesiologists or nurse anesthetists and they agree.

    • Miranda,
      Thanks for the comment. As you might be aware, genes are not always like an on/off switch. There is a grey area (pun intended). Just like some people can have dark blue eyes and others have light blue eyes, there are variations on hair color.
      I will freely admit I have not researched the genetics part of this story beyond what I have posted. There very well may be “partial mutations” as you call them or “semi redheads” with the same local anesthesia resistance. I’ll have to research this more and do another blog post! Post here if you uncover research on this!

  11. Michele Moorhouse says:

    I am an exception to the red hair theory … but I do have fair skin & irish decent. I have always been a challenge to numb in the dentist chair and require 2 injections. The same thing occurred during kidney biopsies. No connection was made or inferred, I just received 2 shots. After years – during a steroid epidural procedure; I flinched and the doctor announced “you must be resistant to the numbing agent, Lidocaine.” Finally a connection was made. I have been very curious as to the cause and/or if there are any other related conditions, complications one may find wise to know about.

  12. I noticed this phenomenon with my husband, who is a redhead, and extremely phobic of the dentist. Fortunately, we found a dentist who “gets it” and will numb him like crazy. His children have the same issue, despite neither being redheads themselves. His son, who has very dark hair freaked out when he found out we were taking him to the dentist. Turns out, he *always* feels pain! Likely he carries the redhead gene. When I explained that he needed extra numbing, the dentist was good with it, and that visit went a lot smoother than anticipated. On the other hand, his other child, who has dark blonde (with a hint of red) hair, had her wisdom teeth pulled by a doctor who did NOT get it, and would not numb her more. She was in agony. So having a close family member with red hair would also increase one’s sensitivity, I think.

  13. A. Rakosi says:

    I am a natural redhead. For 35 years I have not allowed a dentist to use Novocaine on me during my dental procedures as the shots have always been far worse than the procedures. And yes I have had root canals without it. I am about to have an implant placed as a tooth crumbled recently. My dentist whom I trust only does this procedure with Novocaine, no Versed. I am extremely anxious about this procedure and the lack of conscious sedation. Is there something other than Novocaine that can be given that would work better? And evidence based practice that I can present to my dentist to effectively communicate my concerns, so that we can come up with a viable plan that we are both comfortable with for this procedure? Thank you for assistance with this matter.

    • There is no good answer to your question. However, based upon what you are saying, assuming it is true, I would contact your dentist and ask for an anesthesiologist to be brought into the office to sedate you.

      • A. Rakosi says:

        Thank you for your input. I have done additional research on evidence based dental practice I found in addition to your articles, “Articaine is superior to Lidocaine in providing pulpal anesthesia” (JADA, August 2012), as well as “Increased Sensitivity to Thermal Pain and Reduced Subcutaneous Lidocaine Efficacy in Redheads” (Anesthesiology, March 2005). I believe that you are correct that for the procedure I am scheduled I will need to seek an Anesthesiologist to assist ensuring that the pain is not an issue.
        Blessings to you, your practice and patients

  14. Thanks for sharing this (and re-posting the link in a more recent article)! Thankfully my copper haired granddaughter doesn’t have any cavities yet, but it’s good to know in advance that she could be pain-relief resistant. Might be best to just start her out with a dentist who practices sedation dentistry. (I’m all for doing everything in advance I can to make seeing the dentist a positive experience!)

    • A. Rakosi says:

      Kate,
      The best thing one can do is prevention. However, if that should not be enough, the above articles are a great starting point. I used Google Scholar to find those articles as well as others which I presented to my dentist. He and I decided that I would try to do the procedure without the use of anesthesia as I have trust issues so preferred to have him do the procedure.
      I just had the procedure done today (3 August 2015), with premedication of oral meds, and 3, 4%Articaine with epinephrine shots. My dentist worked fast and we did not take any breaks so the Articaine did not wear off too quickly. I felt the last stitch he put in but overall the procedure was a pain free positive experience. It is my prayer that your granddaughter need not experience this type of procedure. Brush, swish with listerine and floss regularly.
      Blessings, A. Rákosi RN, BSN

  15. I am so grateful to have come across information like this recently. I am a natural blonde with natural reddish highlights, fair skin, blue eyes from a family that has more than it’s fair share of gingers. I’ve always had trouble getting numb. When I have a good dentist, that’s not a problem, they are more than willing to use extra injections or a combination of techniques and types of injections.

    My problem is with certain dentist (which unfortunately have not been merely a few in number) who treat me like I’m a baby and and have to almost beg for them to give me even one injection let alone multiples. It’s like the went to the Dr. Mengele school of dentistry and I have to prove myself some kind of hero to them. It’s as though they are offended by my apparent weakness?!

    Things are ok when I have a good dentist, but if my dentist is on vacation or away and I need to see someone else, or if the dentist I have no longer accepts my brand of insurance or my dentist moves I am left scrambling to find a replacement and fear ending up with one of the sadist. I won’t know until I’m in the chair whether I have a humane dentist or a sadist.

    Needless to say, this does not help reduce my increasing fear of going to the dentist, particularly if I cannot see a dentist I know and trust.

    • Nancy,
      This site was a God send for me. As a professional in the healthcare industry the best thing a client can do is research on their condition. There are several good websites with information on the redhead phenomenon. It is a mutation on genome 16, MC1R that is the cause for the redhead difference’s in pain tolerance, pain thresholds, and how we process the numbing agents used in traditional dentistry. If you use the above terms in a web search on “Google Scholar” you will find many articles to support your case with “Evidence Based Practice”. Most dentists are open to this form of education if they are not aware of the phenomenon that affects those of us with the mutation that causes us to have altered pain response as there are numerous articles in the dental journals devoted to research and education.

  16. Wow! I was so relieved to see someone is finally addressing this issue. I have HORRIBLE dentist anxiety, and I am prone to cavities, and I have weak tooth enamel (always have). I am in my thirties and I already have lost several teeth. I have trouble getting numb on one side of my mouth. I have been on several occasions and received the maximum number of shots and still felt everything and then had to leave and come back to try it again without success. there has to a better way than this!! I cannot stand going to dentist now. I am terrified and put it off and put it off. Any ideas????

    • Beth,

      It sounds like you have red hair? That could be the problem. The most predictable way to deal with this is to be sedated. However, besides red hair, there are other factors. Since you’ve had difficulty in the past, you want to make sure you are going to a dentist who will exhaust all the options. There are many types of local anesthetic out there, and there are many different types of injections to deal with the “patient who is tough to get numb.” I outline some of these in:
      http://directionsindentistry.net/5-reasons-cant-get-numb-dentist-2/

      • Yes I am red-headed… have been since the day I was born. I found this article very interesting. Apparently red-heads have issues with all types of procedures, not just oral procedures. This has proved true for me time and time again. I have lost 3 of my chewing teeth on the bottom. I had to have a tumor and tooth above it removed and the other two abscessed. I need a partial, but apparently I can’t have one without having a massive surgery on that same side where the tumor was removed to add bone back in (I lost too much). Well that terrifies me!!! that surgery was TERRIBLE and I cannot imagine having surgery on that same site yet again. Some of the dentists keep pushing implants, but due to the fact I am red-headed and I have so much trouble with procedures and recovery, implants does not seem like a good idea. Any thoughts on that? It is very hard to find a dentist that offers sedation and is also very caring and thoughtful towards patients with extreme dental anxiety. My regular dentist is very caring and thoughtful but they do not offer sedation. And when you have extreme dental anxiety the thought of changing dentists is even more terrifying. Thanks!

        • Beth,
          Red hair should not impact the success rate of implants. But based on what you are saying, it sounds like you cannot handle any procedure with just local anesthesia. I do know where you live but in the United States there are practitioners called Dental Anesthesiologists. They can come into the office of a regular dentist and sedate you. That would be a great option. It will likely cost more out of pocket but if that is what it takes then you should consider it. You can talk to your regular dentist about it or go to this site: http://www.asdahq.org/findmember and then find one and then see if he/she will work with your regular dentist.

  17. Hi, I’m really glad I found this article! I’m very fair skinned with reddish brown hair. My severe phobia started with a cavity; I was given five shots with absolutely no relief. I’ve had several done since that hurt so much I feel like I’m being tortured. I am so scared to go in now that I nearly make myself sick with fear. I sit up at night worrying about what I might need done when nothing is even wrong. My mom has the same problems with numbness and has woken up during two major surgeries.

    I want to try oral sedation dentistry but I’m terrified that all it will do is leave me still in horrible pain but I simply won’t remember it, and that’s not OK! What can I do to avoid severe pain?

    • Chloe,

      I am sorry to hear about your experiences (as well as your mother’s). My personal experience is that I am able to numb most redheads given enough time, planning, and patience. If I and the patient know in advance, we can typically plan for it, and are usually successful.

      Regarding sedation dentistry, if you do “conscious sedation”, which is what many dentists will do, you are not paralyzed. You are able to respond to stimuli. If you feel pain, you are able to motion and/or communicate with the dentist. This is not the same phenomenon as the patients who go to the ER and wake up but are paralyzed.

      I hope this helps.

  18. Merlin Rigard says:

    Hi,
    I am a red head, and have just come back from my second traumatic experience within 8 days of trying to have root canal treatment on a tooth. The first attempt I had 7 injections, everything was numb apart from the tooth itself I told him to just drill it as I always experience pain at the dentist but when he popped through to the nerve I thrashed out in the most pain I’ve ever experienced, that night was the worse night of my life. The second attempt today was 6 injections and was better than before but after drilling only a about 2 mm around the nerve I jumped at the pain again. I left very unhappy and he has now reffered me to a specialist which I can never afford. I live in Hong Kong so I’m pretty sure its unlikely he’s ever had a red head patient, I don’t no what to do can you help please?

  19. SO WEIRD!! I was only trying to search to see if lidocaine resistance was something that actually existed. I never knew I was different. I just thought lidocaine was a weak and useless drug that doesn’t work for anyone. –Like Tylenol 😉 — but then a few friends said it works perfectly on them, so I googled it and WALAH!! It’s a real thing !! And here’s the kicker…..(drum roll)…..I’m a fair Irish red headed Lass!

    Thanks for posting

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  1. […] have a well documented resistance to dental local anesthetics, research I documented in one blog post about redheads and then another recent article.  I always explain to red haired patients the research on this […]

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