Archives for June 2014

The Most Interesting Tattoo in the World?

As a dentist in private practice, I’ve seen my fair share of crazy and interesting things. I’ve seen cases of horrible gum disease, scars from sucking fentanyl patches, disastrous attempts at people doing dentistry on themselves, and many other things. I’d thought I had seen almost everything. That was until this patient walked in the door:

Beer tatoo on the lip seen at the dentist

Beer tattoo on his lower lip. Clicking on the image will show a larger version in all of its glory! Image copyright Dr. Nicholas Calcaterra.

As you can see by the facial hair, this was obviously a male – at least we would hope it is a male!

beer tatoo seen at the dentist on the inside lip

View of the tatoo looking down (which is why “beer” is upside down).

In talking with him in my dental office about his tattoo, it was clear that he was both simultaneously proud and ashamed of it. He loved showing it to me and my entire staff  – and to a couple of my other patients too! He enthusiastically gave a long and detailed description of how it was done, when it was completed, and who did it. It was clear this was one of his favorite stories to tell.

But then he confessed in an almost bashful demeanor that it was “the last stupid thing I ever did.” His tone and level of excitement were much lower than before. He did not advertise this to anyone but me. It was clear he had a love/hate relationship with his tattoo.

Most Interesting Tattoo in the World?

Most Interesting man in the world with an interesting tattoo

Does the Most Interesting Man in the World have this tattoo? (image courtesy Anderson Group via

Could this possibly be one of the most interesting tattoos in the world? Could it be the most interesting? Do you think the most interesting man in the world has anything close to this? After all, the actor who plays the Most Interesting Man lives in Vermont, less than three hours from my office in Orange, CT.

At his last dental visit, I did not get a chance to ask him what his favorite beer was. But part of me thinks the beer he enjoys the most is Dos-Equis.

Despite my patient’s mixed emotions about this tattoo, I don’t think he will be trying to get rid of it anytime soon. After all, it is not visible to anyone, except when he comes to our office.

As I said before, I’ve seen a lot of crazy things as a dentist, but this one was totally unexpected. To this day, I still look at it every time he comes in for cleanings. And he enjoys showing it to us!


A dental visit without Novocaine or Epinephrine?

lidocaine local anesthetic with epinephrine used at the dentist

Lidocaine with Epinephrine is the most common formulation in the U.S.

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.

photo of epinephrine capsule used for injectionStill 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.

photo of tooth cavity that needs lidocaine for fillings

These cavities are too big to be filled without any local anesthetic.

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!