5 More Reasons You Can’t Get Numb at the Dentist

In my recent post titled 5 Reasons You Can’t Get Numb at the Dentist, I laid out five reasons why this phenomenon occurs. This was based on years of experience as well as my own research.

In writing that post, it became clear that there were more than five reasons to explain the “I couldn’t get numb” occurrence.  So here are five more reasons why some patients experience this difficulty.

6. You have a Hot Tooth

Flames representing a hot tooth

Hot Teeth are tough to get numb!

If you are in severe pain in a specific tooth, it can be much more challenging to get you numb. This phenomenon, known by dentists as a hot tooth, produces these challenges in a different way than having an infection (infection was Reason #1 in the the first post on this subject.)

So why does this happen? There are two major reasons. When the nerve of a tooth becomes inflamed (such as from a large cavity), the nerve actually changes and becomes more excitable. Stated another way, the nerves are much more easily stimulated, and thus way more local anesthetic is needed.

The other reason is that the cavity can also cause the nerve to develop even more “receptors.” While the specific details are not that important for this summary, it basically means that there are more nerves that need to be taken out by the local anesthetic.

The end result in these cases is that it can take several injections to get a hot tooth numb. And in rare cases, sometimes antibiotics and two days off are needed for the tooth to calm down enough to be properly anesthetized!

7. Your metabolism

The term metabolism is technically inaccurate. But it is the best term to describe that in some individuals, your vascular system removes the local anesthetic from the area of the tooth nerve much more quickly than in other individuals. This results in you being adequately numb for only a short period of time, or simply not being numb enough at all. In either case, you end up feeling pain during the dental procedure.

Modern dental anesthetics are primarily metabolized in the liver. So any dentist who says you are metabolizing the local anesthetic too quickly is technically incorrect. But that will be addressed in another blog post.

8. I just used expired local anesthetic!

Dental lidocaine photo about to expire

Box and carpule of lidocaine. Yes, it can expire!

I can personally vouch that this has never happened to me. My assistants and I check the expiration date of each and every cartridge before injection. However, local anesthetic can and will expire. The average shelf life of local anesthetic is 12 to 18 months.

What happens if it expires? I really don’t know – but like any expired medication, it will likely begin to break down and result in a decrease in efficacy.

9. I missed

In many cases, in order to achieve adequate numbness, a dentist has to do a nerve block.

Femoral nerve block with an ultrasound

Ultrasound guided nerve block. Courtesy wikipedia.

Nerve blocks are not unique to dentistry. The photo to the left shows a femoral nerve block being performed by an anesthesiologist. In this case, the anesthesiologist is using an ultrasound to help guide the needle. This is done because inserting the needle and guiding it to the nerve is difficult.

Dentists do not have the luxury of using an ultrasound. Nor is it practical. For many nerve blocks, we have to insert a needle one and a half inches deep and rely on several anatomic indicators to help guide us.

Ted Williams was the last baseball hitter to hit above .400. That means 60% of the time, he didn’t get a hit. Most dentists have a batting average of around .900 for nerve blocks. So that means, just like Ted Williams, we sometime  swing and miss! So we have to inject again. And sometimes again. It’s part of doing nerve blocks… you don’t always hit a home run on the first at bat.

10. You’re Nervous

It is not a surprise that many people hate coming to the dentist. That it is a fact. Many people get very nervous coming to the dentist. That is a fact as well.

nervous people are tough to get numb

Dentistry is not a walk on the beach for most!

There is very little research to support my observation (and similar observations of other dentists) that patients who are very nervous tend to be more difficult to get numb.

Over the years, I’ve developed many theories for this. Many patients will forget to breathe and/or hold their breath. They may also clench their jaw muscles. Any of these will change the blood chemistry in a way that makes the local anesthetic less effective (similar to the blood chemistry changes I outlined in Point 1).

Since I do IV and Oral sedation dentistry, I’ve observed that patients who are sedated are much more easily numbed. This also suggests that nervousness and anxiety can make you more likely to experience pain.

The end result is that a nervous patient = a patient who may be difficult to get numb.

An eleventh and important reason – Ehlers Danlos – has its own post here

Do any patients or dental professionals reading this have other reasons? I have another list going but it is not at 5 yet. Leave a comment or email me at nick@directionsindentistry.net.


  1. Hi , just wondering if possible if you may be ale to help me with a question I have please ? I’ll give you a little background information first , I have had several dental procedures over my 40 years and all of them have always required a needle and I have never had any dramas or issues everything has always gone quite smoothly that was until a few years ago when I needed a tooth extracted I went in as per normal and as the lady dentist was giving me the needle I felt extremely dizzy , couldn’t see properly was having difficulty making sense my heart was racing a million miles an hour I wasn’t with it at all. My dentist noticed this and immediately layed my head down further and elevated my legs she then said I passed out because of stress ? she wouldn’t let me sit up for over 15 minutes. By the time I sat up I bolted out of her surgery in such a state I left in pain and didn’t have my tooth extracted I was freaking out that bad as nothing like this has happened to me before. It took me months I mean months until I got the nerve to finally go see another dentist. I advised him of my situation last time and he told me that I had a vasalvagal syncope I had no clue what this meant he mentioned that more than likely the previous dentist had hit a nerve or blood vessel when giving me the needle causing me to faint. He also stated that when the previous dentist gave me the needle she would have noticed when she drew the needle back there would of been blood in the syringe. This didn’t make me feel any better at all if anything it freaked me out even more I had to get this tooth extracted as the pain was unbearable my dentist saw how much of a state I was in and he said he will give me the anesthetic without the adrenalin in it as my heart was already going a million miles an hour I freaked out but I got it done but unfortunately I could feel everything that anesthetic didn’t work so he had no choice but to give me the one with adrenalin in it. fast forward until now I now need another tooth extracted because I have left it that long it’s not salvageable now I’ve been in horrific pain the last 2 days and I need to work up the courage to go see a dentist. Basically my question is do you think it’s possible that the needle that I was given hit a blood vessel or nerve and caused me to pass out ? I am beside myself with worry about going to have this done. I have never passed out since and never had prior to me it was the needle that made this happen not stress because back then needles nor the dentist ever bothered me now sadly I revert back to a 2 year old. I am situated in Sydney ,Australia and I am not sure if they use the same stuff as you guys in the US. You have a very informative website and I have enjoyed reading your comments. Many thanks Linda

    • Linda,
      Sorry I didn’t respond earlier. In dissecting your post:
      The first incident sounds exactly like vaso-vagal syncope. Basically, you get so nervous, blood flow to your brain stops or slows down, and you pass out. The protocol is for the person with you to elevate your legs above your head to encourage blood flow to the brain. Your dentist did exactly what she should have done.
      Episodes of this type of syncope can happen for many reasons. Stress can do it. Sometimes a reminder of something can set it off too. This happens quite frequently in medical and/or dental procedures so you shouldn’t feel bad.
      Now, when you inject, it is not uncommon for the needle to come into contact with a blood vessel. This can result in the local anesthetic and/or epinephrine entering the bloodstream. This can lead to all sorts of scary but TRANSIENT things – such as a racing heart.
      Local anesthetic that does not contain epinephrine is not as effective. That is why you can sometimes feel it.
      I think your passing out has less to do with hitting a blood vessel and more with just being nervous.
      If you were my patient, I would suggest some type of sedation for the procedure. That would solve nearly everything. And in Australia, the brand names of products may be different, but the procedures and medications are basically the same.

  2. I have a tooth that needs extracting when I was numb the dentist tried to extract the tooth on several occasions I could feel it being pulled so he never pulled it. So I went to a specialist on several occasions he was going to give me laughing gas while checking my bp it was to high so he did not do it I never went back. Question can high bp cause me to feel that pain when in the process of getting tooth pulled? I really need it pulled.

    • Kathy,
      High BP on its own is not the reason you felt something. Based on your description, the specialist likely did not want to treat you because doing an elective surgical procedure on someone with dangerously high BP could potentially have a horrible consequence (stroke, aneurysm, etc.). That is likely why he/she did not do the procedure.
      If I had to guess, you likely got very nervous, which caused your BP to spike. I outlined the “You’re nervous” as point #10 in this post. But it could also be other factors why the first dentist could not get you numb.

  3. I had TMJ surgery. I do not get numb at all for my Dentist to work on my lower molars. Did the surgery do some nerve damage?

    • Theresa,
      Without knowing the details of your surgery, it is impossible to know. However, lower molars are consistently the most difficult sets of teeth on which to achieve profound anesthesia. So there is no way to know if it is from the surgery or from another factor.

      • Thank you, for your prompt response. My surgery was in 1981, all done from inside my mouth. I was 18 years old. I have scar tissue that my dentist injects on or near to anesthetize me and I never achieve numbness, and I now have Dental Anxiety, and really hate feeling procedures because no one believes that I could not possibly be numb, with the exception of my new dentist, but nothing gets accomplished because I don’t get numb. He is doing some research, I’m being proactive…I have to go back in weeks to try again! Thanks again…Theresa

        • Theresa,
          As I read your description I believe the surgery likely altered the pathways of your nerves on the affected side. In addition, scar tissue could also make it more difficult for the local anesthetic to travel to where it needs to go. There are other injection techniques – notably an Akinosi as well as a Gow-Gates (you can google these to learn more) – that may be more effective. I hope this helps.

          • Thank you, Dr. Calcaterra! Just read and viewed videos. I think there just might be a glimmer of hope!! Thanks for all your help this past week!


        • Karen Antle says

          Dentist’s have more than one type of injections to freeze you. Find one that has a different option. My dentist had to switch mine years ago…it stopped working. https://en.m.wikipedia.org/wiki/Dental_anesthesia

          • Karen,
            You offer a good suggestion but it is somewhat simplistic. There are many factors that simply cannot be overcome by selecting a different anesthetic. For some patients who are difficult to anesthetize, I can use a very powerful one (.5% bupivicaine with 1:100,000 epinephrine), but the numbing sensation can last sometimes close to 10 hours. So you can solve one problem but create another one…

  4. What is your take on someone who never had a problem with local anesthesia (and no “dentist visit anxiety”) then suddenly the dentist is unable to get numb? After age 25, it now takes the dentist multiple injections to get the patient numb (“If you were a horse you would be on the ground”), and the dentist must work promptly as the anesthetic wears off within ~ 15 minutes. ( This has been a consistent theme over ~ 8 years: Not a one time fluke. As a result, now there IS “dentist visit anxiety”!)

    Did the patient’s metabolism change? If so, why? Did something in vascular circulation change? Could it be the sign of a medical condition? Why would the response to lidocaine change “mid stream” so to speak?

    Any peer reviewed or scholarly articles, etc., would be read with interest!

  5. Very nice post!! I am a newbie here and trying to understand if root canal is an option in my case, I have recently has tooth ache on my left wisdom tooth, I have gone for check up with 2 dentists; dentist 1 recommended that I extract my both lower wisdom tooth as I have a huge cavity there and dentist referred me to a oral surgeon and suggested that I remove my upper 2 wisdom tooth as there is huge cavity, and asked me to check with the surgeon on the lower wisdom tooth.my question is can I do root canal and save my tooth? Both of the docs recommended to remove them as we don’t use them at all. But I would like to know if root canal is an option in my case?

    Also I only feel the pain in the evenings when I drink anything cold or eat anything sweet.

    • Dammi,
      It is very rare that dentists do root canals on wisdom teeth. In general, most individuals are fine with the 28 other teeth that they have. Furthermore, wisdom teeth have complex and variable anatomy, and as a result the success rates of root canals on wisdom teeth are not as high as other teeth.
      Lastly, sometimes a cavity is so large that a root canal might not save the the tooth.
      All of these are likely reasons why it was recommended they be removed.

  6. I went to the endodomtist this morning for a root canal and he was unable to get me numb enough to proceed. I’ve never had this problem before. He gave multiple injections and would wait and then test to see if I could feel anything and when I continued to have feeling, gave more injections. The numbest I got was an hour and a half after the first injections and it wore off within 15 minutes. Needless to say, I didn’t have my root canal this morning. Going to try again in a week and he’s also going to use nitrous oxide. I was nervous and when he gave me the injections my heart raced and pounded. Anything I can do for a more favorable result next week when we try again? He did ask me to come in ahead of the appointment time to allow the numbing to work longer before he starts drilling.

    • Jen,
      If I had to guess, this was a lower back tooth? Of all the teeth that can be challenging to get numb, lower back teeth are the most frequent culprits! What you may also want to consider – but only if you can get a ride – is to to see if the endodontist can write you a prescription for Valium (or Ativan or Xanax). Those can go a long way and can sometimes be more effective than nitrous oxide. Other than that, your endodontist is likely very skilled at anesthesia – so it will likely work next time.

      • Thank you so much for your reply. You are correct in your suspicion of the tooth – very back tooth bottom right. Almost as worrisome as not being numb was the reaction I had to the numbing injections – when he gave me the first injection (and a couple more times after that) my heart raced and pounded fiercely. It was very scary. I called my endodontist’s office and while I couldn’t talk to him, I related this to the receptionist and said that I would like to have an anesthetic without epinephrine she said that since I was difficult to numb an anesthetic without epinephrine would not be as effective and last as long. True? I’m scheduled for Wednesday morning to try again. Honestly, if it doesn’t work on Wednesday, it’s highly doubtful that I will try a third time!


        • Jen,
          Your endodontist is 100% correct. Not only will epinephrine make the numbing feeling last longer, it also contributes to a more profound degree of anesthesia. So if you were having difficultly getting numb last time, switching to a local without epi will almost certainly decrease the likelihood of you getting numb enough for the procedure. Unfortunately, local anesthesia is not black or white – it is not like a light switch where you can turn the light off and on – so every factor needs to be in your favor for this to be successful. When this happens to me – which is rare but does happen, I use different anesthetics (but all with epi) and use different techniques – most notably a technique called the Akinosi injection – and that nearly always seems to work. And a little Ativan or Xanax would help. Good luck and let us know.

  7. I had to get an anesthesia done to get a tooth extraction. My gum became a little numb, but I could still feel my tongue touching it. Also i could feel my tooth when touching with my tongue. She gave me the shots again and it still didn’t work. She gave me amoxicillin to take 4 times a day for 10 days. I am scared of what could really happen since it did not work the first time.

    • Sheila,
      This sounds like a lower molar right? Did you have an infection in the tooth? If yes, you’re looking at points #1 and #4 (https://directionsindentistry.net/5-reasons-cant-get-numb-dentist-2) for why it is tough to get numb? Are you seeing a dentist or oral surgeon? While some general dentists are excellent at removing teeth and can do it with the equivalent skill of an oral surgeon, some aren’t. You could choose to be seen by an oral surgeon instead.

    • Nicole Kohut says

      I also am in the same boat. Have 2 lower left bicuspids that need out. I was put on pennacillan for 7 days then went in for the extractions. They tried to get me numb for over an hour and I could feel everything and teeth were still very sensitive and throbbing so then the dentist said the teeth were still too infected and the infection was right next to the nerve. And prescribed clindamycin to take for 7 days. I am extremely terrified that when I go back in for the extractions I will have the same traumatizing experience =( also with this toothache my left jaw/chin became numb on the 4th day and are still 100% numb but the actual teeth aren’t and have 100% feeling. Thanks

  8. Hi. I have been having dental work for over 50 years with no success in numbing the actual tooth. Several dentists and many endodontists have tried and given me the max amount of lidocaine with no success. I am a wreck going to the dentist. They have tried even putting the needle in my palate (which is no picnic) to help me numb, but no success. My lips, nose, tongue, etc., all get numb, but I can always feel the drilling in the nerve of the tooth. I especially get pain while the drilling is done near my gum line. Valium has not helped me and I am thinking of trying sedation, however, that scares me too. Not really sure what the answer is at this point.

  9. Terrie Achacoso says

    Gosh, thank you for an excellent article. It was easy to understand and thoroughly informative. I fall into several of your categories. The doctor told me to take Xanax before I go to the rescheduled appointment. Funny, no one could tell me how much. My husband will drive me. I am 67 years old, in good health, female, 104 pounds, 5’2″. I have Xanax .25 mg tabs. I am very nervous and stressed when I go, and am extremely sensitive. I was going to take four or five. I don’t want to die . Thanks if you can help, I understand if you can’t comment. Thank you.

    • Terrie,
      Obviously I can’t comment on your specific situation because I am not your provider. However, the dosing recommended in the various resource manuals I use is .5 mg the night before, and then another .5 mg one hour before the procedure. Again, this information is not specific to you, these are just the general guidelines that are published. And as an FYI, most dentists should be somewhat comfortable in discussing a pre-operative relaxing dose of this family of medications (benzodiazepenes). I’m a bit surprised that the office was not able to give you a recommendation.

      • Terrie Achacoso says

        Hi Doctor. I think that because I told the dentist I had Xanax, maybe he thought I knew dosage?? Was surprising to me. He’s a very good dentist and I have had lots of procedures. It was his Endodonist that couldn’t numb me. I did have an old bridge drilled out a week before in the same area plus I was unbelievably nervous. I premeditated with Amoxicillin because I am a kidney transplant recipient. That was the only other thing that I took. This is the first time I didn’t numb. Both dentists tried. Not a tad worked. They tried several times with several things.

        It is in the back of my mouth and I am more terrified after reading what COULD happen. They want to try again next week. I am extremely sore from all the sticks.

        I only take the Xanax as need. I tolerate one .25 very well. I will take your advice and suggested dosage. Maybe I will take one or two with me if needed. My husband will drive me. The Dentist mentioned Halcion. Maybe that’s what he uses. Will that be more effective? He would give me a prescription for that.

        I reall appreciate and thank you for what you do. It is very helpful information. I will read more of your articles.

        Thanks again. Terrie A.

        • Terrie,
          It sounds like you have the xanax already – and it was not the dentist who prescribed it. So that explains why he didn’t know the dosing. If you take xanax on a somewhat regular basis, you have a tolerance to it, so you’ll need more.
          Halcion is in the same drug family as xanax. I find it to be more effective, and it doesn’t last as long. I’ve done hundreds of cases using halcion. Just be sure to tell the dentist that you take xanax and tell him how often you take it. That will let him know that you likely have built up a tolerance to it.

  10. Kimberly says

    I am currently 27 weeks pregnant and had a failed wisdom tooth removal attempt today. Non impacted upper. He initially gave me the epi free lidocaine but I immediately felt pain when he began to work. He finally decided to give me a dose of the normal lidocaine but just waited maybe 30 seconds before starting to work again and I still felt the pain, just not as severely as the first attempt. He was frustrated and said the cavity/old infection changed the composition of my nerves. I am wondering if he just didn’t give the “normal ” numbing agent time to work since it didn’t hurt as bad after it? It was the very back tooth and he did tell me it was hard to get back to numb what he needed to as well. I have no active infection at the moment. I’m terrified this will happen again. Can a previous infection really ruin my chance at a complete numbing of the tooth, ever, or could he just have missed the mark on where to inject?

    • Kimberly,
      It’s hard to know what really happened but I’ll post some pretty accurate generalizations:
      1. Unlike lower molars, upper molars are RARELY difficult to numb up, even in the presence of an infection.
      2. During an extraction, you will feel lots of pressure, and that pressure can sometimes be difficult to handle. Anxiety about the procedure can sometimes make someone interpret the pressure as pain.
      3. Epi free local anesthetic not only does not last as long, but the numbing feeling is simply not as profound.
      4. An active infection can change the local chemistry of the tissue, thus affecting the ability of the local to work.
      5. 30 seconds is not enough time to wait for an additional injection to work.

      I extract teeth on pregnant patients quite routinely (when needed of course). Perhaps you could ask your OB about allowing the dentist to use lido with epi for the entire procedure?

  11. Courtney says

    Does diabetes have anything to do with not being able to get numb? I’m type 1 and have been for 5 years now. My previous dentist did a root canal on a baby tooth (I think the same one they were having problems with today) and they couldn’t get it numb either so I felt everything! They used 4 full needles of Novocain and I could feel everything they were doing to my tooth but when they worked on the tooth directly behind it I could feel nothing. I am literally numb up to my eyes!

    • Courtney,
      I took a while to respond because your description intrigued me.
      In general, I am not aware of any research that says DM Type I will DIRECTLY affect your ability to get numb. You are more susceptible to infections, and a localized dental infection can certainly decrease the efficacy of the anesthetic. But that doesn’t sound like the case here. DM I when more advanced can lead to neuropathy, but again I don’t think that is the case here, unless you are experiencing neuropathy elsewhere in your body.
      The fact that the tooth directly behind it was effectively numb makes me think that there is something with this specific tooth – unrelated to the DM. Retained baby teeth in adults (I am assuming you are an adult) can be very unpredictable. My bet is that there was an extra nerve innervating that specific tooth that your dentist was just unable to find and anesthetize. At least that is my guess – based on your description. Hope this helps.

  12. I went in yesterday to get fillings replaced on my lower right wisdom tooth and the molar beside it. After 4 injections, The doctor could not get me numb. My cheek would numb but my mouth never did. This is our second attempt. We are going to try again in 3 weeks. Ive had fillings done on these teeth before so I know I can numb, but I dont understand why Its not working. (I am not a red-head).

    • Angie it’s hard to tell what the issue is/was but lower wisdom teeth are the hardest to get numb consistently. This happens to ALL dentists. Some dentists are trained to use other injection techniques when the traditional technique is not working. When I have a lower wisdom tooth that is tough to get numb, I do what is called an Akinosi. This injection, along with patience, always does the trick (at least for me).

  13. Hello, my dentist today tried to repair a cavity on my #2 tooth. Upper right molar 2nd from back. A 2 surface repair as the cavity is between the teeth. He could not get me numb after 4 normal injections and then a 5th that was slightly different, not sure how. Every time he began to drill I would feel the sharp shooting pain. He could tell I was getting more nervous each time we tried and gave me nitrous to try to help. Didn’t seem to work much even capped at the Highest mixture level he could do. Needless to say he called it quits and sealed me up without having done much. He gave me a RX for Valium for next time I feel like trying. Not sure I want to as I now fear the same result. I almost want to get put out under general to avoid this unpleasant experience again. Any thoughts on why I’m having so much trouble? Have had plenty of repairs done due to deep craters, but they were never as deep as this repair requires. The nurse made a comment on my metabolism too.

    • Zach,
      Sorry to hear about your experience. It is extremely rare for upper molars to be difficult to anesthetize. It’s hard to tell without knowing all the circumstances. It could be your nerves, it could be expired local anesthetic (highly unlikely), or lots of other factors – all listed in this post and the other post. If it is your nerves then valium will help. Sorry I can’t give you more advice.

      • Thank you for the info. I am exploring a different dentist, primarily due to insurance change. I spoke with them and told them what happened and they said they use articaine and rarely have issues. I am not sure what my other dentist used for his injections. Is there a type or mix that is stronger or better than others I should ask for? Should I ask for a nerve block instead, if that would be any easier from my perspective?

        • Zach,
          Articaine is known to give a more profound feeling of anesthesia than other anesthetics. That’s all I use for upper teeth and I really can’t remember the last time time I had difficultly getting a patient numb on top. While a nerve block for upper teeth could actually be done, very few dentists know how to do it, and there are risks involved. Hopefully, several articaine injections will do the trick for you.

  14. Lauren Dee says

    Hello! I just came back from having my fill-in fixed on one of the lower right molars. The needles scares me ever since I once felt pain shoot through my face when it was administered. I had done some research since then and noted that the lower teeth require the nerve block as opposed to the upper teeth, which can become numb more easily. What happened for me to have that weird facial pain?

    As a result, I’m scared of the needle for the lower teeth. Today it went okay…I want to know exactly what happens though, so I’m less nervous for the additional work I require on the other side of my lower mouth. It felt as if the needle was placed into several positions, each where I would feel the tip of the needle hitting my gum (or something else). Does the needle go into several points for the lower nerve block? It also felt like it really is a longer needle than the one used for the top teeth.

    Thanks! 🙂

    • Lauren,
      You have done your research well. When a nerve block is done, if the needle gets very close to the nerve, or even touches the nerve, the patient can experience a sharp pain. Most describe it as an electric shock type of feeling. That may have been what you experienced.
      For the lower nerve block, the dentist frequently has to position and re-position the needle mid injection. Every person’s lower jaw is different, and the objective is to get the needle as close to the nerve as possible. This can result in what you are describing.
      Lastly, the needle is longer. On average, for an adult, the needle has to go in a little more than an inch.
      In most other areas of medicine, when a nerve block is done, the patient is most often sedated. And many times the person doing the block can be guided by an ultrasound. We dentists don’t have that luxury.
      FYI, I did touch upon some of these subjects in this post: https://directionsindentistry.net/doc-that-shot-hurt-part-1/ as well as part II

  15. Amy Tucker says

    Thank you for the article.

    My “impossible” tooth is #13. I had a cavity drilled in #14 when I was a child and again a few years later in the same tooth. At that time, neither dentist (switched practices between the two) were able to get that area of my mouth numb- they drilled the cavity without. As an adult, I had a deep cavity in tooth #13 last year. Dentist #3 gave me 10 shots of numbing agent (two types) and was able to get me numb for about 20 minutes. He needed to go through the hard palate to get any numbness at all. The effect wore off prior to the end of the procedure. I did take an anti-anxiety medicine prior to this appointment.

    I am now in need of a root canal in tooth #13. I have changed dentists again (due to moving states) and tried to express to my new dentist that it has been difficult getting numb. He said he’d never had a problem and left it at that. All the research I’ve done shows that it shouldn’t be difficult to get numb on that upper area. Am I the one exception left to the rule? Is there anything left I can try?

    Thank you again for your article.

    • Amy,
      Your are correct that upper back teeth are very rarely tough to get numb. In fact, in my own experience, I’ve never encountered an issue with #13.
      Are you a redhead? That is the only I can think of without doing a complete exam and questioning you. Have you been able to get numb elsewhere in your mouth? If yes, then it is likely an anatomical issue specific to that area. If no, then it is likely a systemic factor (redhead, metabolism/blood flow, etc.).

  16. Elizabeth Mojica says

    Hello! These are all very interesting points. Next week I have to have an upper tooth, number four on the right side to be exact, extracted and to be quite honest I am absolutely terrified. I’ve been crying all day. It sounds very childish, but I had a horrible experience when I WAS a child — a tooth got severely abscessed and had to be removed, long story short it took the dentist 4 hours and I could not get numb at all. In the end, he got the tooth out, but I went into shock and an ambulance had to come, and my screaming scared all the other patients in the waiting room away.

    To this day, I have issues with getting numb. Reading the article, I’m assuming it’s because I’m so uptight and nervous; even going into the office today for the exam, while I was just filling out paper work I started crying. So my question is this; regardless of nerves, is there anything I can do before the proceedure to kind of prep to get numb? For example, I’ve been told that drinking a lot of water before doing a blood draw makes said drawing of the blood a lot easier as it opens the veins. Are there any tricks for making it easier for the dentist to make me go numb?

    • Elizabeth,
      It is unfortunate that you had such an unpleasant experience as a child. The abscess – ie active infection – was likely a factor in why you were not able to get effectively numb.
      It’s hard for me to know exactly why you have difficultly as an adult when there is no infection. Part of it is likely nerves. For patients who are nervous, benzodiazepene medications work very well. These include Valium, Xanax, Ativan, and Halcion (generics: diazepam, alprazolam, lorazepam, and triazolam). Ask the dentist who will be pulling your tooth about them. But you will likely need a ride to/from the appt.

      • Elizabeth Mojica says

        Thank you for answering! He did give me a script for diazepam, 5 MG each. But diazepam doesn’t really help me… thre are four pills, and I’m so anxious that I very much want to swallow all four the day of the extraction. But seeing as they don’t make a 20 MG diazepam pill it is probably unwise to do that. The dentist I am going to does not have laughing gas, either, so it seems I will just have to suck it up. I’m just worried because if it took that long to pull a baby tooth and it hurt that bad, I can’t even imagine how badly an adult tooth will hurt, or how long it will take.

        The only thing I can really think of to do to help relax is get some loud music uploaded onto my phone and put my earbuds in so I can’t hear any of the noise while he is extracting the tooth, and pray that it’s over quickly. Unfortunately, the tooth in question is apparently so very decayed [ my lousy workplace would not let me have insurance up until last year, and I have been working there for 7 years so I have not been able to actually have an exam in that amount of time ] and can easily break, so I’m extremely worried this will play out the same as last time.

        • Elizabeth,
          5 mg of diazepam in a healthy adult is not a big dose. Please note that I am NOT recommending you take more. I would suggest you call the prescriber to find out how many pills he/she recommends you take. No nitrous is a bit disappointing, but hopefully the music will help.

          • Elizabeth Mojica says

            The closer the date comes, the more anxiety I’m getting. The tooth is an upper tooth by a premolar, so I’m really hoping this won’t be anything that will take hours and hours like that baby tooth did back in the day. I am really praying that this takes only a few minutes to get out.

            I have read that white grapefruit juice can enhance diazepam’s effects, but I’ll call the pharmacist to see if that’s a safe thing to do or not.

  17. I’m 67 years old and had a tooth that was slightly sensitive to pressure. X-ray showed cavity and infection. On 9/16/2015 I had my lower right back molar (#31?) extracted. 8 hours in the chair, i had nitrous throughout and I lost count on shots of anaesthetics at 25. Dentist never was able to numb the nerve. Dentist segmented tooth and drilled away part of adjacent tooth (no problem) and part of jaw bone (no problem) Completely numb right side of face and jaw. But when he touched the tooth, Extreme pain with chills and sweats in my extremities. Some hallucinations. 3 days later, jaw is noticeably swollen and painful to touch. Currently taking Amoxicillin (sp?) and Tylenol/Codeine 3. Follow up scheduled in 2 weeks. Guess I’m an example of your 5 reasons but now concerned that Dr. buried infection under sutures. What should I ask Dr to do now to make sure I won’t have ongoing problems? Should I consider having an oral Surgeon ( or other) look at it? (l am scheduled for hip replacement in 6 weeks and seriously warned (scared!) by surgeon to not have any infection that could be carried to the hip.) Thanks, I felel better just having read your article and answers to others! P. S. Bald, (Not a red head!)

  18. I went to get my right lower wisdom tooth extracted which has erupted(only one) and I have 4 other teeth that need to be removed. When I first went for an extraction I took amoxicillin for 10 dayds before the procedure and after getting 12 lidocaine injections all over my mouth I was still in extreme pain from them attempting to start to remove the wisdom tooth. I went to an oral surgeon and they gave me clindamycin for a week and tried to remove the tooth again and the pain still made me unable to do an extraction. They are doing a 3rd round of antibiotics to try to cool the tooth down and use nitrous oxide even though I told them I would prefer IV sedation. Is it possible the tooth is still infected after this long? I always have problems getting numb on my lower right side of my mouth. Even getting fillings done I need the maximum amount possible of lidocaine they can give. The tooth in question is now broken in half from the second extraction and keeps getting impacted into my gums side ways more and more. Thankyou.

    • J,

      I am sorry to hear about your troubles getting numb. If it is any consolation, you are not alone. There are some people out there whose unusual nerve pathways make it so getting lower back teeth 100% numb with local anesthesia only is next to impossible.

      Based on your description, and call me a pessimist, I think your inability to get numb has less to do with an infection, and more to do with your anatomy (ie nerve pathways). The fact you had difficulty getting numb for fillings is a big tip off (presumably you had no infection when the fillings were being done).

      Based on your description alone – and keep in mind I was not there – I would skip the nitrous option and try to get straight for IV sedation.

  19. I am a 52 year old female. I have a decent amount of anxiety about going to the dentist as a result of a childhood dentist who liked to drill before I was numb. After reading all your posts now I wonder if I really was just not numb at all and he had no idea. Basically all my life since I switched from that dentist I have never had an issue getting numb until one incident a couple years ago. The dentist was frustrated with me because I could feel what he was doing and he ended up nicking the vein under my tongue which took a while to heal. I finally got up the nerve to see a new dentist a month ago and he is wonderful. Very patient and kind and my first filling was a walk in the park. I was so relieved.

    Today I went in and was unable to get numb. He was planning to do 3 small cavities – on on my lower right towards the back and 2 behind my 2 front bottom teeth on the right. Shots don’t bother me but I could tell I didn’t get fully numb. He was able to complete the front 2 but not the back one.

    I wondered about a couple things. I just started my period and I always bleed more easily around that time and also there are the hormones. I also have had a poor diet recently due to stress eating that I didn’t have the first time so I’m wondering about inflamation being an issue. I don’t have red hair but I had auburn highlights when I was younger. I also have high blood pressure and am on 3 meds. I don’t have an infection in my tooth but I have a bit of stuffiness like I’m getting a cold and my eyes have been goopy. Gross I kinow. I’d love to know what you think about any of these things being factors. I’ll definitely try to clean up my diet and be sure I’m healthy before my next try but I was really curious about the period thing. Do you think that could be a factor? Thanks so much for answering everybody’s questions. You make all us “woosies” feel like we are heard.

    • Heather,

      I have heard histories like yours before. You are not alone.

      There are certainly some outside factors that could play a very minor role (stress, stuffiness, etc.) but I doubt those have any significance.

      If you were to ask any dentist about the toughest teeth to get numb, 100% of them will say “lower back teeth.” It is no surprise that in your most recent episode it was a lower back tooth that was difficult, while the front ones were a piece of cake. Lower back teeth fall into #4 of this post: https://directionsindentistry.net/5-reasons-cant-get-numb-dentist-2/

      Depending upon which anatomy textbook you read, lower back teeth can have 4 or 5 different nerves going to them. This means that the standard injection – usually the one that makes your lower lip numb – is not sufficient in those people who have variable nerves.

      Some dentists – myself included – know their anatomy, nerve pathways, and injection techniques inside and out. Other dentists don’t.

      About once every 2 months, I encounter a patient with a lower back tooth that needs me to anesthetize all 4 or 5 of the nerves. This can be time consuming and frustrating. However, in the end, the patient is FINALLY, typically for the first time in his/her life, able to have a filling and feel no pain. My experience is that most patients end up being very grateful for the extra time and efforts put in.

      So, without seeing you, I would guess that you have additional nerves innervating your lower back teeth, and just need a dentist who is able to identify the extra nerve(s) and properly anesthetize them.

      • thank you so much for your reply. Since the day I posted my question I have had the cavity fixed that they were unable to numb and it was a piece of cake. I also ended up needing a root canal on the original #22 eyetooth that I had filled and that also was a breeze and it was again right when I got my period so I was thankful I was able to be numbed. Guess that wasn’t the issue after all! I did want to thank you for replying again and also tell you something I learned through the root canal process. I am a pretty big baby at the dentist and I asked for gas as it always helps calm me down. I was super brain-foggy later and it didn’t lift as it normally does so I researched it a bit and found 2 things…1. I’m on Catapres for high blood pressure and that can accentuate the effects of the gas and 2. I happen to be low in vitamin B12 and the gas lowers your B12 level even more. I took B12 a couple times in a few hours and the fog did lift. I just wanted to let you know in case other people have similar issues. I still love my gas but will know to have them lower the dose and I’ll beef up on my B12 next time! Thanks again for taking the time to answer all our questions!!!

  20. My son had to have additional carbocaine the first time he was numbed for fillings, and it seemed to work well once he received the additional injection. He even remained numb for a couple of hours after he left the dentist office. Today, he had to receive additional injections, and while his lip and tongue were numb, his tooth was not. By the time they were finished drilling, my son was experiencing severe shivering which lasted less than 5 minutes. I assume most of that was from anxiety after continuing with the drilling while in pain (his heart rate was normal)? In addition, I have read that you said “Epi free local anesthetic not only does not last as long, but the numbing feeling is simply not as profound.” My son had dysautonomia, and due to the risk of tachycardia, his physician feels epinephrine is not a good choice. What other suggestions would you have to help improve his experience?

    • Let me add, both times the teeth were lower molars.

      • D,
        Certainly based upon your son’s diagnosis it does appear that avoiding epi is a good idea.
        Based on your description, given that your son was effectively numb with 3% carbocaine for teeth in areas OTHER than lower molars, my hunch is that his lack of anesthesia had less to do with the carbocaine and more to do with the fact that lower molars can be tough, in general, to get numb. The fact his lip was numb tells me there was likely an additional nerve(s) affecting the tooth. This happens periodically in people on whom we can use epi.
        The question then is whether the dentist elected to give additional carbocaine to attempt to get those additional areas numb. I will tell you from experience that sometimes even when I explain this to patients – at this point they are exasperated – they just tell me to continue going.
        If your son needs fillings on lower molars in the future, he (or you) could simply tell the dentist that “we believe his lower molars are also innervated by the long buccal, lingual, and mylohyoid nerves. So please give buccal and lingual infiltrations in additional to a traditional IAN block.”
        You may come across like a pushy patient – but if I had someone tell me that – I would likely appreciate it. It would save us both a lot of frustration throughout the procedure.

  21. Hi. Thank you for your very informative article! It’s nice that you took the time to write. I recently had a root canal on my lower right molar. It had been bothering me for quite some time, but I would normally take a course of antibiotics and ibuprofen and it would feel better within a few days. The last month and a half the antibiotics and ibuprofen didn’t touch the pain. It continued to throb non-stop even after weeks of antibiotics. I was also taking 10mg oxycodone along with 800mg ibuprofen. I was referred to an Endodonist for a root canal. I have had root canals and extractions in the past and although it’s uncomfortable, it was tolerable. The Dr gave me several shots of lidocane and let it sit for awhile before he began to drill. I immediately felt the most excruciating pain I have ever felt in my life (which says a lot as I’ve had surgeries and natural child birth along with a painful autoimmune disease and I have a very high threshold for pain) The Dr then injected more anaesthetic and began to drill, again I experienced pain so excruciating that I tensed up and jerked. I felt like I was going to go through the roof it was so bad! I was using nitrous oxide during as well. The Dr kept telling me I had to lay still and that it shouldn’t be hurting. Then he said he would inject the numbing agent directly into the nerves which did not numb me and caused just as much pain as the drilling. He seemed annoyed with me and just kept telling me it shouldn’t hurt and there’s no way I couldn’t be numb. He called my Dad in to hold me down because every time he drilled and hit nerves, it made me tense up and jerk. I was crying and tried to take the nitrous off and he put it back on me. He continued to drill and told my dad it was probably just anxiety and that he wasn’t going to be able to work while I jerked. I’m 30 years old and as I previously stated, I’ve had a lot of dental procedures and other surgeries. There were 4 canals in this tooth and he drilled for 3 hours. For 3 hours I experienced the most excruciating pain I have ever felt in my life, no exaggeration. I kept getting dizzy and getting tunnel vision like I was going to black out. I let him finish the tooth because he kept telling me I should be numb and I needed to be still. He made it out as if this is how it goes and he made me feel as if I was being a baby. The next day when I woke up, I felt like I had pulled every muscle in my body from tensing up and jerking. Yesterday, part of the root canaled tooth broke off. I am terrified to go back to that Dr for the two other root canals that I need. I’ve been having panic attacks ever since the procedure as if I have some PTSD. It was truly that traumatic. I am sorry I’ve written so much, I just felt I needed to be as descriptive as possible so that maybe you could help or give advice. Again, I thank you for this article and for your time reading my story!

    • Trish,
      Dentistry is likely the only procedure performed on the human body in the 21st century in which live nerve tissue is removed without the benefit of general anesthesia.
      Your tooth was likely hot. I covered this as point #6. In situations like this, despite overwhelming local anesthesia, the patient still feels something. Unfortunately, this can happen, despite everyone’s best attempts. The alternative is either not do the procedure – or to do general anesthesia – neither of which are feasible in most cases.

  22. Interesting insights. I must be wired differently, or something, then.

    Strangely enough, it’s my upper teeth that are, by far, the hardest to numb. Not that the bottoms ones aren’t. But the top requires a minimum of 3 injections. Every time. Today included.

    Also with both, I have to sit up after the injections, or it just pools somewhere, and does very little to numb the teeth.

    Now if I could only figure out why I’m prone to cavities, and decay, despite going above and beyond the recommendation of caring for said teeth was…. Life would be better. And likely filled with less needles. lol

  23. Hi doctor,

    Today I had an appointment for wisdom teeth extractions, (4 of them) but unfortunately my tongue couldn’t get numb. In fact, the first attempt numbing was ok, but it only last for like 15 minutes. Then they had to give another injections, but I still can feel my tongue. 5 minutes later, I start feeling dizzy, and my heart beats was going so fast, I get more nervous, I start shaking with hard breathing. The doctor then had to lay me down slowly, putting on me the oxygen and gave me some sugar water. After a few minutes, I came back to my sense.

    So I was confused, why I couldn’t get numb? Even though I had fillings done like two weeks before the extractions appointment, and everything went smoothly. I don’t like visiting the dentists, but the situation I went through today, I never experienced it before. And it’s not like my first time to the dentist, I been there several times.

    Therefore, I had to reschedule my appointment to come back after 2 weeks to try again. But to be honest I’m so scared, because what’s in my head right now is that I might go through what I went through last time. 🙁

    • Nimah,
      It’s hard to tell exactly what happened, but it sound like your nerves played a major role. You could call the dentist and see if he/she could give you a relaxing medication to take beforehand. Or you could even consider sedation.

  24. Cal Driver says

    Thanks so much for these! Seems like every other time I’m at the dentist, he’s asking “Does that hurt?” as I’m writhing around in pain. After reading #10, though, I think I’ve been caught in a vicious cycle. I’m nervous at the dentist because I don’t like the pain, which as a result makes the pain less tolerable, which makes me more afraid of the dentist…and so on.

  25. January 7, 2016
    I recently went to the dentist and asked for nitrous oxide which I had never had before. It had absolutely zero effect on me. After a few minutes I told him I felt nothing different so he said he was going to turn it up and still I felt nothing. Is it normal not to feel ANY effect from the nitrous oxide?
    So to relax me or try to relaxing he gave me a 10 milligram valium which also had zero effect on me. Why don’t I feel anything? I’ve always been resistant to that kind of stuff and I’m just wondering is it just my metabolism and it’s normal or is it something odd and very rare?
    Thank you in advance for any information.

    • DC,
      Some people are resistant to the effects of drugs. Ever see someone drink half a glass of wine and get really silly? Ever see someone drink 6 beers and walk around like nothing is affecting him/her? I’ve seen people practically fall asleep with 10 mg of valium and others take 40 or 50 with little to no effect.
      So, to answer your question, when it comes to valium, your metabolism plays a large role.
      Did the dentist turn the nitrous up all the way? The maximum amount is 70% nitrous and 30% oxygen. I’ve never seen someone not feel at least something at very high levels.

  26. Lindsey Bickley says

    Thought this may be useful to you. I’m 5ft 9in and 140 lbs & female, have always had fast metabolism. Never had any problems getting numb. During a morning appointment I had 2 silver fillings replaced with the white (no toothache), but my dentist tried 3 rounds of injections and I still wasn’t properly numb. He said he was using stuff that wore off a little quicker and it was advertised on tv as enabling you to return to work sooner etc. I am always very hungry in the mornings and burn through food quicker than afternoons. So I now make appointments for around 1:30pm and ask for the ‘regular’ stuff!

  27. Rosy Mendez says

    Hi I need a root canal on #31 and I went to the dentist but no luck getting my tooth numb is there anything that can help

  28. I’m guessing I’m wired differently. My lower left jaw is very hard to numb up. I had my wisdom teeth taken out as a teenager and the lower left was the one I felt when the oral surgeon broke it apart. Just today, I had a small cavity to fix on tooth #8 and they could only get it half numb. They gave me a couple more shots but never quite got the nerve. I didn’t tell them and just let them go for it. Thankfully, I have a really high pain threshold and don’t get nervous at the dentist. I can say that the filling material is surprisingly cold….

  29. I hope you have time for another question, I have read some comments and response’s and I hope you could help me. I was getting a filling under a sliver filling and only part of my tooth was numb, she said it was the shallow part that I could feel, and the deep part of the cavity was numb. Now I have to get 3 wisdom teeth pulled and I’m afraid I won’t be able to get numb and I had no fear of the dentist until I felt that pain. And my dentist is very gentle.

    • Nicole,
      Your explanation is a bit perplexing. It is safe to say that the tooth wasn’t completely numb for the procedure. A nerve does not have an on/off switch. Rather, you need enough local anesthetic around the nerve to block the majority of nerve impulses (this is a very simplistic generalization). Sometimes that requires more than one injection and/or there is more than one nerve going to the tooth. I wouldn’t let this incident affect how you approach your wisdom teeth procedure.

  30. Hello,
    I need a cavity filled on my lower right wisdom tooth. I’ve never had issues of not getting numb before. This was a first. But also the first wisdom tooth w a cavity. I need the tooth due to prior molar extractions. So I’m suppose to go in for another shot at it. I already have dental anxiety and I’m extremely scared that they won’t be able to again, and then what? A root canal or extraction is the same prob(but worse pain prolly). Dr said maybe take ibprofin ahead of time to help pain. I’ll do that. But what happens if he can’t get it again? It’s on the side of my tooth between my cheek and tooth(if that matters). But I feel it a little more and more each day and know it’s actively getting worse. Serious anxiety over this ;(

    • Lower wisdom teeth are notoriously difficult to numb. It is possible that the water or suction happened to be causing sensitivity in areas other than the wisdom tooth. I would ask your dentist for more local anesthetic next time.

      • Well, I finally went again and was able to successfully get numb. But now I have another prob:
        When he numbed me this time I felt a “shock” and jumped for a second. Since he got that this time I thought all was well. I immediately started becoming numb in my lip and tounge and I thought all was well. Until he went to drill. I felt it some still so he numbed around the tooth itself several times. That is what finally did it. Yay done and over right? Wrong.
        That was on a Friday and literally on Monday I began having pain again. But of a different sort. Worse than with the cavity. This time behind my ear down into my neck. He saw me about a wk after and gave a antibiotic because it was slightly inflamed. And then again a week after that. We push on it and such and no pain! When I am NOT in pain I can eat on it and function. The prob is the persisting pain. He said he wanted to give it a month. Next week will be that. And yet I still get pain. I went from taking 3 200mg ibprofin to 2 every 12hrs. But that doesn’t mean that it doesn’t “act up” during then. It does but I’m able to see it through or ice it.
        Why is it not the tooth anymore? He did say it was deeper than thought but he was confident it would be ok! The tooth is semi sensitive still but not really painful. I’m beginning to wonder in his aggression at trying to get to it, if he did any nerve damage or hit a nerve!? Why behind my ear and in my neck? If it was a failed filling and needing a rtc why isn’t the tooth painful!? Any ideas?

        • Jenn,
          When you feel an electric shock, that usually means the needle and/or anesthetic got VERY close to the actual nerve, or perhaps the nerve was even touched by the needle.
          The post-operative symptoms you are experiencing, as you describe them, could be from an inflamed nerve, or possibly other origins. If it is from an inflamed nerve, sometimes steroids are given. That’s the best I can tell you without seeing you for an exam. Please note that only your dentist can diagnose this – I am NOT diagnosing you. Take care.

          • Oh man. I thought that meant he just hit the spot on the dot(that needed to be numb). Given that advice I’m almost certain he effected a nerve now! He’s seen me twice since and even felt the area and tapped on it. What do I do if he try’s to push a rtc at the next look at it? I have a feeling he will. He said it was a “mystery” since the tooth itself doesn’t hurt much. Also, how long for the nerve to calm down? It’s been close to a month already and I still need more work on that side. Which I obv don’t wanna do while its messed up. 🙁 I’ve just been icing it and ibprofin. Funny thing is within 15-20 the ibprofin takes effect and it’s never worked so fast for headaches! Is there a reason for that?? Not complaining but think it’s a but odd. It’s so hard to ice the exact spot sometimes. I have to dig the pack in or open and close my jaw. Someone mentioned maybe tmj from keeping my own mouth open during the procedure. I looked up symptoms and no cracking though.

  31. Note: maybe I should mention that most of where it was coming from seemed to be the suction or the water. So the sensitivity. My tounge did get numb as did my face. So is there a way to do the procedure without? Or is it likely to still be painful?

  32. Marianne says

    Thank you so much for this article. It was very informative. After close to 2 1/2 to 3 years of no dentist visits, I finally got insurance back and went. To no surprise, I had a mouth full of cavities. Since I told my dentist I get extremely anxious at the dentist, he has scheduled me for or 5 seperate appointments so I wouldn’t have to do a lot at once. A couple weeks ago, I had my biggest cavity filled on the top right. No problems at all, I was actually surprised at how well it went. Then there was the 2 cavities on my lower right side today. Wow. I never had issues getting numb before, so when I could still feel everything after the first needle, he did give me another one. After waiting a few minutes, he began to drill. To my complete surprise, I could STILL feel it! In certain areas much worse than others. I let him know that I could feel it. It was very uncomfortable and I kind of felt stupid or like something was wrong with me because I could still feel it. He continued to drill knowing I could feel it. Now while it was not excruciating, it was definitely very uncomfortable, and painful. My heart was racing. Is it normal that he kept going, knowing that I was not fully numb? Could he have given me more? i have to go back for two more fillings on my lower left side in a couple weeks, and for someone who already has terrible anxiety at the dentist, this experience made it 10 times worse! Now I’m scared to even go back for fear of this happening again. Could my dentist have given me a third, or even a fourth shot? And do most dentists typically keep going, knowing the patient isn’t fully numb? Thanks again for all of the information. It’s comforting to know others experience the same thing!!

    • Marianne,

      It is unfortunate you had such a bad experience. As you probably learned in the article, lower back teeth can be challenging to get numb. You experienced exactly that. There can sometimes be 5 separate nerves (depending upon which anatomy textbook you want to read) that can go to bottom back teeth.

      It is not at all unusual for some patients to still feel things after two injections for a lower back tooth. When that happens to me, I stop, and carefully and thoroughly ask the patient questions about what part(s) of their mouth/face/tongue are numb and which are not. From there, I can determine what additional injection(s) and in what location(s) they are necessary. With this approach, the teeth can ultimately get numb. And unless you have an unusual medical condition or there is some other consideration, doing more than 2 injections – if needed – is fine.

      I hope this helps.

  33. Railey Hewson says

    I am learning about a condition I have called “EDS” ( Ehlers–Danlos syndrome (EDS) is an inherited connective tissue disorder). I am learning that is likely the biggest reason I’ve always had a hard time getting numb- for dental procedures, as well as other procedures/biopsies, etc. (my dad always had an EXTREMELY hard time getting numbed. Horribly hard time). I’ve had a couple dentists whom refused to treat me as they said they couldn’t give me another shot…it was embarrassing (he made me feel horrible…basically he insinuated that I was lying/being too sensitive. But the fact was, I was barely numb!) I did not know for all my 42 years why I always had such a difficult getting numb! Now, I’m one who’s had to have 8 surgeries. The last being a brain & spine surgery. I’m certainly glad that I found out about my EDS, (through my Rheumatologist, what and why-because of tge EDS), prior to my brain&spine surgery as they did more nerve blocks preparing for the surgery…as that is not a surgery you want the numbing to wear off too quickly-it’s hard enough to come out of a 6hr. brain&spine surgery- mind the excruciating pain WITH a nerve block is nearly more than one can handle.
    I digress….point being- I now know WHY I don’t numb easily…I now know it’s NOT just being a big baby (as I’m a bit scarred by my history w/Debtists implying I was just being a “difficult” patient- I always told them-if I get numb, I’m good…I’m FINE with being in this chair. My anxiety was more due to whether or not if GET numb!) luckily, I’ve found a dentist..a prosthodontist…who is the MOST kind, gentle, understanding and trusting dentist I’ve ever met. I’m happy to report that as long as I’ve been with him, I’ve always gotten numb. I found him prior to my EDS diagnoses, but I explained to him on my 1st consult about my issues with getting numb. He said he knew how to help me with that- and whatever he’s done (whatever is in those injection/wherever he places them, they WORK…I’ve noticed that he also does inject as he goes along in the proceedure) it works and I’m MUCH more at ease going into any proceedure- be it a filling or thebridge I had to have done- I don’t stress & worry about the procedure b/c I know I’ll be good & numb. He took me seriously, didn’t make me feel like I was being a baby/that I was overreacting (refreshing, as that was a 1st w/a dentist for me!) and he got me numb!!!
    And now I know the REASON…I know it certainly was NOT me being weak or… Too sensitive. It’s due to EDS & people with EDS do have a very difficult time getting numb! Likely, that was the very same reason my father had such a hard time as well! ( it always haunted him & he feared any proceedure due to lack of getting adequate numbness…I wish he were alive so I could tell him it was not his fault either! But, he passed from brain cancer. Oddly, I just had a massive brain surgery, at the same age he was when he had brain surgery…but he passed only a few months after.)
    OK….even given my tangents, I wanted to stress the point that NOT getting numb is a very real thing! And it’s SO very stressful for the patient- likely the reason some get so stressed&anxious just getting INTO the chair- that was always my biggest stress(now, even though it’s never a wonderful experience, I no longer freak out wondering just how much I’m going to feel & whether or not the dentist is going to make me feel bad b/c I’m not numb!). The reason could actually be a medical condition…like EDS.
    Sorry this was so long…just wanted to give my experience and journey through insbiluty to get numb & why.
    Thank you for this article!!! And for recognizing that there are REASONS.
    It’s very important & I appreciate the thought you’ve put into it & not just tossed your patient aside as a “difficult patient” or implying they’re just being a baby / too sensitive. Oral health, teeth play a role in our overall health & are too precious to let go, uncared for due to the fact that you can’t get numb& thus, avoid the chair. We need dentist who care enough to understand why & help. So-thank you kindly, from one patient who now CAN get numb!

    • Railey,

      Thank you for the very thoughtful and comprehensive reply. I am certain some of the readers will benefit greatly from your post.

      While I can claim to be in the small minority of dentists who are aware of local anesthesia resistance in patients with EDS, I will freely state that I was negligent in NOT including it in this article.

      While I am very busy in my own private practice, I will make the time to research and write an article about this.

      Thank you again.

      • Railey Hewson says


        Thank you for your reply! I’m happy to know other dentists are aware of the connection between EDS and failure to get adequately numb/local anesthetic’s.
        While it’s not 100%, that all patients with EDS will have a hard time getting numb, it certainly IS a factor for many with EDS. As well, many with EDS have TMD(TMJ) issues-due to joint/ligament laxity, slower healing…etc.
        Anyways, I’m certain your a very busy man with your practice alone, being so attentive here, let alone carrying out your life outside of the dentistry world! Mad respect/props to you for all you do! Thank you for your time – and making me realize there are dentists out there whom are aware that there is a connection between a connective tissue disorder and a patient being resistant to local anesthetic’s.
        Cheers, from a patient who knows WHY now! ☺️
        (I posted a link- but there’s SO many in the interwebs…as though you have time to read, I know ☺️. But, perhaps patients might find it helpful. I would like to clarify though, that a patient that doesn’t get numb/numb easily does NOT automatically mean they have EDS. A true diagnosis, from a Dr., a geneticist, can diagnose EDS. So, not getting effectively numb does NOT automatically mean one has EDS. Just wanted to clarify that )
        Thank you kindly, Railey

  34. I won’t get numb and I feel like they don’t believe me. My tongue is numb but inner gums are not. He says that is impossible as the tongue and inner gun share a nerve. I don’t know what to do. This is not in my head. I’m getting 10-12 needles. I want my teeth fixed. I’m a 30 year old mom with a bad dental family history. Any suggestions?

    • Linda,
      I understand your frustration. Your dentist is correct that the tongue and inner gums (in most areas) share a nerve. However, there can often be an EXTRA nerve that can supply the inner gums and/or teeth. That could explain why you had that experience. If this is the case, one extra injection could potentially have gotten that area numb. Dentists don’t usually do this extra injection because most people don’t have this anatomy. I hope this helps.

  35. Hi. I’m in my 50’s and have had a lot of dental work done. I can tolerate a lot of pain, but nerve pain is different. I have never had a problem getting numb before. Earlier this year, I had to have a filling replaced on my lower front tooth. At time, the dentist made the comment that the filling was deep. Later that day I started to get zingers and tooth pain. Hot and cold didn’t seem to bother it, but sweets did. It also hurt to tap on it and bend over. I went back to the dentist and he put me on antibiotics and scheduled a root canal. I went to the dentist the other day to get the root canal. He numbed me on the outside of my gums with carbocaine (I think) without epinephrine. I usually ask for no epinephrine, because I don’t like the way my heart races and I have a heart murmur. He then started drilling, which I didn’t have a problem with. When he stuck in the post, I nearly jumped out of my skin. He then numbed me on the outside of my gums again with epinephrine this time. He put the post in and I again I jumped out of my skin. He then numbed me again in the inside of my gums. It still didn’t work. He took x-rays with the post in to make sure the post was in the canal properly and that it didn’t poke through to the nerve. He said it looked just like it was supposed to and didn’t understand why I was still having nerve pain. I think he said the nerve was infected. He tried squirting anesthetic directly into the canal, still with no success at numbing the nerve. We then stopped for the day and I scheduled the root canal for another day. He said he would start numbing me higher up on my jaw somewhere, which would make the whole side of my face numb. He gave me another RX for antibiotics in case it started hurting again (which it hasn’t) Is there anything else I can suggest to him to help get this nerve numb?

    • Katie,
      Based on what you wrote, your dentist is doing the right thing. For lower teeth, sometimes you need to do what is called a nerve block. That is where, to use your terms, you go “higher up” and get the main nerve before it enters the lower jaw. The result is that half of your face is numb. You often don’t have to do this for small fillings but for more invasive procedures you usually do.

      • Thank you so much for your reply! It’s good to know we are heading in the right direction.

  36. Hi Dr. Calcaterra ,
    I hope you can help me. My daughter (6 yrs old) is a CYP2D6 ultra-rapid metabolizer. (1-2% of people in the US and not a lot of info about it. Most medical professionals recall learning about it in school, but that’s about it). She’s about to have her first dental procedure (laser frenectomy), so I’m researching all the medications. (Our dentist would have normally prescribed Tylenol with Codine for pain management, but we’re obviously not going to that because she metabolizes Codine into higher doses of Morphine). My concern is that the go-to anesthetic, Lidocaine, is CYP2D6 metabolized, so I’m thinking it may not work for her. Do you know if there are any other numbing agents we should consider? I really don’t want this to be traumatic for her. Thanks.

    • Jo,

      Let me first state that it is apparent you have done a lot of research regarding your daughter. You clearly care for her greatly.

      Most dental and medical professionals know very little about the pharmacology of the drugs they prescribe. I happen to have a great interest in pharmacology as it relates to dentistry.

      What you are saying about your daughter having elevated levels of cytochrome P450 2D6 is 100% correct. All of us convert codeine to morphine using CYP450 2D6. In fact, without that enzyme, codeine would have little effect on us. In those individuals who over-express this enzyme, when given codeine, they will experience a much greater effect of the codeine than a person with normal amounts of the enzyme.

      Kids – especially a 6 year old – are not as resilient as adults, and how they respond to medications is a bit unpredictable. So I would agree that Tylenol with codeine is not a good idea because of the potential for her to over-respond to the codeine.

      Regarding the lidocaine, I consulted several sources, and all the sources indicated the lidocaine is metabolized by a different enzyme system. The system is CYP450 3A4. I know that seems similar to 2D6, but it is different.

      Another thing to keep in mind that is local anesthetic metabolism is different that a drug you would swallow. In the case of lidocaine, it will not be metabolized until it reaches the liver. So, even if it were metabolized by 2D6, it would not impact it very much. By the time the local anesthetic leaves the site and makes it to the liver, it is no longer eliciting its desired effect.

      Lastly, having done many laser frenectomies, because of the laser, there is little post-op pain. I’ve never had to Rx Tylenol with codeine for a frenectomy, and I’ve done this multiple times on 7 year olds.

      I hope this helps.

      • Thank you so much for taking the time to reply. As you said, there isn’t a lot of information, which is frustrating. When you do frenectomies, do you do any pre-med and/or nitrous oxide? And for post pain management, just ibuprofen? Thanks.

        • A lot of this depends on whether it is a lip (also called a labial) frenectomy or a tongue tie one. And it also depends if it is being done with a laser. A laser frenectomy hurts much less post-operatively. Nitrous oxide and/or a med beforehand to relax the patient is all dependent on the patient. I’ve done frenectomies on 6 years olds with just a little lidocaine. Then I’ve had 12 year olds who needed nitrous and valium.

          When done with a laser, most patients only need a little ibuprofen.

  37. Patrick says


    I’m a 21 year old male (with a really good pain tolerance) and last week I went to the dentist for two fillings in the left side of my mouth, one on the top and one on the bottom both on my back teeth. I had a needle for the top and a needle for the bottom tooth and everything was fine, no pain no discomfort, perfect. I had to go back earlier today for two more fillings on the right hand side, the same again one tooth on the top and one tooth on the bottom so I had one needle for the top of my mouth and again a needle for the bottom of my mouth. I had no anxiety about what was going to happen because I knew what to expect having only gone last week for the same procedure on the opposite side of my mouth. He started drilling in the bottom and I could feel it so he said he would try the top tooth to give the anesthetic in the bottom more time to work, so he tried the top tooth and it was exactly the same as the bottom. He then gave me another injection in the bottom and top of my mouth and told me to wait in the waiting room for a while for it to start working. So time passed and he called me back in and he tried again in both teeth and both had the same result, I could still feel the drilling, it was a really uncomfortable sharp sensation, it wasn’t that painful but it was really close to being so. He then asked me if I have been on any additional medication to which I replied “no”, but for the past few days I have been really unwell with bad flu symptoms e.g. really bad chesty cough, blocked nose, sore throat, muscle weakness you get the idea. So I told him I’d been taking paracetamol and asprin for that but he said that it shouldn’t interfere with anything. He said that if he was pulling at straws he would guess that with me being unwell it has made my nerves hypersensitive, but he said that in all the time he has been a dentist he has never known anything like it because he said it shouldn’t really be painful for me because he didn’t really go that deep, he had just started the procedure. Anyway he put me temporary fillings in place and I have to go back on the 25th May (which I am REALLY not looking forward to) to try again. So I am just wondering what your thoughts are and if you could shine any light onto the situation to ease my mind about going back there on the 25th. Thank you in advance!

    • Your case is a bit atypical and does not match the usual “I couldn’t get numb at the dentist.” It could be a lot of different things. I wasn’t there so I can’t offer any more details. Best bet is to go back and see what happens.

  38. Hi Dr Calcaterra,

    I live in Australia, am 32, have had several fillings over the years, two root canals and get a scale/clean every 6 months. I’m quite familiar with the dentist and have never had a problem so there has never been any anxiety. My last two root canals were done on my lunch break and I went straight back to work afterwards.

    I’ve become familiar with the pattern of when a tooth is dying, which happened for the third time in December 2015. So I went straight off to the dentist who agreed a root canal was needed. He cleaned out the first of the three roots no problem but when cleaning out the second root I jumped sky high. The nerve was as live as ever and stayed that way despite repeated anaesthetic. We had to give up and book another time to try again.

    Today was the second attempt. My dentist did extra nerve blocks on account of what happened last time but this root just will not anaesthetise. The past two root canals were fine – both far back teeth, one upper right and one lower left – but this one (lower right) is a monster.

    I just don’t understand what’s happening. My dentist says it’s very rare, the he only sees probably one instance a year where this happens. I do have red hair but I have quite a high pain tolerance and have easily withstood painful procedures no problems, but I wouldn’t say that it’s pain that I’m feeling during this attempted rool canal. Whenever the dentist pushes that little tool down into the root, it feels more like an electric fence has been connected to the nerves in my face and I’m being electrocuted. It’s not a sensation that I can just tough out until the root canal is completed.

    My dentist has referred me to an endodontist to have the root canal completed under general anaesthetic. Unfortunately I think I’ve developed a phobia of dental work. I’d actually go so far as to say I am now terrified. I started shaking so bad in the chair and even now I can’t bring myself to make an appointment for this endodontist’s consultation.

    My question is, do you have any advice that you’d normally give to patients who have become afraid? How is the fear treated? At this stage, trying to treat it by going back to a dentist/endodontist probably isn’t going to work. I’ve always had regular dental work but I don’t think I can go back even just for a scale and clean without shaking. I’m not sure what to do.

    Thank you for your time 🙁

    • Leesa,
      As you may have gathered, lower back teeth can be difficult to numb, especially for a procedure such as a root canal. Based on what you wrote – the only thing I would recommend is the procedure with either sedation or general anesthesia. Now, the endodontist may have a trick up his/her sleeve to numb you completely, but I think with your anxiety you’re beyond that and need sedation and/or GA.

  39. Elvira Gulla says

    I found your article very interesting! I went to my dentist about 3 weeks ago to have teeth #30 and #31 prepped for crowns. I had no problems getting numb and felt to pain (or anything at that) while my dentist drilled, removed the cavity , or placed temp crowns. I had a lot of sensitivity while waiting for the perm crowns to come in. I couldn’t eat on that side (my left) of my mouth and I was sensitive to any cold stuff that would run over it. Today I went back to get my permanent crowns put on and was again numbed. Tooth # 30 went fine. No pain or anything but #31 was excruciating. I tolerated the removal of the temp crown and the cleaning off of the tooth fine but when they were”drying” the tooth to get the permanent cemented on I couldn’t take it. My dentist gave me more numbing shots but to no avail. He told me I had reached my anesthetic limit and that I prob have a hot tooth or my nerves had re-routed some how. They had to place the temp crown back on and we are going to try again on Monday. After reading previous posts I will take a dose of my Xanax (for general anxiety…I have no dental anxiety at all) to see if that will help before the appointment. Is 3 days enough down time for trying again? Do you anticipate this will likely happen again?


    • Elvira,
      Lower back teeth can be difficult to numb. The fact that you were able to numbed enough for a crown prep previously is a good thing. It was likely just an off day. The human body is unpredictable. Chances are, you will be able to be successfully numbed again.

  40. I have a question, I am scheduled to have two extractions. One will be surgical. It always takes more numbing meds to get me numb, is it ok to tell him to give a extra shot cause it always needs one. I am also very nervous and almost have a panic attack due to traumatic exp in the past. I will use the nitrous and also have 2 mg Xanax to take before. The Xanax was prescribed by another dr for panic attacks. Do u think the Xanax and nitrous will do the trick. Last extraction I had a dry socket which is very painful. I would appreciate any insight u can offer.

    • Hope,
      You really should talk to the dentist who is extracting your tooth about this, since it sounds like he/she did not prescribe the xanax. 2 mg is a fairly significant dose. That dosage could affect you to the point where the dentist does not feel you can properly give consent to treatment. As an example, if a patient comes in drunk (which has happened before), their intoxication prevents them from being able to give proper consent, and treatment can be refused. Also, there is usually nothing wrong with an extra shot, so just ask.

  41. Jerah Dickson says

    I had a filling yesterday at 9am, here it is after 10am the next day and I am still numb. Is this normal? What would cause me to still be numb after 24 hours? Everything that I looked up on the web (taken with a grain of salt, obviously) says at most 10 hours of numbness… my tongue and left cheek still feel like they are 3 times normal size and I can’t eat solids as I chomp down on my lip or tongue. What gives?

    • Jerah,
      This is highly unusual. I would call your dentist ASAP.

      • Jerah Dickson says

        I called them and they didn’t seem overly concerned. Told me to monitor it over the next couple of weeks and let them know. I’m now 5 days out and while I have gotten back the feeling in my lips and cheek, the left half of my tongue and lower inner jaw is still numb. Has this happened to anybody else? What are the risks of just “monitoring” it for a couple of weeks and reporting back? I have to say that my poor tongue is getting the worst of it. I am chomping the heck out of it without trying to.

        • Jerah,
          I don’t practice dentistry over the internet.
          However, based on what you are saying, if you were my patient, and still numb 5 days after a procedure, I would be having you come to the office immediately so I can assess the situation and determine next step(s), if any.

  42. Lauren Caulfield says

    My teeth are always sensitive however the past week I have extreme toothache on my upper front tooth and the second one in on th left. I got an x ray was advised there is tooth decay and an abscess and also previously failed root canal treatment. Dentist advised me I need root canal to get rid of the pain I was experiencing. I thought this was fine as having had route canal done before I didnt see this being a problem. The dentist numbed the tooth twice and then tried to drill, I shot through the chair as it was like an electric shock through my body, she tried to preserver for nearly 2 hours she increased the anastethic and ended up trying to numb me 4 times, my lips and cheek were numb but the tooth being worked on wasnt! The dentist advised me the root canal will be sore and i WILL feel it because the tooth is hyper sensitive and is infected, she tried to PURSUADE me to get the root treatment done i tried but couldnt deal with the pain each time she drilled i jumped through the chair. She basically told me my only option was to suffer this, I couldnt believe this I had to go home as i felt sick with the pain i had just experienced. During the night the toothache was even worse than before I had to go to a dental hospital they provided me with anti biotocs and painkillers. I advised my dentist of this and she told me she will do the root canal again once the infection has cleared. But why didnt she do this first she has now scarred me for life I am terrified of allowing a drill anywhere near me. I am having nightmares of the pain! I am scared that the infection wont “clear up” as im still having severe toothache I am on my third day of anti biotics and pain killers and that I will need to “suffer” the pain of the root canal. I do have a high pain threshold but this was something else can someone give me some advice what if the tooth is just senstive and so badly decayed it wont ever numb ? Will i have this sever toothache forever ? I want to get help I am not scared of the root canal treatment itself its just each time she did it she kept hitting the nerve she told me she had to go through the never to solve the problem ? PLease help

  43. Michael Alberga says

    I took my wife to the dentist. DR. said that her infection was too great to do the root canal. He wanted her to take 750mg amoxicillin 2 times a day for a week first, then come back. Upon hearing this my wife asked if she could get temporary relieve with an injection of Novocaine or something and he agreed. She complained about not feeling any relief the whole day, now the next morning I can see her face all swollen. She has a temp of 101.
    Question? is it normal to give injections into infected tissue.
    Its Satureday now. Do you make house calls? joke Thank you so much for your time and expertise on the subject.
    People hate to go see you but love to say they’ve seen you

    • Michael,
      I wouldn’t say it is “normal” to give injections into infected tissue, but we do that periodically. Sometimes, a patient will present with swelling and a bad infection and the area needs to be drained of the pus. In those cases, we do it. Regarding your wife, I wasn’t there for the exam nor the conversation, so I can’t know if this was a good idea or not. If she is swollen now, she likely has infection, but you should check with her dentist.

  44. Hi, I just had a tooth implant yestarday and I still have one more to go.
    I have been immune to local anesthesia since childhood. When i first got my teeth removed I felt it all at the age of 10. When i had an accident and my dentist tried to extract my broken teeth my whole jawbone felt that so he put me on general anesthesia and operated on me.
    Yesterday he knew i was immune to anesthesia so asked me again would like to be operated or would you like to give local anesthesia a shot?
    I knew I had to get this done numb or not so I took a chance. it was not that painful but i felt it all.
    he gave me 15 injections through out the implant procedure there was no pain but the sensation was so strong i felt everything the drilling the filling the screw being tighten. He didnt drill much as he knew i felt the vibration so he did it manual giving me time. My injected area was heavy but i still felt it all. My Dr calls me superwoman. lol

    My question to you is why local anesthesia does not work on me ?
    all my life i have to suffer my tooth ache specially if extraction or implant or any other thing.

  45. Great info!

    My question is regarding a possible crown procedure for tooth 31. I received a silver filling in 1985 and in 2007, my dentist said the silver filling was showing signs of “wear” around the margins and needed to be replaced with a white filling—no decay was present. Had white filling done late 2007 and no problems since. Two weeks ago I had my 6 month cleaning (never miss one) and it was time for full x-rays. Hygienist said everything looked great to her and finished her portion. Dentist came in at end to do her examination—all went well except she spent a lot of time on 31 going back and forth with her pick. She finally said I need a crown and here is her reason why……x-ray looks fine, white filling is good and there is no decay BUT she is afraid the tooth may/could break or fracture if I eat something hard or due to me grinding my teeth.

    I know you can’t diagnose but in your opinion, is that a valid reason to get a crown—–especially since it was fine for almost 9 years not to mention the cost of a crown due to where I live. My dental anxiety is bad and this seems like a waste of time and money.

    Your thoughts? Get a second opinion?


    • This a very subjective.

      If I were to proactively do a crown on every molar with a large filling for all my patients, it would take you 6 months to get an appointment because I would be super busy doing crowns all day.

      If I were to never do a crown until a large fracture occurred, in addition to doing crowns, I would be doing tons of root canals, extractions, and implants. Sometimes, a fracture occurs on a tooth, and the tooth cannot be saved. Or it ends up needing more than a crown (root canals, gum procedures, etc.) Many of those fractures could have been prevented with crowns.

      I can’t offer you any more insight without reviewing your case. But doing a crown proactively is legitimate in many cases.

  46. Janie Hines says

    I had an emergency c-section when I had my son. My left side would not get numb for anything. Being pregnant I had maxed out in doses. They numbed me from the neck down.
    I recently went to have my 2nd molar pulled it has a big cavity.
    (This is the 2nd molar upper right side.) After about 3-4 sticks with the needle the Dentist was ready to pull.
    He pulled the tooth to the right: Nothing
    He pushed to the left : I felt like he grabbed all the nerves and twisted them like spaghetti.
    After two more attempts I was entirely too sore
    He said it might be infected but gave me Motrin 800 the only
    Did I miss something?
    Anyone else have this problem?

  47. Hi,
    I need to get a crown in one of the bottom molar so I got 2 shots To get it numb the area, but as soon I was getting the first injection I felt like hot or burning sensation all the way to my palate and right nostril, we waited for my lips or cheek to get numb and nothing happen so during the day I’ve been sneezing and dripping only from my right nostril. What happen here?

  48. Hello,

    I was attempting to get a root canal on a lower molar; however, after many shots the tooth wouldn’t numb. Everything else around it was numb but the tooth was still wired for sound. My dentist explained that the break I had in the tooth fractured below the gum line and the root is angry; sounds very similar to the “hot tooth” explanation. I was put on an antibiotic to be safe and referred to a oral surgeon since after a second look by my dentist and the fracture he could now see it can’t be saved. My concern or better yet fear is regarding the oral surgeon and if they will be able to numb the tooth for extraction. My dentist has explained the oral surgeon uses a much stronger numbing agent, is that true? Not that my dentist would lie to me but I was very nervous and I don’t know if he was attempting to just calm my fears. Also I am asking to be completely knocked out. I don’t want to be conscious at all since it’s likely the tooth will break upon removal and I don’t want to hear it. Will being sedated completely help with me not feeling anything?

    • Bonnie,
      Oral surgeons can do deep sedation and general anesthesia. If you choose that route, you likely won’t feel anything. However, I would ask the oral surgeon this question, as he/she can elaborate on the details more than I can.

  49. Good morning,
    I am currently in the process of getting several teeth removed. On Tuesday my dentist was successful removing tooth 14. During that same visit he was unable to remove tooth 29. He gave me antibiotics and scheduled me for the following day. Wednesday morning I went into the office and was preped to have tooth 29 removed. After 6 shots of numbing medicine I was still in continuous pain. The dentist proceed to tell me about a “hot tooth” and mention oral surgery. I am a cash patient and I’m sure it would cost more than $500 I paid the local clinic. Instead, he sent me home to complete 5 more days of antibiotics. I am scheduled to go back next Tuesday. My question is this; is it possible to pull a “hot tooth” after 7 days of antibiotics or best to have it done by an oral surgeon?

    • Audriana,
      The human body is variable so there is no way to know for sure if you can be successfully anesthetized. Waiting the 5 days of antibiotics should help. Oral surgeons have the ability to use sedation which can overcome the most stubborn of all teeth. If you want predictability, I would see the oral surgeon. But it will likely cost more than your regular dentist.

  50. Jessica Wallace says

    I’m going to start by saying that I have a huge fear of the dentist and my anxiety is no joke. So I cracked my 2nd lower molar. No cavity. My new dentist who is amazing!!! Had offered me diazapam the night before my filling and an hour before my procedure. I felt amazing! Ready to concur this and finally have a good dental experience. Everything was going great until my tooth would not numb. Actually several.of my teeth and face went numb but my back 2 molars! I had a total of 8 injections! She would not do the filling and reschedule for this Friday. And has told me to take the diazapam again and also take 4 ibuprofen. Is there anything else I can do to prepare for this and help make my tooth get numb? Also today is 5 since our first attempt and the swelling and pain is still there from all the injections! Is this normal?

    • Jessica,
      As you may have seen, lower molars can be the most difficult to consistently numb. I would do exactly how your dentist described.
      Injections to numb lower back tooth typically involve placing a 27 gauge an inch through muscle. When that happens repeatedly, you will be sore. This is often seen when you open wide the next day.

  51. Getting a molar extraction in 2days, nerves are getting bad. I turned down painkillers because I did not want it to over power the numbing during the procedure. What was I thinking!! Well been in pain for 2weeks. I don’t know if I’m more scared or anxious, can be both. Dentist said since its already had a root canal nothing else can be done to save the tooth. Tooth under the cap is very bad needs to be taken out. Can the X-ray show if any abscess is under there lots of throbbing pain face, ear, head. Have to sleep up right for now but he didn’t say why. Thank you for your time
    Dr Nicholas Calcaterra DDS.


  52. my dentist was unable to numb my tooth today for a filling. He injected my jaw three times to no avail. He aborted the filling procedure. This past summer I was diagnosed with fibromyalgia; my doctor prescribed massive doses of gabapentin. Which I took for a period of three months. I no longer take it. Is there a possible The gabapentin damaged nerve endings to the point of my inability to except anesthetics?

    • It is hard to know for sure about the gabapentin. However, a difficult to numb tooth can occur for much more common reasons. Was this a lower back tooth? These are sometimes the most challenging to numb effectively.

  53. I had a molar abcess last Spring & dentist was kind enough to see me on a Saturday; gave me antibiotics& somethibg for pain.@ two wks later, maybe a week I went back for Dr. to fix.
    It took@ 5 injections to get numb enough for Dr. to work on. I am a very nervous, hyperactive person. Frind just told me she just met a friend for lunch who also is hyperactive and that person had to have 9 shots to numb her enough for Dr. to work on her and her dentist ask her if she was hyperactive and she told him yes; thus it took alot of numbing med.

  54. Hello there I am a 61-year-old woman who is had dental work done regularly throughout her life no anxiety no issues with becoming numb and now this past year I’ve had several fillings redone and a crown and the numbing is not working I’m wondering why. I have one more crown to do and now I have true anxiety

    • Can I also add that these were upper back teeth not lower ones and I used to be a natural redhead but I’m no longer due to age.

      • Jeanne,
        It’s hard to tell what is going on since I was not there. Did you mention this to your dentist? How many times did this occur? Did the dentist elect to use a different anesthetic? All of these would help in understanding what went on.

  55. This question isn’t necessarily about getting numbed, but more about when the numbing wears off. I never get fully numbed, but enough to get through. Then when it begins to wear off my mouth and tongue feel hot, even when drinking cold water. It also feels like my tongue is slightly bigger. No fever. No signs of allergic reactions like hives. It will feel like this until it wears off completely. Is this normal?

    • Amber,
      The feeling of numbness is somewhat subjective. Everything you are describing I’ve heard before and appears normal. Being numb is not fun – no one likes it – but it sure beats feeling pain during a procedure.

  56. tess nerdo says

    I have a question. If you have an infected tooth or gums, and a dentist tries to numb the area surrounding it, isnt he basically by putting the needle in and out your gums several times and places, – spreading the infection to that other tissue?

    • Tess,
      That is a technically true statement but I think you’re making more significance out of it than you should. Even in the absence of an infection, you have billions of bacteria in your mouth. So anytime you receive an injection in the mouth, that tip of the needle brings millions of bacteria into the tissue. Infections resulting from injections are incredibly low.
      In the case of an active infection, the bacteria is spread around because of the injection. However, the alternative – such as allowing the patient to keep an infected tooth in – is far worse. Before antibiotics were invented along with modern oral surgical techniques, many people died each year from untreated tooth infections.

  57. Joe silvest says


  58. Hello and thank you for your article. I have a very hard time getting numb for dental procedures. Today, even after several injections, I was still in pain but wanted to get the procedure over with and told the dentist I was fine as he was obviously getting frustrated with me. I know the problem is that I’m terrified because most visits are incredibly painful. However, I did stumble upon something that hase helped me. I’ve found that if I can lay off caffeine the day of and a day or two before, I feel about 70% less pain during the procedures. They still give me lots of shots, but I can get numb. I totally messed up this time and drank a lot of caffeine as I was adjusting to daylight saving time after vacation. I wondered if this could help anyone else or if you’ve noticed this before.

  59. Andrea King says

    I am in the process of getting a root canal done on my bottom right molar. During the first visit I was given several shots to become numb but once the dentist went in to the actual tooth I started to feel everything – metal on my nerve… it was awful. He numbed me more and it still didn’t work. So, yesterday I went back for him to finish and I have to say that I was very nervous due to the first time. Once again I got several shots and thought everything was fine- it wasn’t. I was okay for part of it and there was one spot that brought tears to my eyes- I can handle pain pretty well but this was insane!! He stopped working and told me that the nerve was irritated and had a slight infection so he gave me a script for an antibiotic (take for 7 days). He told me to come back in a couple of days but I am so afraid of the pain now that I made the appointment 13 days later. He said the anesthetic wasn’t working on the nerve because of the infection- Is this true? And should I change my appt. and go back earlier? Am I now making things worse?

    • Andrea,
      I don’t think you are making things worse. As you probably learned from this article and from the comments, lower molars can be sometimes be difficult to completely anesthetize. It sounds like you are falling into this category. Usually, time and antibiotics will do the trick. Hope this helps.

  60. Lynda James says

    OMG!! Thank you!! From the time I was a kid, I have felt every procedure done on my mouth. My mother and dentist used to say I was faking or nervous. But, going to the dentist was the most painful and cruelest thing, I thought someone could do to a child. So as a result as an adult, I never went and suffered through that pain. When I got pregnant, I discovered, they would just pull the tooth rather than work on it, so the next couple of times I had a toothache, I would just say I was pregnant or have them put me to sleep to work on my teeth.

    Today, I went to the dentist and he tried to numb my tooth area and it took what he described as the most shots he has ever had to give a patient…five shots; and in and hour it was starting to wear off.

    In my mind I thought something was wrong with me or my psyche. So I decided to check and see what the heck was going on and found this and found I was not alone.

    Thank you!!!! Thank you…

  61. Hi,

    I stumbled on this looking for how long it would take for the injection site in my palate to heal. My upper palate is still sore. Thanks for the explanation of what the injections there are like. It makes sense that it would still be sore. At any rate, I find that I have serious dental work PTSD: I hear the sound of a drill (even one NOT meant for teeth), and I break into a sweat – because I’ve had a LOT of very painful drilling sessions on both upper and lower teeth. No, I don’t have red hair, though I was born with red hair. 🙂 Oddly, I’ve not had pain with getting my teeth PULLED. Monday afternoon, I had a tooth pulled: the bicuspid on the upper right. The dentist had to drill part of the tooth so she could get a proper hold on it with the tool and not break the tooth (about 75% of the tooth was gone). I heard the drill, tensed up, broke into a major sweat all over my body, but miraculously felt no pain. I’m thinking that in my case a session or two of EMDR therapy will help with the PTSD issue. I think that will be important if I need drilling work done in the future since being anxious, nervous, etc. makes it harder for the anesthetic to work. I’m thinking that the nerves INSIDE the tooth are more sensitive than the nerves AROUND the tooth. Is that correct?

  62. * andromeda * says

    Hi! not entirely a dental issue, but whenever I get anesthetic, it always seems to take more or be ineffective. For example, when I was in 7th grade, I had several baby teeth pulled. The dentist put a shot of anesthetic in my mouth, but it did very little. (yeouch!)

    a more recent example- I have had to get several minor foot procedures recently. There were two surgeries that required anesthesia. for the first one, the doctor hesitated to put two shots in, but he did. That should have been sufficient, but no- it required another shot (ow). at the next appointment, I had to get 6 shots of anesthesia to numb my big toe. SIX!

    Keep in mind, I am reasonably slim and lightweight. it should not have taken six shots, but it did. my doctor waited more than they typical amount of time before attempting to start again. I also do not have abnormally large toes or anything…

    Am i just weird? is this a sign of a larger health issue? it’s good to know there are other people out there!


  63. So happy to have found your blog. I’ve read and read for something similar to my situation, but I can’t seem to find anything. At 23 I had my first cavity (on the top) and they were never able to get the tooth numb. My next visits years later (bottom teeth) no issues. About 5 years ago I needed my first root canal (top). Horrible experience all around. I ended up walking out of this office with a hole in my tooth and the dentist refusing to work on me any further. She “maxed me out” on 2 different types of the numbing agents but was unable to get it numb. I’ve never in my life experienced that type of pain when her tool touched the nerve! In the past few years I’ve met a wonderful dentist that has tried everything to get me numb. We’ve tried adding Halogen (I believe thats the name) and nitrous. I’ve spent extra time in the chair waiting. He’s consulted colegues and is just baffled. Seems no issues with bottom teeth, just upper. Currently I need a root canal and I’m absolutely terrified to go. I haven’t been back in 2 years because of this one tooth. I guess its “easy” to push through the pain of a cavity, but I don’t want to even come close to another chance of feeling that nerve pain again. I do have Chiari Malformation and other health issues. I suspect EDS for several different reasons, but I’ve never seen anyone for an official diagnoses. I would love to hear some of your thoughts. Maybe this could help ease my mind (and others reading). Again, thanks so much for all your hard work on this blog. It’s extremely helpful.

    • Christi,
      Your case is complex and without seeing you there is no way to come up with a good explanation. EDS could be a factor (assuming you have it) as well as red hair. Not much else I can say without doing a complete exam and history.

  64. I took almost 11 injections in my mouth today to try to get numb but my teeth was hot n the dentist said they can pull it out yet that I need antibiotics that I should return Friday,The Dentist also said I have symptoms of abscess and as am speaking my tooth is burning like it’s really really hot,how can I calm the pain down so I could go to school I really need to calm it down n I hope I can get numb to pull it out Friday

  65. I have a similar problem with getting numb especially on the upper teeth. I find my teeth numb only by 1/2…so either the front toward the lips or back toward the gums. Rarely is a tooth fully “dead” after several injections. All my dentists are never able to fully numb my canines, which luckily have only needed work 3 times in 20 years. I can be numb up to my eyeballs and still feel the tooth.
    Any thoughts on the sensation of being only 1/2 numb?
    I also had a root canal previously which had 3 roots which was only found on the X-ray after I insisted that I could still feel the presence of my tooth.

    • J,
      Local anesthesia (a.k.a. the numbing that you get) is NOT like an on/off switch. Rather, it is like a dimmer switch. The more local anesthesia molecules surround the nerve, the more the nerve impulses carrying pain are blocked. Ultimately, assuming there are enough local anesthetic molecules, only a few nerve impulses carrying pain reach your brain, and you no longer feel pain. This is a gross oversimplication, but it illustrates the point.
      This can explain why, in some circumstances, you can feel a tiny bit of pain. Most, but not all of the nerve impulses are being blocked. Hope this helps.

  66. Thank you so much for that explanation. I just came back from the dentist and he couldn’t numb my front tooth to extract it. Everything else was numb bit I still felt Paul in that tooth..And I just couldn’t understand why. But since I read your post now it all makes sense. Thank you.

  67. Phyllis seiz says

    Does the non epinephrine anesthetic cause any side effects, specifically copious urination?

    • There is nothing specific about local w/out epinephrine that would produce urination that would not be seen in local with epi. The two components in local with epineprhine are epinephrine and a sulfite preservative. Both in relatively small quantities. The presence/absence of those two components should directly cause that side effect.

  68. I have anxiety and I have a resistance to local anesthesia. Honestly, to ALL pain meds. Over-the-counter, local, and prescription. I usually end up having to take the max dose to feel any relief, including with local anesthesia. Most dentists did not believe me about the novocaine and one thought I was faking (why, I don’t know), but usually I am warned that I cannot be given any more and have had a dentist switching to septocaine too!

    No one ever believes this. I always attribute this to anxiety. My pulse is always really high. I’m always nervous. I think some sensations people feel as minor irritations actually hurt on me, like a playful bite or a slap on the arm.

    This year, though, I met two people who had the same problem at the dentist! When I asked about other pain meds, they both agreed it never seems to work! Yet other medicines will always work TOO much.

    I’m a woman and the other two are men, cousins actually. But all three of us suffer from anxiety! Three isn’t proof, but I thought I’d share that nervous people at the dentist likely IS a huge problem with the local anesthesia.