Dental MythBuster #4 – Dentists Still Use Novocaine

Dental MythBuster #4 – Dentists still use novocaine

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

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

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

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

History of Local Anesthetics in Dentistry

Cocaine is still used as local anesthetic in certain medical fields

Cocaine as a local anesthetic

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

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

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

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

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

Why this dental myth persists…

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

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

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

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

 

Dental MythBuster #3 – Root Canals Hurt!

One very common dental myth that I encounter frequently in private practice in Orange, CT is the notion that root canals hurt.  If you even mention the word “root canal” to someone they will often shudder with fear.  This is one dental myth that does not seem to die, and as a dentist, it really strikes a nerve with me (pun intended).  To see the degree to which this root canal myth is propagated, watch this video:

President Obama’s reference to a root canal is at the 38 second mark.  This dental myth transcends politics.  It doesn’t matter if you are a Republican, Democrat, Independent, Whig, Libertartian, or other party affiliation.  If the President of the United States maligns root canals, you are inclined to believe that root canals are undesirable and are to be avoided at all costs!

Why Teeth Need Root Canals

Root Canal Picture

Root Canal Picture. Courtesy of the American Association of Endodontists.

In my personal experience as a dentist in Orange, CT, over 90% of the time a patient needs a root canal it is due to dental decay (a.k.a. cavities).  In these cases, the bacteria from the decay enter the nerve of the tooth, resulting in pain for the patient.  This should be very intuitive: you have live nerve tissue that is normally sequestered from the outside environment which is now suddenly exposed to nasty bacteria.  Of course it is going to hurt! The other teeth needing root canals are primarily due to other factors such as trauma, cracking, and resorption.

Why Patients Associate Pain with Root Canals

Woman with a toothache needs a root canal

A woman in pain needing a root canal. She will associate this pain with the actual root canal procedure.

This scenario plays out fairly frequently.  A patient calls our office with extreme tooth pain.  The pain is often described as “unbearable” or “the worst pain I’ve ever had” or sometimes even “worse than childbirth.”  An x-ray is taken and I perform a limited exam. I observe dental decay into the nerve of their tooth.  I discuss the findings with the patient and recommend a root canal. The patient consents.

I place topical anesthetic over the injection site and assure the patient that the pain will soon be gone. I then administer the local anesthetic with the patient feeling little to no sensation of the needle.  Within just a few minutes, they are profoundly numb, and their pain is gone!  I then perform the root canal procedure, removing the bacteria in the tooth, and then filling the roots of the tooth.  The procedure now done, the patient goes home, the numbing wears off, and the pain is still gone.  And it is gone for good and they still have their tooth!

Years later, the patient will then recount his/her experience, and say:

Yeah, I had a root canal at the dentist. It was the worst pain I have ever experienced!

This happens all too often. The patient confuses the pain that caused him to need the root canal with the pain (or lack therof) of the procedure.  And every person who listens to this story then thinks that root canals hurt.  And thus, the myth lives on!

So remember:

  • Root canals do not cause pain, they relieve it.
  • Root canals allow you to keep a very compromised tooth.
  • There are no substitutes for your own natural teeth.

If you’re still scared after all this, you can always be sedated for the procedure. But we hope we’ve busted this myth and eliminated this fear.

What the heck is numbing jelly?

“Numbing Jelly” or Dental Topical Anesthesia.

I often ask my patients what they hate the most about a trip to the dentist, and a solid majority always says one thing: The Shot.  There are other things that patients do not like, and I even compiled an abridged list of things patients have told me they dread:

  • The sound of the dental drill.
  • The feeling of “too many things” in their mouth.
  • Being tilted back too far.
  • The thought of a “hole” being drilled into a body part.
  • The “suction thingy” (a.k.a. saliva ejector or spit sucker).
  • The spray of the water.
  • The taste of metal instruments.
  • Two individuals (dentist and assistant) staring into their mouth
  • And literally hundreds of other things…

All of these things are reasons why patients avoid the dentist.  However, based on my experience as a dentist, these items all pale in comparison to the administration of local anesthetic.  Local anesthetic is necessary for all types of dental procedures, including fillings, crowns, root canals, implants, etc.  It doesn’t matter whether you’re in Orange, CT where I practice or thousands of miles away, patients hate the shot!

Dentist and Needles | Topical anesthetic| West Hartford Family DentistryNot surprisingly, dentists and dental supply manufacturers have been identifying and developing techniques over the years to eliminate the pain and fear associated with the local anesthesia injection.  Perhaps the biggest and most significant development was the introduction of narrow diameter disposable needles.  Prior to the 1950s, the needles used were much larger in order for them to be able to stand up to multiple sterilization cycles. I’ve had many older patients who experienced dental procedures back in the 1940s who described these as “horse needles.” Now we use much narrower disposable needles.  I will cover the history of dental needles in a future blog post.  But regardless, a needle is still a needle!

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