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Comfortably Numb

One of the amazing things about dentistry is that dental procedures are overwhelmingly outpatient surgeries.tooth pulled anesthetic extra

You might be thinking, “surgery? I’m just having a filling done! What’s this about surgery?”

Well, having a filling done is actually a small surgery on your tooth. You come to the office, I administer your anesthesia (aka: numb your tooth) and then do the surgery. Since most procedures are done in a matter of an hour or so, that’s pretty quick surgery! Compared to other types of surgery, dental procedures are piece of cake. Mostly because dentists are experts at local anesthesia. And even though having a numb lip and/or tongue is a bit of a drag, it sure beats feeling what the dentist needs to do to restore teeth.

Local anesthetic is an important part of delivering comfortable dental care. Luckily, it’s a very safe drug that can be used without concern on most patients. It works by temporarily blocking the pain signals from a stimulus (aka: someone drilling on your tooth) to your brain. The signals are still sent, but when the anesthetic is in place, these signals never make it to your brain. Local anesthetics can do this without affecting your ability to drive a car or sedating you. Which means dental procedures can be quick and painless!

local anesthesia diagramEvery dentist will tell you that some patients are more difficult to get comfortably numb. According to Dr. Stan Malamed, the guy who wrote the book on local anesthesia (no, really. He wrote THE book on it!), as long as you get local anesthetic close to the nerve, it will block the conduction of nerve signals. So what’s happening when we have a patient that isn’t getting completely numb?

First, we may have not put the anesthetic close enough to the nerve. It’s almost always on the lower teeth that we cannot get a patient completely numb. This is often due to the dentist attempting to block the large nerve that runs through the jaw. This is called an inferior alveolar nerve block and if you’ve ever had one, you’d probably remember it. When done correctly, it numbs your entire jaw from your back teeth all the way to your very front teeth on one side of your jaw. It also often makes your tongue, lip and gums numb. It’s a lot of numb! It also happens to be the most difficult and inconsistent injection for the dentist. The nerve canal runs differently in each person, so sometimes we don’t place the anesthetic close enough to the nerve and we don’t get complete anesthesia. Furthermore, some people have extra nerves coming from the tongue side of the jaw. So even if we’re successful with our nerve block, we may not have placed anesthetic in all the right spots.

Secondly, inflamed and infected tissue doesn’t always allow anesthetic to pass into the nerve and thus block conduction of pain signals. I’m less confident of my ability to get a patient comfortably numb on a very inflamed or infected tooth.

So, we can get patients comfortably numb most of the time. But what about the times when we can’t? What if we could “supercharge” our anesthetic to get more patients numb more consistently? Well, funny you should ask!

Local anesthetic solutions are relatively low pH. Which is to say they are acidic. Anyone who has read this blog knows I’ve talked a lot about acidity and pH, but it’s usually in reference to the acid produced by bacteria and in foods that can cause tooth decay. In a previous blog post I explained pH in this way:

pH is a measurement of acidiy or alkalinity in an aqueous (water based) solution. A solution that is high in acidity has a low pH and a solution that is more alkaline has a higher pH. pH is measured on a 14 point scale with 0 being the lowest pH (most acidic) and 14 being the highest pH (most basic or alkaline). A pH of 7 is considered neutral, neither majority acid or alkaline. This 14 point scale is logarithmic, which means that each number on the scale is 10 times higher or lower than number above it or below it. For instance, a substance with a pH of 3 is 10 times more acidic than a substance with a pH of 4 and 100 times more acidic than something with a pH of 5.

The low pH of anesthetic is what can cause a burning sensation when anesthetic is being injected. Furthermore, the molecules of anesthetic actually cross the membrane of nerves more easily if the solution is at a higher pH. You’re probably asking yourself “why don’t we make the pH of anesthetic higher so it doesn’t burn and it’s more effective?” It’s a great question with a simple answer. The chemicals that we use to raise the pH of anesthetic (aka: “buffer” the anesthetic) aren’t stable for a long time. If you’re going to buffer local anesthetic for patient use, you actually have to add the buffering agent right before you use it.

At Mead Family Dental, we’re now able to do that. We recently invested in the Onset System, which can effectively buffer anesthetic for more comfortable injections as well as more profound anesthesia that takes effect more quickly. This means more comfortable injections, faster injections and less pain at the injection site after the appointment. If you’re interested in a technical description of how it works, take a look at this video.

We’re pretty serious about patient comfort. We’ve always been pretty confident about keeping our patients comfortable during dental appointments. The Onset System is one more way we’re make sure our patients have a comfortable experience in the office!

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If you’re looking for a Saginaw dentist, we’re always happy to accept new patients! You can request an appointment online or call the office at (989) 799-9133. And, as always, you can email me at I always answer my own emails!