Extraction Woes

monkeyfudge

Just back from a third attempt at an extraction and it failed yet again.

The tooth doesn't seem to be responding to the anesthetic at all and I get a very sharp pain whenever the tooth is pulled on followed by a residual ache.

Is it common for a nerve not to respond to the anesthetic at all?

Big_G

This is quite a common phenomenon, the bane of many a dentist and patient.
It usually happens if there is an infection around the root of the tooth. It can even happen when giving a nerve block which is nowhere near the site of infection, and should block nerve transmissions above where they are being sent from.

It is not fully understood why this happens, but it invariably happens in the presence of infection and it is theorised that infection changes the pH of the area surrounding the nerve thus making the nerve resistant to the effects of anaesthetic. This theory works fine until it comes up against nerve blocks (which should work on a nerve a long distance away from the site of infection).

When this happens, many dentists will prescribe antibiotics to decrease the infection before attempting anaesthesia again. In my experience this works very well. Another option is an intraligamentary injection (down the socket of the tooth) which can be very painful, and may not be successful.

A second possibility is that the anaesthetic is not being delivered to the correct anatomical position in order to achieve anaesthesia. This is unlikely, but can happen, particularly in the case of lower nerve blocks. In order to hit the correct spot, the dentist uses anatomical landmarks as a guide for the angulation and positioning of the needle. This means the injection is essentially given blind and due to anatomical variations this can result in 'misses'. I must emphasize that this is the unlikely possibility! However, even a very experienced dentist can 'miss' in the face of obscured landmarks, poor mandibular opening or a larger than average mandible.

A third possibility is the misinterpretation of pressure as pain. This is a difficult concept to convey to patients on occasion. Anaesthetic works well on narrower nerve fibers. These fibres tend to carry senses like proprioception (spatial awareness) and nociception (pain). Pressure sensation is carried by other, thicker fibers to which the local anaesthetic does not penetrate. So the sensation of pressure is experienced during extraction and can often be confused for pain.

Don't worry, you'll eventually get it out. The residual ache is due to the trauma being caused to the tissues around the tooth during the extraction process and is nothing to worry about. However, a person should not experience pain during an extraction.

monkeyfudge

Interesting.

We pretty much tried all of that over the past three sessions. Any infection that was there seems to be cleared up from anti-biotics.

I'm pretty sure I was registering a very sharp definite pain as I could feel the presure seperate to it.

I'm going to have to go into hospital now to be put under a general anesthetic for it to be removed.

Thanks for your thoughts.

lomb

articaine seems to work very well in these cases where lignocaine doesnt.