A recent experience with a patient brought back a flood of memories from the dental school days. It was one of my early morning patient’s so the situation in hindsight all fit together. I am an early bird so I begin my day with my first patient at 7:00 AM. This patient was my third patient of the day and I was working on a lower tooth. As I began my procedure it became obvious that the patient wasn’t numb. I immediately stopped my work and gave the patient more anesthetic. Another attempt at beginning my procedure resulted in the same outcome – the patient was still not numb. I repeated this once more before turning to some alternative methods to make the patient numb. I was then able to complete my procedure successfully and comfortably for the patient. I’m sure there are some of you reading this that may have had such an experience happen to you. I then went forward and questioned my patient to see what I might discover and come up with some things that I thought I will share.

There is a host of ways that we as dentists are able to offer our patients to insure their comfort. The range goes from patients of mine that choose no local anesthetic to patients I have taken to Auburn Memorial Hospital operating room to care for them. As a member of the Dental Organization for Conscious Sedation I can also offer patients the option to treat them with virtually no memory of the visit! There is also a host of different ways to administer local anesthetic for the patient who has a hard time getting numb. All dentists are well trained in the anatomy of the head and neck so that any type of anesthetic can be given in a safe way. The techniques that are available to us dentists allow us to complete nerve blocks, place infiltrations and place anesthetic right in the bone to achieve profound numbness.

Now back to my patient from earlier in the day. I know that there are a number of factors that can make it difficult for a person to get numb with conventional anesthetics, the most common being Lidocaine. A discussion with this patient revealed that on his way to my office he stopped a Dunkin Donuts for a large coffee. This is where the dental school flashbacks come in. Now I won’t be too much of a geek and bore you with the physiology but suffice it to say that the caffeine in the bloodstream affected this patient in a couple of ways. One way is that the blood pressure is increased so that local anesthetic was cleared away quicker. The second is that the caffeine makes the tissues of the body more acidic and therefore neutralizes the anesthetic effect. If I had known this patient had the high test coffee prior to the appointment I could have then taken steps to avoid the difficulties in getting them numb.

If you are a patient who has noticed in the past that you have had difficulties in getting to that comfortable level where the procedure can be completed, be sure to speak to your dentist about this. We as dentists are trained to be able deal with these situations so that we can help our patients get to be as healthy as they can in a comfortable manner.