Another it's 2020 Question [Why are dentists still using painful novocaine shots!?]

“Novocaine” has become like Kleenex - a brand name that has entered the general vocabulary. Procaine isn’t used much for local anesthesia, either; lidocaine is usually used for short-term local anesthesia, although I once got something called articaine that kept my face numb AND PARALYZED for hours afterwards.

The needles are also smaller than they used to be; long-term diabetics will also know what I’m talking about.

Thirded. I just had two root canals yesterday.
I hardly felt the injections to numb the area. There are certainly other things I can grumble about, but not the injection.

I usually/always get the topical swab followed by a small injection a few minutes later. This causes brief discomfort. A few minutes after that, the full injection which I barely feel, if at all.

Once during a dental procedure as a kid, perhaps a root canal or extraction, after Novocain (or whatever they use) didn’t numb it enough there was, what I best could describe as a spring? loaded powered injectable. The dentist held it to the spot, pulled the trigger that shot some numbing agent deep into the area, perhaps thought the bone or tooth. Whatever it was it got to the right spot for no pain.

I’ve had a few root canals in the past decade. When I was growing up in the 60’s root canals were touted as the ultimate agony. But for me, it was as painless as any other dental procedure. Except… in one, she must have strayed into an area not completely numbed, and I had a sudden twinge that hurt like hell. But, only for a second and she didn’t hit it again.

What really hurt, back in the 80’s, was a needle in the palate. Never had that issue since then, i think for the same reason - they use a numbing swab first.

(You want real pain? One time had what I think was inflamed sciatic nerve for a week or so. Sliding my butt down the back of the bathtub - I’ll never make that mistake again. )

IMMENSELY. The first time I had a shot under the gas, I couldn’t believe how not a big deal it was. It either felt like just a prick, or I just didn’t care, because I was flying, so I remember it that way.

The main reason root canals are so feared is the pain leading up to having one, although the procedure itself is not a whole lot of fun. However, in my case, it cleared up a terrible infection, and when it had to be done over 25 years later, led to the preservation of a front tooth


said do-over failed and I had to have an apicoectomy. So you don’t Google-image that, I’ll describe it with a spoiler.

They peel back the gum and break off the jawbone, which over the roots of the teeth is about the thickness of an eggshell, and clean out any infection and trim off the end of that tooth’s root.

It sounds horrible, but in my case, it took about 10 minutes and was less traumatic than a filling.

Well, I wonder if part of it is a miscommunication ala the telephone game.

What I mean by that is, I actually would dread having a root canal again, but that’s because 1. It takes a while, including at least 2 visits, 2. It is somewhat random when you are going to get that “whack to the funny bone” sudden nerve pain (I had it at one point when the dentist was not even touching me), so you’re kind of on edge, and 3. The knowledge of what the dentist is actually doing (sticking various pins deep into the root, including a drilling pin) is somewhat squicky.

But, on hearing that I am dreading going for a root canal, others may assume that’s because it’s agony…
I can’t speak for how root canals may have been in the 90s or earlier, but IME nowadays they are not so painful, certainly not in terms of duration of pain, but are uncomfortable for other reasons.

I had a friend go in for some dental procedure and, while in the chair, chickened out and demanded he get gas and be put under for the procedure (which was an involved thing and he was told it was borderline get gas or get Novocain).

That resulted in the whole thing being delayed many days in order to get an anesthesiologist in to administer the gas. People are different and you need a specialist to knock you out with drugs. IIRC anesthesiologists have some of the highest insurance premiums in the medical industry because knocking people out with drugs is fraught with unknowable outcomes.

tl;dr Dentists really, really, really want to avoid knocking you out for a procedure. Sometimes they may have to but that is the last resort.

Where do you live? I have had three different dentists give me gas, and they all do it themselves.

The only time I was completely out for a procedure under GA was my wisdom tooth extraction, because that was actually a pretty involves surgery; they did all four at once, so as not to put me under twice, removed a bone spur on my jaw, and one tooth that had invaded to roots of the tooth next to it, which took a long time. I was under for 2 & 1/2 hours. An anesthesiologist was present at the oral surgeon’s office for that, and I did have to see a maxillofacial surgeon for this-- an ordinary dentist could not do it.

But I have had one root canal, and one marathon session where four childhood fillings in different places in my mouth were replaced, and those were all done under nitrous, not GA.

I always have nitrous at the dentist, even for cleanings, because I gave an extreme gag reflex (I could never do porn). I have thrown up on dentists before. The nitrous prevents this from happening.

Knocking people out with drugs is giving them drugs that try to shut their body down entirely, but easing off at the ‘unconscious’ stage but before the ‘dead’ stage. There’s a pretty narrow window between the two, and when you think about it that way it’s pretty obvious

Those are two radically different things, BTW - laughing gas is a sedative, and in typical use just makes you happy and relaxed, it doesn’t knock you out. There’s a decent number of dentists that offer gas for all procedures, primarily to attract clients who have a fear of dental work, and it’s considered a pretty routine thing for a dentist to handle themselves. Full general anesthesia is what you need a specialist for, and is much, much rarer.

I’ve had that. It sounds bizarre, but it does help. Some googling shows DentalVibe is one of the main players in this field.

I think the dividing line between needing an anesthesiologist and “the dentist/doctor doing the procedure can handle it” is whether you remain conscious enough to control your breathing reliably.

It’s not just dentists. Some gastroenterologists do colonoscopies with sedation without bringing in an anesthesiologist. At least, i read some article about doctors lobbying for another type of sedation they could use on their own.

The place i go for gi procedures uses an anesthesiologist, though. (And I’ve never been sedated for dental work. The Novocaine has always been plenty.)

The only time I’ve ever experienced general anesthesia was for dental work, my wisdom teeth extraction (all four at once, with them being a bit on the impacted side.)

They did start me off on some nitrous (which was interesting, only time I’ve ever done that), but once they were actually getting started, put me completely under.

They did have an anesthesiologist for the procedure.

I had three endoscopies (over the course of about 6 weeks) and IIRC, there wasn’t an anesthesiologist present. I did ask what they used for the twilight sedation (which, from my POV, might as well have been general) and it was something along the lines of morphine, benedryl and possibly versed.

When I had general anesthesia for shoulder surgery, that one involved a call the day before from the anesthesiologist to discuss any meds I’m currently taking, risks etc. None of that happened for the endoscopy.

It’s my understanding that, even though I don’t remember any of it, you’re still kinda awake for an endoscopy so you can work with the doctor. I assume that’s also why they numb your throat. If you’re totally knocked out, you’re not going to gag to begin with.

I had an upper and lower endoscopy, one right after the other, and yes, they use Versed. Versed is the drug that causes amnesia. I had a combination of Versed, Xanax, and nitrous. I didn’t remain on the nitrous, and the doctor thought I was asleep most of the time. They did the entire upper, and about 85% of the lower, when I came to. I remember talking to the doctor, and being able to watch the screen, so the Versed must have worn off, but the Xanax was still working, because I was feeling no discomfort. They did strap the nitrous back on, anyway. I remained conscious, but I couldn’t have cared less what was happening to me.

I did a colonoscopy with no drugs, and while it was pretty uncomfortable when they shoved the scope up into my gut, once they started pulling it out and actually doing the exam, I felt no discomfort. At least, any discomfort was not enough to distract me from looking at the screen and seeing what my insides looked like.