Question:

I am 46 and pre-menapausal (not sure if that is part of the probem) but the last few times I have been to my dentist for two replacement crowns I don`t feel any effect from novacaine even after approximately 5-8 shots. The last time they game me the 8 shots and then tried nitrioxide gas and NOTHING!

Unfortunately now I need to get a root canal done on one of the two crowns that just got replace and am terrified of getting no relief from the above. Can I take Vicodin prior to going and how much would you think would work? I have a prescription for severe migraines. The dentist also suggested an IV type of sedative but said it would cost an additional $700, so instead of the out of pocket being roughly $300 it would be $1000. I`m thinking ahead for other dental work because I can`t be going IV for the rest of my life. HELP!

Answer:

Taking Vicodin, or really any oral opioid (narcotic), would not provide enough analgesia (pain control) for a dental procedure. Even with intravenous moderate sedation, rather than general anesthesia, the pain would be intolerable for most patients. With IV moderate sedation, it may be possible to start a root canal with patchy local anesthesia and the IV drugs since when the nerve of the tooth is entered into, local anesthesia can be applied directly and works very well. There is a reasonable, but not certain, degree of amnesia so you might not remember the procedure.

There are some other options, however.

• Intraosseus local anesthesia is very effective when conventional techniques have failed. You should inquire if your dentist or endodontist does this procedure. It would be very well worth trying.
• There are alternative techniques for lower jaw anesthesia, such as the Gow-Gates approach, but not all dentists do this.
• Lastly, articaine, a less commonly used local anesthetic, comes in a 4% solution and is sometimes more effective than the standard 2% solutions.

Talk to your dentist about these options. If nothing works, and there is a small group of patients for whom local anesthetic is not effective, general anesthesia is the preferred alternative.

For more information:

Go to the Root Canals health topic.