There are simply some people that are resistant to local anesthetic. The nerve can be flooded with local anesthetic without any numbing. These people often go through dental procedures enduring the pain or just avoid going to the dentist altogether.
It doesn’t seem to matter which local anesthesia is used.
It is not known exactly what causes this. It could be the nerve supply comes from multiple nerves simultaneously.
Many local anesthetics block pain by inactivating sodium channels so these patients may not allow the drug to connect properly on the channel. Or it may me a genetic resistance to local anesthesia.
Very recently I saw a 57-year-old woman that had a history of not achieving adequate numbness with Lidocaine, Septocaine or any other local anesthesia (and she knew them by name). She needed extraction of two wisdom teeth and full-mouth scaling and root planing.
IV Sedation Was the Answer
The problem was not dental fear. Instead it was a physiological issue that prevented local anesthesia from working.
We used IV sedation. IV or intravenous sedation is administered through a vein. With this method you are in a semi-awake state and will likely have little to no memory of the treatment.
The procedure went smoothly and without discomfort.
I called her that night. She was thrilled, and she said, “I can’t believe it. I have no pain. I was expecting to be in pain. This is amazing.”
We were not only able to remove painful wisdom teeth that were bothering her for 15 years plus. We were able to treat her periodontal (gum) disease all in a single session.
For patients that just can not get adequately numb with local anesthetics, IV sedation just may be the solution.