Prepare for a Visit

The process of reducing pain sensation during dental procedures is often referred to as "numbing a tooth" or "putting a tooth to sleep." This occurs through the use of a local anesthetic. A local anesthetic is a medication that blocks nerve signals and temporarily causes a lack of pain sensation in a small area.

Some local anesthetics also contain ingredients to control localized bleeding for surgical procedures. These ingredients also help to keep the local anesthetic confined to the area of the dental procedure.

There are many types of local anesthetics. Your dentist will choose the most appropriate type based on factors such as how long the numbing should last, your health history, medical conditions, allergies, and potential interactions with medications you take.

Local anesthetics are typically administered through injection and can affect one or more teeth based on the procedure. Your dentist is trained to apply the anesthetic to the appropriate nerve or nerve branch in your mouth based on the area that needs to be numbed.

Upper teeth are often easier to numb than lower teeth. The upper jaw bone is less dense, and the nerves to the upper teeth can usually be put to sleep with relatively shallow injections.

If your procedure requires work on two or more teeth in the same area of your mouth, your dentist will likely anesthetize a nerve branch. This is called a "regional block." Regional blocks are more commonly used in the lower jaw because it is more difficult to anesthetize individual teeth properly. Regional blocks require fewer injection points than multiple, individual teeth.

Before the procedure

• Type of anesthetic: It is important to be open and honest with your dentist regarding your health history and personal habits to avoid adverse risks and help your dentist pick the right type of anesthetic. Your dentist will then decide which local anesthetic to use based on several factors:
  • How long the anesthetic needs to last.
  • Your health history and medical conditions you may have.
  • The possibility of interactions with any medications you are taking. These include prescriptions, over-the-counter medications, supplements, and recreational drugs.

  During the procedure

  • Strategies to reduce discomfort and anxiety:
    • A topical numbing gel may be applied to the site to help reduce discomfort from the injection.
    • Some dentists may use a microprocessor-controlled injection system that controls the pressure and volume of anesthesia delivered. This system has an injection tip that resembles a pen. It appears less intimidating than a needle and may be effective at reducing injection site discomfort.
    • If you are particularly anxious about injections, or dental procedures in general, your dentist may recommend sedation.
  • Injection(s): Your dentist will insert a needle and dispense the anesthetic into the tissue and jaw area around the numbing site until it reaches the nerve. Depending on the procedure, you may need more than one injection.
    • To make the injection process more comfortable, your dentist may dispense the anesthetic slowly, over a period of approximately one minute. This gives the tissues more time to absorb the anesthetic. You may lose sensation during the injection process itself.
    • Your dentist may wiggle your lip or cheek to gently stimulate nerves away from the injection site. This may help reduce any discomfort from the initial injection.
  • Losing sensation: After your dentist administers the local anesthetic, your teeth and soft tissues will begin to lose sensation. Once the area is numb, your dentist can begin the dental procedure. While you won't feel pain, you may feel pressure in the area of the procedure.

  After the procedure

  Depending on the type of anesthetic used, the numbed area may not regain sensation for a few hours. Unless your dentist administers local anesthetic reversal agents, you cannot speed up the return of normal sensation.

  While you remain numb:

  • Do not eat or drink hot beverages while your lips, cheeks, or tongue are numb. It is possible to burn yourself.
  • Be careful when eating. You can bite your lips, cheeks, or tongue and not realize it.
  • Do not pull on or poke at the numb areas in an attempt to make the feeling return. There is no way to reduce the period of numbness. Sensation usually returns within one to two hours. The amount of time that passes until feeling returns depends on the type of anesthetic used, the length of the dental procedure, and other factors.
  • You may experience slight difficulty with speech until the anesthetic wears off.

• Drug interactions:
  Be sure to discuss with your dentist any allergies, medications, or medical conditions you have before beginning treatment
  . Local anesthetics can have adverse effects with the medications you take. They can also have negative side effects if you have certain medical conditions or are allergic to the anesthetic ingredients.
• Fainting: Fainting is the most frequently reported adverse reaction to local anesthetics. It is primarily due to fear of the injection. If you are prone to fainting or afraid of injections or dental procedures, you should discuss this with your dentist before scheduling treatment. On the day of treatment, it is always a good idea to remind your dentist and their staff before they start the procedure.
• Prolonged numbness: In rare cases, prilocaine and articaine may produce prolonged numbness. Their use may not be advisable near major nerve branches. Contact your dentist immediately if you experience numbness that lasts longer than your dentist said it would.
• Pregnancy: Be sure to tell your dentist if you are pregnant. It may affect which anesthetic they use.
• Nerve injury: Injections may result in injury to the nerve's protective sheath. If nerve injury occurs, it can result in sensations ranging from pain to numbness. It is most often temporary but can be permanent in rare cases.
• Pain management: Certain dental procedures, including the injections for the procedure, may result in swelling, bruising, bleeding, and infection. In most cases, your dentist will recommend or prescribe pain relievers or anti-inflammatory medications following these types of procedures.

If you feel you can tolerate discomfort without local anesthesia, your dentist may suggest topical numbing gel. This can sometimes provide adequate comfort for minor procedures without the use of local anesthesia.

Your dentist may not be able to make you comfortable enough to have certain dental procedures performed without using a local anesthetic. If you are anxious about dental procedures, your dentist may recommend sedation. Keep in mind that avoiding dental care because of these fears can lead to additional, more complex, and costly treatment in the future.

It is important to note that dentists generally perform at their best and practice more safely when you are not twitching or jumping from discomfort during a procedure. It is always best to be open and honest with your dentist. Discuss your concerns before treatment begins. Your dentist will work with you to develop a plan that makes you as comfortable as possible.

• What type of local anesthetic will be using? Why did you recommend that type? What are the pros and cons?
• Will the anesthetic you recommend have any adverse effects on the medications I am taking or any of my health conditions?
• Is there any risk to my unborn baby?
• What is the risk of nerve injury?
• What can we do to help reduce my risk of fainting?
• How long after the procedure should I expect to remain numb?
• What should I do if the numbness does not wear off when expected?