Anesthetic question

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If a patient does not like to have local anesthetic administered, or gas, would it be possible to perform the composite restoration procedure by applying topical anesthetic directly to the dentin if pain is encountered during the drilling process? Would the topical anesthetic application to the dentin interfere with the composite bonding process later? Or flushing the cavity with the water syringe and acid etching would clear the residue away? Thank You

I'd be surprised if the topical would do much for you. Is it the injection or the actual anesthetic that the pt doesn't like? Are they opposed to oral or IV sedation (if these options are available to you)?

Sounds like a PITA patient and one I wouldn't want to dedicate too much time to. By forgoing the anesthetic, not only do you make the patient uncomfortable, you make yourself uncomfortable treating the patient too. I've given in to the wishes of several patients in the past who dreaded the needle only to find myself sweating bullets while trying to keep from hurting the patient. You will work much faster knowing the patient is properly anesthetized.

To answer your question, topical works exactly as it's named, topically. It usually works (doesn't) on the oral mucosa past 0.5mm from the surface. Trying to get topical to diffuse through hard tissue like dentin would be impractical. I don't think it'd affect the bonding of the restorative material like some other chemicals would.

In the end, I'd focus my time more on patient management and trying to allay their fears. If they refuse to continue with the procedure with anesthetic, then maybe they're not quite right for your practice.

Hydrodynamic theory of dentin sensation says movement of fluid in dentinal tubules causes nerve endings to fire causing pain. (so putting topical anesthetic on dentin would not numb the nerve to the teeth since the nerves are all the say in the pulp and you would be on the other side of the thick dentin).

Also the dentinal tubules exert a pressure outwards and/or are covered by a smear layer when you are cutting that would not permit the anesthetic to diffuse through them into the nerve.