Cannot get aneshesia on # 18

[kerrydds06]

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I'm redoing a PFM on #18 that was done at Aspen Open Margin & chipped porclain. Pt was referred to me by one of my patients. I gave the block, Long buccal, PDL, coronoid, block again, nothing! (2 other instructors tried unsucessfully) I pulp tested 19, 20, 22, all numb, 18 still hurts on cold and EPT +ve (64). #30,31 EPT 34. So there is some altered sensation. Tongue, lips, everything else numb. After 1/2 I was able to get the crown off by cutting a lingual groove, once exposed there is no decay, no fractures, But I can't refine the margins, too sensitive so I put a temp on.
The instructor says there is innervation from somewhere else. But the patient claims the tooth was numb when the Aspen dentist put the crown on.
This happen to anyone?
Any suggestions on what i do now?

 

[omemnow]

Same thing happened to me yesterday on #19. I gave 4 carpules of lidocaine on gow-gates, IA, long buccal, and PDL and she still got sensitivity on that tooth even though she's numb at the lips and tongue etc. We finally gave her carbocaine without epi 3% gow-gates and it worked a lot better, even though she still felt some pain.

 

[kerrydds06]

yup, this happened yesterday.

 

[umkcdds]

did you try a nerve to mylohyoid injection?

Same thing happened to me yesterday on #19. I gave 4 carpules of lidocaine on gow-gates, IA, long buccal, and PDL and she still got sensitivity on that tooth even though she's numb at the lips and tongue etc. We finally gave her carbocaine without epi 3% gow-gates and it worked a lot better, even though she still felt some pain.

 

[karlmone]

Nerve to the mylohyoid can give sensation to lower molars sometimes - try infiltrating on the lingual next time.

 

[omemnow]

Nerve to the mylohyoid can give sensation to lower molars sometimes - try infiltrating on the lingual next time.

Actually I meant infiltration not PDL, yea I did try lingual infiltration.

 

[umkcdds]

Nerve to the mylohyoid can give sensation to lower molars sometimes - try infiltrating on the lingual next time.

try hitting it lateral to the mandible - kinda like giving a long buccal, but more lateral and more vertical.

 

[Sterichind69]

Try Septocaine...Articaine 4% with 1:100000 epi via loal infiltration see if that works.

 

[kerrydds06]

Try Septocaine...Articaine 4% with 1:100000 epi via loal infiltration see if that works.

I wish, I asked him, but my instructor said he doesn't like to use it?!?
said their are "side effects"???

I havent had a chance to use it yet, we have to get signatures to get it from the dispensary.

 

[aphistis]

I wish, I asked him, but my instructor said he doesn't like to use it?!?
said their are "side effects"???

I havent had a chance to use it yet, we have to get signatures to get it from the dispensary.

Articaine can cause paresthesia when used for an IAN block, but how frequently it actually *does* is still being argued about.

The nerve to mylohyoid was a good thought, but a properly delivered Gow-Gates should take care of it if that's the problem. I'm surprised nobody has suggested an intraosseous injection yet.

 

[St. Appolonia]

that sounds like a hot tooth. I once assisted on sectioning a crown off #3 and no matter how much we gave, or how many people tried, whenever we sectioned on the mesio-lingual aspect, the guy came out of the chair. He had one hot canal that was resisting the penetration and action of the anesthetic. This frequently means that one or more canals is irreversibly inflamed. Eventually this means small acsess followed by pulpal injection to get anesthesia for rtc.

 

[aphistis]

that sounds like a hot tooth. I once assisted on sectioning a crown off #3 and no matter how much we gave, or how many people tried, whenever we sectioned on the mesio-lingual aspect, the guy came out of the chair. He had one hot canal that was resisting the penetration and action of the anesthetic. This frequently means that one or more canals is irreversibly inflamed. Eventually this means small acsess followed by pulpal injection to get anesthesia for rtc.

Very frequently, yes. As in, "always" is probably a better descriptor. 😉

 

[DcS]

The research on parasthesia and septicaine is shaky at best. This summer I worked with a 76 y/o oral surgeon who has used septicaine for his entire career without incidence. He had us use it on all exts...very good stuff for anesthesia.
We are also not allowed to use it in school.

 

[DrJeff]

Get an endo consult, even theough it's vital now, with the symptoms/ data you're reporting that tooth is realistically on its way to non-vitality. Better to get the endo done now while the sh%^^y aspen crown is on it than have to cut a hole through the beautiful new crown you're going to put on it!

 

[Mayo Ortho]

I'm redoing a PFM on #18 that was done at Aspen Open Margin & chipped porclain. Pt was referred to me by one of my patients. I gave the block, Long buccal, PDL, coronoid, block again, nothing! (2 other instructors tried unsucessfully) I pulp tested 19, 20, 22, all numb, 18 still hurts on cold and EPT +ve (64). #30,31 EPT 34. So there is some altered sensation. Tongue, lips, everything else numb. After 1/2 I was able to get the crown off by cutting a lingual groove, once exposed there is no decay, no fractures, But I can't refine the margins, too sensitive so I put a temp on.
The instructor says there is innervation from somewhere else. But the patient claims the tooth was numb when the Aspen dentist put the crown on.
This happen to anyone?
Any suggestions on what i do now?

Stabident will work wonders!
http://www.stabident.com/

 

[kerrydds06]

Get an endo consult, even theough it's vital now, with the symptoms/ data you're reporting that tooth is realistically on its way to non-vitality. Better to get the endo done now while the sh%^^y aspen crown is on it than have to cut a hole through the beautiful new crown you're going to put on it!

I'm bringing her in tommorrow for an endo consult. She called me tonight saying it was really bothering her all weekend and she couldn't go to work today. I think I may have to remove the nerve tomorrow.

 

[lnn2]

I think I may have to remove the nerve tomorrow.

good call! Use the metal disk from the prostho kit. It'll cut right through that IA nerve without any problems! 😀

I usually use 1/2 carpule Lidocaine then 1 carpule .5% Marcaine. Marcaine is great for endo and exos.

 

[tx oms]

Try Septocaine...Articaine 4% with 1:100000 epi via loal infiltration see if that works.

I knew this was going to come up. Try throwing away all your anesthetic except lidocaine.

There is a technique for extraoral V3 blocks that would probably work. I wonder if you patient is FOS.

 

[lnn2]

I wonder if you patient is FOS.

What's FOS? Full Of ****?!

 

[kerrydds06]

I knew this was going to come up. Try throwing away all your anesthetic except lidocaine.

There is a technique for extraoral V3 blocks that would probably work. I wonder if you patient is FOS.

The thought did cross my mind, She has shown abnormally high anxiety,and seems to like the extra attention i've been giving her, I'm thinking of sending her to post grad where the works cost more to see if that works.
It has been a lesson well learned. So some good will come out of the experience. I'm giving her 2 more weeks then i'll refer.

When i'm practicing on my own next year, I'll just refer these patients cause they take up too much time and energy, in their minds, Nothing good can ever come from all the help and caring we show. Sure they are people, but they need a shrink not a dentist.
I feel bad now, but i'll get over it. There are many more people who appreciate my care.