Carbocaine, Marcaine, Articaine and Septocaine
One way or another, dental anesthetics are of interest to us all. When you're having some dental treatment, you want to be confident that the tooth is completely numb - and that includes me, both as a dentist AND as a patient!
But which is the BEST anesthetic? We have carbocaine, marcaine, articaine, septocaine, as well as the older lidocaine and novacaine. Does it even matter?
You'd also like to get a PAINLESS shot, too. After all, what's the point in dental anesthetics if the shot is worse than the dental treatment? I've always thought it strange that a dental anesthetic injection can be painful. It just seems plain wrong!
So here's a guide to getting a painless shot. Please feel free to print this out and show it to your dentist if you feel it might be useful!
Here are the main points, and I also include some tips of my own.
First off, YOU THE PATIENT need to follow the dentist's instructions as well as you can.
If he asks you to stretch your mouth open really wide, just do it. And hold that position. It will make the shot more comfortable. And if he asks you to close your mouth up and relax your cheek, just do it. And keep your cheek relaxed! Again, it's to make things more comfortable.
Those are the two main things that a patient can do to help the dentist.
Now your dentist has to do his bit!
First, a surface anesthetic gel. This numbs the gum before you get the shot, but the dentist has to get a few things right. He needs to use a good quality product. The best I've found is from a compounding pharmacy in Nashville, and the gel is called Tricaine Blue TAG.
Next, the dentist needs to dry the gum with a cotton wool roll before he puts the gel on. Then he needs to let the gel sit in place for at least 3 minutes. Even better is 5 minutes.
So far, so good!
Next, he needs to use a local anesthetic called Citanest Plain - it doesn't have any adrenalin in it, and it is neutral on the acidity scale, with a pH of close to 7. Nearly all other dental anesthetics are acidic - it's like injecting lemon juice! OUCH!. Your dentist should just put a couple of drops of the Citanest Plain in there first, then wait another 3 minutes.
Then he should VERY SLOWLY add the rest of the Citanest Plain. If this is done very slowly, over about 4 minutes, you shouldn't feel a thing.
Now you need to wait 2 minutes while the gum goes numb. The Citanest works very quickly, but it doesn't last long, so the dentist has to add a second shot, but this time with a different, longer lasting anesthetic.
I believe that the best for root canal is Articaine 4%. Again, the dentist should give the shot very slowly, taking about 4 minutes over it. It's like getting a shot in slow-motion, but you DO NOT feel anything.
Over the next 5 minutes the tooth will get extremely numb. When I use this technique, which I learned from Dr. Kit Weathers, I can't remember the last time a patient felt any discomfort.
If you've been adding up all the minutes in that list, you'll see that it can take about 15 minutes all up just to get the tooth numb! That's a lot of time in a busy dental office. What are the advantages to doing it that way?
For all the above reasons, the actual dental treatment is much less stressful for everyone in the room! I believe it makes sense to invest that extra 15 minutes right at the start of the appointment.
So which dental anesthetic should the dentist use?
As I mentioned above, the first one should be Citanest 4% Plain. It's non-acidic, so it doesn't cause any initial discomfort; and it works REALLY quickly.
But it doesn't last very long. The second anesthetic is usually Lidocaine or Articaine. Articaine is the same as Septocaine. It is very widely used in Europe, but not as much in North America.
Carbocaine is the trade name for mepivacaine. It's not used a lot, but it's a good anesthetic. It works rapidly, and lasts for a reasonable length of time.
Marcaine is the trade name for bupivacaine. This is an exceptional anesthetic, in several ways. It has a very rapid onset, and produces a profound anesthesia. Here's the special thing - it lasts for seven hours or more!
This is a VERY STRONG dental anesthetic. Another special property is that, as it wears off, you get all the normal feeling back, but it continues to block pain for several hours more. It's probably best used for long, invasive procedures such as dental implants.
What are the possible reasons for anesthetic failure?
But if the cartridges are left in the warmer for too long, the anesthetic agent decomposes. Again, using the above technique means that the cartridge can be used at room temperature.
There are other anesthetic techniques that a dentist can use in difficult situations, but they are more technical and really belong in a dentist's forum!
But one technique that is gradually gaining acceptance is "anesthetic buffering". This involves adjusting the pH (the acidity) of the anesthetic solution immediately before injecting. This makes the solution active instantly - it is numbing the gum and tooth IMMEDIATELY as it is being injected!
This means that the gum is going numb almost instantly as the dentist is giving the shot. As soon as he puts down the syringe, he can start work. SO - the shot is virtually painless, AND you are numb within seconds!
Sounds great - but what are the disadvantages, and why doesn't every dentist use this?
Unfortunately, it's not 100% successful - patients with red hair seem to be a little resistant to the technique. Also, it's expensive for the dentist, and therefore he must pass on the additional cost to you, the patient.
The system and technology is also relatively new, and is still being assesed in general practice situations.
I believe that great dental anesthetics should be at the heart of dentistry. With modern anesthetics like articaine, marcaine and carbocaine, I think it's criminal that a patient should feel any pain at all during dental treatment.