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Is it realistic to attempt to have a root canal without anesthetic?
January 26, 2011 8:26 PM   Subscribe

Is it realistic to attempt to have a root canal without anesthetic?

My wife is about three months pregnant. She has an abscess in one of her lateral incisors. The dentist wants to perform a root canal. My wife wants to try it without anesthetic. She knows that lidocaine is considered safe in pregnancy, but she is not keen on taking any drugs while pregnant.

Is my wife's plan at all realistic? I think this plan is going to last about three seconds once the work starts.
posted by registered to Health & Fitness (67 answers total) 4 users marked this as a favorite
 
Bad, bad idea.
posted by Night_owl at 8:29 PM on January 26, 2011 [18 favorites]


I had cavities filled without anesthetic when I was younger. Root canal? No way.
posted by devbrain at 8:35 PM on January 26, 2011


No. This is not realistic. I guess it depends on how tolerant of pain your wife is, of course, but after having as many root canals as I've had, I'd say that this is not going to work. She will want meds during the root canal.
posted by k8lin at 8:36 PM on January 26, 2011


A possible relevant discussion.

It looks like it's sometimes possible, sometimes not.
posted by SpacemanStix at 8:36 PM on January 26, 2011


No, it is not. Ask her to call her doctor. Maybe she just needs reassurance that the anesthetic will not harm the baby.
posted by Anitanola at 8:38 PM on January 26, 2011


Also, she should talk to her OB-GYN and her dentist to figure out what can be done for her, and what drugs will be best.
posted by k8lin at 8:38 PM on January 26, 2011 [1 favorite]


I have extensive experience, and my counsel is: Fuck, no. Really, no.
posted by mojohand at 8:38 PM on January 26, 2011 [8 favorites]


I had one once, I was terrified of needles in my mouth at the time. I don't remembering it being bad enough to cry, but I'm pretty pain tolerant, and that may also depend on the tooth. I imagine she could try and if it got too bad she could take the anesthetic? Or, could he give her antibiotics for the abscess and then do the root canal in a few months? or are antibiotics bad when pregnant too? Anyhow. I'm just saying it's possible.
posted by lemonade at 8:38 PM on January 26, 2011


What the hell. Go for it. The worst thing that happens is that she experiences a lot of pain and asks for painkillers. She'll be giving birth in half a year anyway, this could just prep her for it.
posted by spikeleemajortomdickandharryconnickjrmints at 8:40 PM on January 26, 2011 [1 favorite]


Oh my goodness, ouch, ouch, ouch. As someone who has been through multiple root canals and an extraction, I can't even imagine it.

Seconding speaking to her OB and DDS (even if it's mostly for reassurance).
posted by purlgurly at 8:41 PM on January 26, 2011


She should really consider that going without pain relief could be stressful enough for mom that it is bad for the fetus. Several pain relievers are used during labor that do not harm the baby.
posted by nasayre at 8:42 PM on January 26, 2011 [23 favorites]


I've had a couple root canals. No anesthetic? No way.

Maybe it depends on the person, though. I found this random website that says:
How Painful Is a Root Canal?

Root canal procedures have the reputation of being painful. Actually, most people report that the procedure itself is no more painful than having a filling placed.
So, if she can have fillings without anesthetic maybe she's one of the "most people" referenced there. Personally I can't imagine that I could have done it, but all of mine were root canal + crown, so there was a lot more tooth removal going on.
posted by chazlarson at 8:46 PM on January 26, 2011


Good lord no. A root canal involves basically roto-tilling a tooth socket, and exposing the nerve below a tooth. They are incredibly painful - and I say that as a person who has broken an arm and not known about it for almost 24 hours because it didn't hurt like I thought a broken arm should. But a root canal? That is a different level of pain entirely.

Echoing those that say your wife should work with her obgyn and the oral surgeon to find something that works, because oh my heavens the pain.
posted by pdb at 8:47 PM on January 26, 2011


I had an unemployed, uninsured and broke roommate with a rotten front tooth that needed a root canal, and it couldn't be put off any longer. He told the dentist he'd like to have the root canal done without any anesthetic. The dentist told him that was a really bad idea. He insisted, and the dentist agreed to schedule it. Come the day of his appointment, he's in the chair and the dentist says, "Look, I understand that money is tight but this is a really painful procedure. I'll give you the anesthetic for no charge." My roommate was a stubborn, tough guy who had suffered plenty or horrendous injuries from stupid Jackass-inspired tricks and stunts. Pain did not scare him at all. He refused the anesthetic. The dentist told him he could change his mind at any time during the procedure.

If you'd have bet the over on three seconds in his case, you'd have lost.
posted by Balonious Assault at 8:47 PM on January 26, 2011 [3 favorites]


Extremely painful operations send cortisol through the roof, which is probably not good for a fetus. They can even cause PTSD. Prior to anesthetic it was not uncommon for those undergoing major operations to have serious psychological issues if they survived.
posted by schroedinger at 8:47 PM on January 26, 2011 [8 favorites]


No. The point of the root canal is to remove the nerve-containing pulp. The tooth is dead after the root canal, not before--in general anyway.

So...she's thinking of having nerves removed that are inside a shell of the hardest substance in the body without anesthetic? Sweet Jesus, I can't even imagine how much that would hurt. I recognize that she's contemplating a local, but to put this in proper perspective, let us all remember that inhalant general anesthesia was first reported for its use in dentistry.

The second public report (not use, of course, the short version of anesthesia's exciting and dramatic history is in the wiki) was for NECK TUMOR REMOVAL. First teeth, then neck tumors.

Incidentally, the random website cited above is referring to a procedure performed with local anesthesia--i.e., what the OP's wife would receive.
posted by Uniformitarianism Now! at 8:48 PM on January 26, 2011 [2 favorites]


It depends on how dead the nerve is, where they have to drill and how much work they have to do. Some root canals don't need it, some need lots.

Thee examples: My Dad didn't have any anaesthetic at all for his root canal because the nerve was totally dead so there was nothing left to hurt. It was a pretty straight forward procedure and no big deal. I don't know which tooth it was.

For my last root canal I had a small amount of anaesthetic near the end. I have curly, fiddly roots and it took three visits to do (plus one more for a permanent crown at some point in the future). I didn't have any anaesthetic for the main drilling and scraping out the canals for the root filling etc (nerve was dead anyway, I didn't feel anything). But then I had a small amount for one of the end parts, maybe when he was putting in the actual root filling (I can't remember exactly), because the gums were getting a bit beaten up by then and all the ramming and messing around was getting sore. This was my ninth or tenth visit in a row though, each a week apart (I needed lots of fillings) so my mouth was sore in general by then. That was a lower molar.

My first root canal was an upper premolar, was infected both in the tooth canal and in my sinuses, and that had lots of anaesthetic. There is no way I could have done that one cold, it was pretty uncomfortable as it was. The root filling now nudges slightly into the sinus (which is not weird or unusual) so even if the tooth's nerve was dead there are other ones around to give pain. If your wife has something like this then she definitely needs the anaesthetic.

In either case her dentist will be able to advise her on what's reasonable for her specific tooth, we can't tell you.

Make sure she weighs up any risk from the anaesthetic (assuming there even is any, which it seems like there isn't) against the risks and health effects of the localised and systemic inflammation that comes from untreated dental issues. It's possibly better for both her and the baby to just get this fixed regardless of the lidocaine.
posted by shelleycat at 8:48 PM on January 26, 2011


The tooth is dead after the root canal, not before--in general anyway.

Actually it's pretty common for the nerve to be totally dead before hand as that's one of the main reasons why people get root canals in the first place.
posted by shelleycat at 8:50 PM on January 26, 2011


No. I agree that the stress to the fetus would be worse than the negligible affect of the anesthetic.
posted by kcm at 8:56 PM on January 26, 2011 [2 favorites]


I had a root canal done with no anesthetic. I was 17 and alone in a foreign country, with a front tooth that had begun to darken and become painful. I was taken to a dentist by my "host family" who arranged for a procedure for that tooth. I had no idea what was about to happen. To say it was painful was an understatement. My feet kept flying off the chair like they were being hit by that knee- reflex hammer. It was a cold sweat kind of pain. Nothing I would ever repeat willingly. It wasn't until years later seeing an american dentist that I was informed that I'd had a root canal done on that tooth....it showed up on x rays. The dentists I've seen over the years have honestly had a hard time believing I really had it done with no anesthetic.
posted by Rapunzel1111 at 9:01 PM on January 26, 2011


No.

So, if she wants to try and do it without localized anesthetic - then, well, it won't be pleasant. Even if the tooth is dead.

And if she has an abscess, it could be life-threatening. So, hopefully when she realizes that it's too painful to have done with anesthetic, she'll decide to use it - instead of putting it off.

I did not take any painkillers before or after my root canal. Well, maybe I took some ibuprofen.... but not rx.
posted by KogeLiz at 9:04 PM on January 26, 2011


I had a cavity drilled once, while on nitrous, no novocaine, that basically turned into a root canal. It was worse then the dentist anticipated.

It was some of the most horrible pain I've ever felt, once I came out of the gas haze. BREATHING hurt.

I would not recommend it.
posted by bibliogrrl at 9:06 PM on January 26, 2011


No, no, no. I'm shuddering. I have had 4 root canals done, with anesthetic. Consider that your wife already has an abscess, which I think means that it will be even more painful than a regular root canal, because everything is all inflamed and infected in the gum. Hell no. Antibiotics are a no-no in pregnancy, so she needs to get this procedure done, because she can't take antibiotics and hold off on it until after the baby is born. Its great that your wife wants to try and keep things as drug free and natural as possible, but remember that the lidocaine is going to be applied locally, not systemically, so this is about as low-risk as it gets for taking medicine. Definitely encourage her to talk to her midwife or OB if that will help assuage her fears.
posted by Joh at 9:14 PM on January 26, 2011 [1 favorite]


No way. I think when I was pregnant I was much more sensitive to pain (and bad smells) and that this is a pretty common side effect of pregnancy. It's your body's way of keeping the fetus away from any potential hazard. It's as though all systems are on high alert for the duration so as to make sure that any and all threats can be identified and avoided. There's no reason for pregnant women to go around being martyrs to pain needlessly.
posted by otherwordlyglow at 9:17 PM on January 26, 2011


My mother has had all of her fillings done with no anaesthetic, but went for the full drug-up for her root canal.

Also, if your wife is planning on having an epidural during childbirth, she should be aware that lidocaine is used in the epi, too. I've given birth both with and without pain medication, and I would do an unmedicated labor a hundred times before I'd get a root canal with no pain medication.
posted by KathrynT at 9:18 PM on January 26, 2011


Antibiotics are a no-no in pregnancy, so she needs to get this procedure done, because she can't take antibiotics and hold off on it until after the baby is born.

Wait, what? I've taken antibiotics in both my pregnancies. Tetracycline is contraindicated, but there are lots of antibiotics that are perfectly safe in pregnancy. Check SafeFetus.org for more info.
posted by KathrynT at 9:20 PM on January 26, 2011 [3 favorites]


They are pulling out nerves. Like, exposing and damaging nerves is the point of the operation.

Just sayin'.

That said, she'll be fine with a local. She doesn't need to get knocked out for it (to the best of my knowledge, IAMYD). Just wanted to be clear on that. I can't promise that the local will completely remove all pain, but it certain makes it civil. And if she takes ibuprofin before the appointment (if that's pregnancy safe, I have no idea), it may help take down the swelling from the abcess and make things less painful.
posted by maryr at 9:24 PM on January 26, 2011


Oh god no. I shudder at the thought. It's not just the root pain, but the pain to the surrounding tissue, etc. Seriously, I'm getting anxious just thinking about this.

If she really, really doesn't want any drugs while pregnant, then wait until after the baby is born to get the root canal done. If the tooth gets so painful she doesn't want to wait any longer, then she's only beginning to experience how painful the procedure will be without the anesthetic.
posted by cgg at 9:25 PM on January 26, 2011


Maryr, ibuprofen is NOT pregnancy-safe. It's pretty much either tylenol or opiates.
posted by KathrynT at 9:25 PM on January 26, 2011


Would an ethical dentist even DO this? I think your wife would have a hard time finding a reputable dentist who would sign on for this.
posted by tristeza at 9:36 PM on January 26, 2011


Um, I had a root canal done without anesthetic when I was 14. I remember a little discomfort, but that was it. If I'm remembering correctly, they were doing the root canal because the tooth was already dead, so that might be why I experienced so little pain.
posted by shesbookish at 9:43 PM on January 26, 2011


Has she not seen Marathon Man? No, this is a terrible idea.
posted by nicwolff at 9:47 PM on January 26, 2011


Would an ethical dentist even DO this? I think your wife would have a hard time finding a reputable dentist who would sign on for this.

Um, I think a lot of people in this thread are getting very carried away and really don't understand the wide range of possible experiences with root canals. Because when my highly ethical, very well trained dentist drilled out the four dead nerves from my jaw with no anaesthetic I felt nothing except some mild pressure. If my gums weren't beaten up from ten previous visits I wouldn't have had any anaesthetic at all, and even then I only had a small amount around the gumline for part of the last visit. And yes, that tooth was infected and painful prior to the operation. This is not at all unusual or unethical, and a good proportion of root canals are done quite happily without any anaesthetic or other drugs.

None of us know if this is possible in this specific situation but registered, it's perfectly reasonable for your wife to discuss this with her dentist. If they agree that it's fine (and you really want them to agree very whole heartedly) then ignore the histrionics and go ahead.
posted by shelleycat at 9:52 PM on January 26, 2011


Talk to her dentist. Some of the people here think that if the nerve is dead and conditions might possibly be right it might be possible and not too traumatic.

I'm with the camp that worry that the pain trauma might be more damaging to the much-loved-soon-to-be-arrival than the anaesthetic might be.

Find out what anaesthetic will be used. Google what it says about the use of that anaesthetic during pregnancy.

What trimester is your wife in matters. A lot of drugs that cause birth defects are window of opportunity drugs. Ibuprofen for example is bad for a fetus if taken in sufficient quantity during a period when the liver is doing some essential growth and that is not most of the pregnancy. In fact a lot of drugs that pregnant women are told to avoid are only known to be harmful during a very short window of fetal development at the very beginning, usually before the woman knows if she is pregnant or not meaning within the first two weeks.

I know of a woman who had a serious allergy to painkillers and who had to have a c-section while conscious and without pain killers. They had to give her muscle relaxants so that she wouldn't damage her own body by tensing up. And they had to give her amnesiac drugs so that she couldn't remember the experience afterward or she would have been severely traumatized.

The thing to work accept is your wife's natural and instinctive fear of poisoning her baby with a foreign substance. Basically right here I would think that the thing to work on is her anxiety. I would suppose that being scared of the procedure and worried about her unborn has ended up focused on 'must-protect-dearly-awaited-at-all-costs' It's a good instinct. It's the one that causes a mother to rush up and grab the baby out of the claws and teeth of a predator.

You need to have a good idea how badly she needs the procedure, how badly she needs the anesthetic and what is best for baby. Is her dentist even willing to do the root canal without anesthetic? The dentist might not be. I suggest you get more information including is your wife willing to take antibiotics, and, if you or the dentist can show her that the painkiller has not been implicated in hurting unborn babies would she be willing to take the anesthetic. You have a very different situation if you can show her a page in the CPS that says, "considered 100% safe for use in pregnant women" and she still refuses to take it, than if she is a tough and brave woman willing to take on a substantial chunk of pain for someone she loves but who does not yet know what is the best thing to do, but is determined to do it.
posted by Jane the Brown at 9:58 PM on January 26, 2011 [3 favorites]


Wait, what? I've taken antibiotics in both my pregnancies. Tetracycline is contraindicated, but there are lots of antibiotics that are perfectly safe in pregnancy.
Oops, thanks for the catch KathrynT! The antibiotic I looked at during pregnancy (ironically for dental reasons) was contraindicated, but I didn't really look at any others to notice there were safe ones. Still, if I had to choose between taking safe for pregnancy lidocaine locally and sake for pregnancy antibiotics systemically, I know which one I would choose!
posted by Joh at 9:59 PM on January 26, 2011


When I had my last filling in one of my molars, which probably should have been a root canal, I had to be on film later in the morning and my face couldn't be numb. The dentist said that he could numb it without a lot of novocaine if I wanted, but it would hurt like hell going in. He put a couple of drops straight down beside the tooth between the tooth and the gum tissue and only that tooth was numb when he did it. I remember that he used a needle with a 90º angle to it. It hurt like a mother as he did it because I could feel the needle scrape, but from then on out it was fine.

Your wife may want to split the difference with the anesthetic and ask if hers could do the same thing - mine said that, if I remember properly, when you go straight down beside the tooth you don't have to flood as much anesthetic into the area around the nerve. If it is the volume she is worried about, that may be the answer.

I am not a dentist, much less your dentist, but have to have a number of things done a year and the idea of going through a root canal without any anesthetic makes my teeth hurt thinking about it.
posted by Tchad at 10:00 PM on January 26, 2011


I had a root canal when I was eight months pregnant, with anesthetic, and my unborn baby was obviously responsive to my anxiety during the procedure. Even with drugs a root canal can be very painful, and when it got especially bad for me, he would struggle in response. It's hard to explain, but his movements were completely different from at any other time during my pregnancy. I still regret putting him through that stress. I would strongly advise your wife not to attempt this.
posted by milk white peacock at 10:15 PM on January 26, 2011 [3 favorites]


If it's any help to your wife, I'd point out that it's not uncommon for women to have to go under general anaesthetic while pregnant, for surgery on uterine fibroids or whatever. I did it at 6 weeks, another woman in my mothers' group did it at 13 weeks. Our babies seem perfectly fine. Of course, I spent the rest of my pregnancy asking every doctor I encountered whether it may have harmed the fetus, but they were always totally unconcerned about it.
posted by 8k at 10:31 PM on January 26, 2011


No, no, no, no, no. She has an abscess - that's a whole other thing than the dead-nerves root canals others have addressed. I've had eleven root canals, of all varieties - uneventful to horrifying. Mostly uneventful.

But. The last one was on a tooth that had abscessed. When a tooth is abscessed, something in the pus (acid or something, sciency types, help??) can neutralize the anesthetic. My endodonist warned me that this could happen, and gave me a larger than usual dose of the stuff, and toward the end of the procedure it did happen. And those were probably the most painful five minutes or so of my life.

A root canal can take an hour and a half or so. Those five minutes seemed like forever - I absolutely cannot imagine subjecting myself to that sort of pain for a extended period of time. Not to mention subjecting an unborn baby to the stress of it.
posted by chez shoes at 10:36 PM on January 26, 2011


So: your wife is probably taking prenatal vitamins, right? She's going outside and breathing the air? She's drinking tapwater? She's using shampoo and toothpaste with sulfates and fluoride? She's eating commercially-produced foodstuffs?

What I'm getting at is this:

Except for people who live on organic farms and wear burlap sacks (made from burlap they grew themselves), we're all more or less constantly exposed to various chemicals, toxins and other less-than-desirable stuff. I can totally understand her concern for the wee one - I'm a mom - but honestly, a local anesthetic is one of the LEAST-troublesome things her body is liable to come in contact with while she's gestating.

For whatever reason, pregnant women are often bombarded with dire warnings from the moment the two pink lines appear. Numerous sources assure them that EVERYTHING is potentially harmful or fatal to their fetus, and ALL OF IT IS TRYING TO GET INTO THEIR UTERUS RIGHT NOW AAAAAAAGH. I hate pregnancy fear-mongering... it's bad for moms and potentially bad for babies.

You wife should get a fully-medicated root canal. And then, when her mouth is all healed up, she should have some Brie and a little glass of wine as a symbolic SCREW YOU to our culture's campaign of terrifying pregnant ladies.
posted by julthumbscrew at 10:42 PM on January 26, 2011 [22 favorites]


When I saw that there were forty answers before I had gotten to this thread I had considered passing, but, as there seem to be a wide range of responses, and none so far from a dentist, I figured I'd weigh in.
An abscessed tooth, or one about to abscess, creates a condition in the body which far outweighs any negative side effects of common antibiotics or local anesthetics (it's the epi that we are concerned about btw, and that can be safely minimized or even eliminated).
Treatment during the second trimester is ideal, because most of the critical development is finished and baby is mostly in the growth phase of things.
The tooth (or nerve in this case) may be alive, partially alive, totally dead, sensitive, not sensitive or anything across the very subjective range of pain awareness.
I prefer my patients to be relaxed during the procedure. A numb patient will be more relaxed than one who is not, but it is not unheard of to do root canal without anesthetic. Patients who are not numb also tend to move involuntarily, in response to , or anticipation of, things that they feel. Not just the drill either, the placement of the dental dam, rinse with water, pressure on other teeth or tissue in the area.
If she were my patient I would explain to her that the risk of a small amount of local is very small. I would also tell her that we could start without anesthetic and add at any time that she would prefer.
Successful completion of the treatment and resolution of the problem is the goal of the procedure, not any other agenda.
Also, a lateral incisor almost always has but a single canal...this procedure should not, barring unforseen complications, take much time, nor much anesthetic, in any case. HMMV.
Good luck to your wife and may you have a beautiful healthy baby! cheers
posted by OHenryPacey at 11:43 PM on January 26, 2011 [9 favorites]


Consider that your wife already has an abscess, which I think means that it will be even more painful than a regular root canal, because everything is all inflamed and infected in the gum.

Exactly. I had several root canals done a few years ago, and the ones where there was an abscess were exhausting and uncomfortable even if pain-free thanks to perfectly delivered anesthetic, in constant little dosages (and a fantastic friendly dentist and assistants that made me feel totally relaxed).

The procedure is quite long, 1 to 2 hours. You may also need painkillers to take afterwards for when the anesthetic is wearing off.

We're not talking sudden unexpected pain (paradoxically sometimes even the most intense pain of say broken bones or cut flesh is manageable at the moment, I guess because it is not something you expected and the body reacts with shock and adrenaline), this is a planned procedure, the brain will know it can expect pain any second, it'll be a constant state of tension.

Could be dangerous too - if you move around suddenly because of pain you're making it more complicated for the dentist to do their work.

You say "she knows that lidocaine is considered safe in pregnancy" - then talk to her about her fear, it's exaggerated anxiety, she needs to relax about this. I'm sure the dentist has worked on pregnant patients before, and will be happy to talk to her in detail about how it really is fine and safe to take the anesthetic, in the relatively small and *localized* doses one needs for dental procedures (as compared to anesthetic for other kinds of surgery, for instance).

You wife should get a fully-medicated root canal. And then, when her mouth is all healed up, she should have some Brie and a little glass of wine as a symbolic SCREW YOU to our culture's campaign of terrifying pregnant ladies.

Yes, this, too.
posted by bitteschoen at 1:00 AM on January 27, 2011 [1 favorite]


As for going without laughing gas, I say yes. I had one without laughing gas, I hate that stuff anyways. But without anesthetic at all? Oh hell no. I would not think that a few shots in the mouth would be harmful to a fetus.

In my experience, once he got rid of the (extremely irritated and painful) nerve, the rest of the procedure wasn't painful at all thanks to the anesthetic. I went to my first Chicago Mefi meetup the very next day, where I experienced one very painful twinge (just sitting in the waiting area of the pizza place we were at, not chewing or talking or anything) that lasted approximately 5 seconds, and some very mild residual pain from that twinge that lasted an hour or two. That was the only Vicodin I really needed to take.

One thing to warn you of: The endodontist put one of those wonderful rubber blocks in my mouth to hold it open. This allowed me to relax my jaw while keeping it open enough for him to work. When I went back to my regular dentist to get the crown, he didn't use one of the blocks, and my jaw got very sore. (It was my farthest back top tooth.) I should have asked for one, in retrospect.
posted by IndigoRain at 1:45 AM on January 27, 2011


For whatever it's worth, I had a tooth removed when pregnant, with a local, and I was fine, and the baby was/is fine. Coming to terms with some compromises is going to be necessary throughout the pregnancy and parenting -- there are a lot of things you can't control and the scheduling of when you need a root canal is one of them.
posted by A Terrible Llama at 2:02 AM on January 27, 2011 [1 favorite]


I've had the root drilled out on a tooth without anaesthetic. It was fine. I can still remember the dentist waving the drill in front of me to show me the goo from the abscess after he'd drilled it out :)

If the nerve is dead (with an abscess it almost certainly is) then the only pain from the root canal comes from the increased pressure on the abscess during the drilling. If you can cope with that then you can cope with having a root canal without any anaesthetic.

Note that it's much quicker & easier to do a root canal on a front tooth than a molar. Molars take ages supposedly, but front teeth only have one root and are far more accessible. I think there was only 5 minutes or so of actual drilling.
posted by pharm at 2:10 AM on January 27, 2011


Also, as the real actual dentist points out above, there's nothing stopping you starting without anaesthetic and stopping to have some in the middle if it turns out to be painful.
posted by pharm at 2:14 AM on January 27, 2011


It's possible, but extremely unlikely.

This isn't like the kind of pain you can intellectualize, like the slow, steady pain of getting kicked in the nuts, or the searing, all-over pain of a chemical burn, or the out-of-my-mind-but-holding-it-together pain of cutting your own arm off. Those are all pains you can understand and plan for.
posted by Civil_Disobedient at 2:26 AM on January 27, 2011


When I asked my endodontist if she could do my root canal without anesthetic she said that they never do that, because she needs to be very precise and if I am in pain and therefore unable to keep my mouth perfectly still it may screw up the procedure. That sounded logical to me.

I do agree with everything shellycat says: do ask the dentist to get a recommendation based on her specific situation.
posted by davar at 2:51 AM on January 27, 2011


As for going without laughing gas, I say yes.

While local anesthetics (and there are a number of choices there; the dentist may use something other than lidocaine) are safe during pregnancy, nitrous oxide is not; see my answer here for more details. Your dentist should know this and will probably not offer it as an option. For many of the drugs mentioned in this thread there are specific reasons they are contraindicated; tetracycline damages the enamel of developing teeth, staining them brown. NSAIDs like ibuprofen and aspirin are contraindicated because they can close the ductus arteriosus, a crucial part of the fetal circulation. In the past there was concern that drugs like Valium might be associated with cleft palate and similar malformations, but that has not stood the test of time; more info here. There is no comparable concern with local anesthetics. Your wife should talk to her obstetrician if she is concerned; this is the sort of anxiety they deal with all of the time.
posted by TedW at 4:24 AM on January 27, 2011 [2 favorites]


I meant to add: If she has an abscess, that can be a serious condition if left untreated and a bigger risk to the fetus than the root canal would be.
posted by TedW at 4:26 AM on January 27, 2011 [1 favorite]


My grandma is a tiny, 80-pound, cotton-haired wisp of a woman, and this is how she gets her root canals. She has never had anesthetic for a dental procedure.

So, I suppose it is possible, but the potential unpleasantness is nearly unfathomable.
posted by easy, lucky, free at 4:30 AM on January 27, 2011


I would be quite surprised if a dentist would be willing to do this, actually.
posted by odinsdream at 5:59 AM on January 27, 2011


Lidocaine does not work systemically when used properly as a local anesthetic (as should be the case here). Your wife's commitment to a healthy pregnancy is commendable, but she is going overboard here, there is NO point in avoiding a local anesthetic, ESPECIALLY when pregnant - the stress hormones and overall major pain/discomfort she would experience are going to be far, far worse for the baby than a local anesthetic, especially since the local anesthetic won't affect the baby at all, but WILL make the difference between a tolerable dental experience and an intolerable one for your wife, and her comfort levels most definitely will affect the baby. You and your wife should discuss this with her ObGyn, because she is not making anything like an informed decision here.
posted by biscotti at 6:25 AM on January 27, 2011


I've had a Root Canal - Trust me on this - use anesthetic ...
posted by mark25 at 6:58 AM on January 27, 2011


So, I suppose it is possible, but the potential unpleasantness is nearly unfathomable.

Like I said odinsdream, I've personally had a root canal without anaesthetic and it was fine. Not what I'd call an enjoyable experience, but what dental procedure is? Clearly, this is something that varies from case to case.
posted by pharm at 7:05 AM on January 27, 2011


holy mother of god DON'T DO IT!!!

I am sitting here recovering from my own (drugged up) procedure. I imagine that an unmedicated root canal is akin to slowly being dipped in and out of the firy pits of hell, while God laughs at you.
posted by pintapicasso at 7:12 AM on January 27, 2011


Basically, I did this. Here's the primer on red heads:

* For everything other than thermal pain, we feel it less than most folks.
* Anesthetics don't work as well...
* Which is ok because half of us have bad reactions with them and can't take them anyway.

The epinephrine used in most local anesthetics, to help them stay in the area, really screws with me (chemically induced panic attack x10) so I get anesthetics without it. They have to use a lot for it to do any good and usually dentists don't. When I had a root canal they used 17 of those little needle vials of Novocain and it was still pure hell, and that's with me feeling less pain than most folks!

I lucked out with my current dentist since her dad is a fellow red head with the same problem. She doesn't bother with the regular little needles and grabs one of those old school ones you see in horror movies with the curled part for the fingers and injects the whole thing, and lets it sit for 30 minutes before doing anything. That was for a cavity filling, and it was the first painless one I've had.

Point is, if she's a redhead or the nerve is dead, *maybe*, otherwise forget it. At least it's a local anesthetic with the epi and not systemic.
posted by jwells at 8:02 AM on January 27, 2011 [1 favorite]


I had a root canal done when I was 22 weeks pregnant. It was unpleasant. I can only imagine how much more unpleasant it would have been had I not been medicated. I did consult with my OB about it beforehand, he made some specific recommendations about sedation & pain meds.
posted by pinky at 8:16 AM on January 27, 2011 [1 favorite]


I had a root canal when I was 13, and the tooth had to be pulled when I was about three months pregnant at 22. I just got local anesthesia for the pulling. What really sucked was pain management afterwards, because I avoided any narcotics. My child is healthy, with no developmental issues.

Apparently there's an adage, "A tooth for every child," because the calcium needed to build a baby's bones has to come from somewhere, and that includes the mother's teeth and bones. This tooth is likely to plague her through the course of her pregnancy if she doesn't do it now.
posted by frecklefaerie at 8:22 AM on January 27, 2011


I've had a couple root canals. No anesthetic? No way.

Maybe it depends on the person, though. I found this random website that says:

How Painful Is a Root Canal?

Root canal procedures have the reputation of being painful. Actually, most people report that the procedure itself is no more painful than having a filling placed.

So, if she can have fillings without anesthetic maybe she's one of the "most people" referenced there. Personally I can't imagine that I could have done it, but all of mine were root canal + crown, so there was a lot more tooth removal going on.
posted by chazlarson at 11:46 PM on January 26 [+] [!]


I'm pretty sure that they mean it's no more painful than a filling when you have anesthesia, and I would agree with that. The root canals that I've had with full Lidocaine injections were about as bad as getting a filling in, so just somewhat uncomfortable. I would never dream of getting one without anesthesia.
posted by Who_Am_I at 8:58 AM on January 27, 2011


Nthing that she _needs_ to have it done now. Periodontal disease is a significant risk factor for premature birth -- according to my dentist, higher than the risk of smoking and alcohol abuse combined.
posted by KathrynT at 9:24 AM on January 27, 2011


Nunn M, DDS, "Essential Dental Treatment (EDT) in Pregnant Women during the Second Trimester Is Not Associated with an Increased Risk of Serious Adverse Pregnancy Outcomes or Medical Events"

No significant association was found between EDT and any adverse medical or pregnancy outcome. Further analysis included stratification of EDT by periodontal treatment group as well as evaluation of the effect of topical anesthetic and local anesthetic on adverse pregnancy outcomes. Neither topical anesthetic alone nor local anesthetic was associated with an increase in any adverse medical or pregnancy outcomes (P > .10 for all adverse medical and pregnancy outcomes).

Although the general consensus of obstetricians is that routine dental care in pregnant women poses minimal risk after 8 weeks’ gestation, dentists and pregnant women often defer necessary dental treatment until after delivery. To our knowledge, this study is the first to examine adverse medical and pregnancy outcomes associated with EDT during pregnancy. However, following landmark studies by Offenbacher et al,[4] and [5] which showed a significant association between periodontal disease and an increased risk for premature birth and low birth weight, several clinical trials were launched to investigate whether treatment of periodontal disease in pregnant women could reduce the risk of preterm birth.
posted by Comrade_robot at 9:43 AM on January 27, 2011


The increased stress of having oral surgery without anesthetic on the mother is more likely to be bad for the fetus than lidocaine.

(Also, if you don't trust the dentist to know that lidocaine is safe for the fetus, it seems weird you'd trust him to do the root canal.)
posted by spaltavian at 10:20 AM on January 27, 2011


I wouldn't at all. However, despite only having auburn hair, I seem to react like a true redhead at the dentist. When get a procedure done, my body just gobbles up the anesthetic like candy. Even for a cavity, I have to get re-shot up 2 or 3 times. So for a root canal? I want to be numbed to the gills.

(And I'm glad that people are starting to understand that people process anesthetic in different ways. I had a dentist as a child who didn't understand this, numbed me 10 minutes before the cavity filling, and didn't believe me when I told him that it had already worn off when the drilling and filling started. Screw you, Dr. Colby of Madison, WI!)
posted by spinifex23 at 10:39 AM on January 27, 2011 [1 favorite]


I'm pretty sure that they mean it's no more painful than a filling when you have anesthesia.

I've had fillings without anasthesia too. It's really not that bad, unless the filling gets close to the nerve, in which case it's a bit uncomfortable.

This really is one of those "Your Mileage May Vary" things: for even before you get to differences in physiology, different people process the same physical stimuli in different ways: what's intolerably painful for one person is merely somewhat uncomfortable for somebody else. That doesn't make the former's pain any less real though: Just because it's "all in your head" doesn't mean that it's not really hurting.
posted by pharm at 12:53 PM on January 27, 2011


i wouldn't recommend it either ... but on a couple of occasions i've had dental surgery and the novacaine just wasn't working. it sucked, but we all agreed to just get on with it as quickly as possible. i think the dentist felt about as bad as i did. for more than an hour, i felt everything. they probably gave me 5 or 6 more shots - nothing.

it sucked, but i got through it. the only saving grace was that at first i was numb. i imagine the initial shock of pain being much worse than "oh shit, i can feel this now." maybe the dentist can just use a really small amount to buffer the initial shock?
posted by crankyrogalsky at 2:17 PM on January 27, 2011


Anecdotal:

I recently had 6 teeth pulled. Before the procedure started, I asked the Oral Surgeon "just out of curiosity, how bad would this hurt if you were to do it without anesthetic?". He said "worse than giving birth", and his female assistant nodded.

I imagine a root canal is as bad or worse than having teeth pulled.
posted by Vorteks at 8:47 AM on January 28, 2011


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