How to deal with unbearable teeth pain now vs unbearable dentist pain
February 12, 2021 9:54 AM   Subscribe

I have another urgent problem that I don't know how to solve. I developed a bad tooth ache which is probably another cavity as I am prone to them. This thing hurts like a 6 or 7 which is highly unusual for me. But if I go to the dentist they will stick novocaine with adrenalie into my gums and that will make me start crying so unstoppably that the dentist can't do their job. My dentist does sedation, but I am still paying off the last round of that and I can't afford another one right now. I don't know what to do.

Here is some background with novocaine + adrenaline. I guess other people experience it very differently from me, but for me, I get a full blown panic attack that I can't stop.

My issues with novocane + or - adrenaline go way back. I used to be able to stoically hold in the tears, but the sympathetic nervous system wants what it wants, and nobody has conscious control over that. Also I am a redhead which has been documented to indicate that my pain relief needs are different, and novocain for me doesn't block the pain, no matter how much they put in there, and especially not if there's adrenaline in it. So it hurts when they put the needle in, the numbing feels intensely unpleasant, and I can still feel everything they're doing in there, plus my system is all keyed up to run the fuck away now. I will start crying pretty much immediately and there is no amount of deep breathing that will convince my system to remain in a situation it has every reason to believe is dangerous (adrenaline! sharp pains! 37 years of memories!) I have a feeling that at this point my system is too sensitive and even if they left the adrenaline out I would still just start crying at some point & make the whole thing a waste of time.

I know this in detail because every time I start at a new dentist they make me give it a try just to see for themselves and then they're like "OK I get it, let's do sedation". Which, I know and they know isn't ideal, and shouldn't be used very often, especially because it's expensive and I have to take out a loan and pay it off each time. But it's either that or nothing, it seems like.

I don't know anyone who struggles with this and I literally don't know what to do. Does anyone have any advice?
posted by bleep to Health & Fitness (23 answers total) 3 users marked this as a favorite
Response by poster: Oh I forgot to mention I tried xanax and everything leading up to sedation, it doesn't have any effect.
posted by bleep at 9:58 AM on February 12 [1 favorite]

Can you get nitrous first? Novocain takes a long time to take effect on me and wears off very fast, often faster then the procedure I need. We found that if they give me nitrous first and keep it up during the work I stay completely calm when they give me novocain and they can get in faster. It adds about $100 to the cost of the procedure. I should make clear it doesn’t stop the pain, it just makes me absolutely not care about it. The Novocain sort of blocks the pain for me, at least enough they have to do something major for me to feel around it.
posted by lepus at 10:03 AM on February 12 [8 favorites]

This is absolutely a thing, a friend of mine has the same issue, and there are solutions. Call ahead, tell them you have an adverse reaction to the epinephrine, and make sure they have the alternative. (It's not weird! It's a reaction some folks have, that's all.) Seconding nitrous as a backup, and you don't ever need to agree to "just try it" - you have an adverse reaction, that's it, that's the end of the sentence.

(Xanax might well help manage the trauma reaction if you don't then have the chemical adverse reaction on top of it.)
posted by restless_nomad at 10:06 AM on February 12 [5 favorites]

Response by poster: Not the threadsit but I am starting to cry just thinking about this.
posted by bleep at 10:09 AM on February 12

Do you have someone who can call and talk to them on your behalf*/on a conference call, to find out what your alternate options are and make arrangements? My anxiety and trauma are too intense for me to do this, having someone else concierge for me is the only way for me.

*I generally find that as long as they are explaining the issue and asking general treatment questions this is fine. They don't need any personally sensitive information about you from the dentist to have this conversation on your behalf. It also helps really really really drive home to the staff that this is a code red anxiety/trauma situation that needs the utmost sensitive handling.

There are alternatives; this is a known issue and there's been some decent advances.
posted by Lyn Never at 10:21 AM on February 12 [7 favorites]

Aw, I'm sorry bleep. This happens to a friend of mine. She gets them to prescribe her a sedative prior (Xanax didn't work for you but there should be others that you can try). She also listens to soothing music to block out dentist noises and calm her system, and wears warm and cozy clothes to help with the panic shivering.

I have a similar but less severe reaction to the novo than you, but young DTMA and I both have intense dental anxiety and nitrous oxide has helped both of us through procedures fwiw.

Lyn Never's suggestion to have an advocate explain the situation and explore options is great! If you don't end up feeling okay about any of the options, you could maybe consider setting up a go fund me (or similar, not sure what the options are) to cover the cost of sedation. I would totally chip in so pls memail me if you do!
posted by DTMFA at 10:52 AM on February 12 [1 favorite]

have you tried nitrous? my dental anxiety is not as bad as yours but I will have no truck with work done solely under local. Nitrous every time. I just pay for it.
posted by fingersandtoes at 10:53 AM on February 12

I have a similar novacaine/adrenelin/crying problem. Ask your dentist for Halcion. It makes things so much easier. You'll need someone to drive you to and from your appointment, but it's minimal (conscious) sedation. Its a small pill, so its got to be significantly cheaper than sedation dentistry. You're still able to react to commands and communicate, but you really wont give a crap about anything, and you might even be relaxed enough to fall asleep in the chair. (I completely slept through an extraction, for example) It also has some amnesia effects, so even if the whole process is tramautic, you wont remember it after so there's no lingering anxiety. Halcion doesn't have any pain-killing abilities, but it does wonders to remove the anxiety around potential pain. Youll still need novacaine, but without the anxiety it works so much better (at least for me). You'll probably have to sleep it off for a couple hours after the appointment as well.
posted by cgg at 10:54 AM on February 12 [3 favorites]

Is it possible to get a higher dose of a sedative prior? I also react badly to numbing and I just don't do any sort of invasive dental work without enough sedative in my system that I'm ready to fall asleep in the chair and require someone to drive me to and from the appointment. I don't think my reaction is as bad as yours, but mine is notable - so bad that when a crown popped off ahead of a dental appointment recently, i insisted on white knuckling it when they put it back on rather than being numbed because I'd rather have a short extreme pain (and omg it did hurt a LOT) than deal with what would happen if they tried to numb me without something in my system.

I've also found that some dentists are just way better at numbing than others - I've had two root canals from the same dude and while I did take a sedative before hand he also just seems to have a special touch for it - I don't know if he uses a different type of medication or a different method but I've never felt a touch of pain when he's worked on me, which I find weird considering its a root canal. Maybe the issue is also the dentist?

One last note: I know money is a concern but if there is really no other alternative and you have to get put under, I'd recommend going for it now and trouble-shooting the financial element later. If this is a serious and acute thing it will only get more expensive if it's ignored and allowed to simmer.

Best of luck and I am so sorry this is happening to you!
posted by amycup at 11:01 AM on February 12 [3 favorites]

It sounds like you have a solution for the dental work part -sedation, but not a solution for paying for it? Usual solution suggested are asking about a payment plan, looking for a dental school near by or I would also ask friends and family or even get a bank loan. All of these option suck in some way, but as someone with crappy teeth who has shelled out wayyyyyy too much in dental costs for my 32 years, the one thing I know if that putting off pain like that with only cause more pain AND money to get it fixed later.
posted by raccoon409 at 11:07 AM on February 12 [1 favorite]

I'm so sorry you're going through this. Have you contacted your most recent dentist, the one you're currently paying off via a payment plan? They know your medical history and needs, and have been willing to work with you thus far. See what they can do for you. [Seriously -- never be apologetic that this is care you need, or that you're still paying off a previous procedure. In many places, dentists are seeing fewer patients right now and want your business.]
posted by Iris Gambol at 11:12 AM on February 12 [1 favorite]

Could you try it without novocaine? I have had a lot of dental work done without novocaine or any other painkiller, not for your particular reason but I was definitely afraid of needles and sometimes fainted when getting shots. I have finally gotten over that, and for the last few decades I've gotten novocaine, but I can tell you that the pain of having your cavity drilled out without novocaine is, at worst, an 8. It's doable. It only hurts when it's happening, and stops as soon as they're done drilling. You won't be the only person in your dentist's office who turns it down. You're already at 6 or 7, 8 is not much worse.
posted by beagle at 11:58 AM on February 12 [1 favorite]

I know this in detail because every time I start at a new dentist they make me give it a try just to see for themselves and then they're like "OK I get it, let's do sedation".

This is so not okay and I'm sorry you've gone through this.

I've had panic attacks in the dentist chair because of novocaine/epinephrine injections too. It's awful. And I'm cavity-prone so this is a regular challenge. I mostly solve it though by telling the dentist I have a history of bad reactions to epinephrine, and to please use a numbing agent that doesn't include it. They sometimes grumble a tiny bit, as the novocaine combo apparently reduces bleeding and lasts longer which makes it more convenient for them, but they always accommodate me. I am very sensitive to any hints of adrenaline or panic feelings and these alternative numbing agents are totally okay for me. I do have to make sure to let them know the moment pressure starts hinting at becoming pain so they can give me another shot, but then it's all good. AFAIK this has never cost me any more money. I'm in the USA and have usually paid out of pocket.
posted by scrubjay at 12:04 PM on February 12 [7 favorites]

Second Beagle. It's only a filling? I have a pact with my dentist to just get on with it, and be finished in ten minutes, rather than giving me novocaine and a thick tongue for an hour afterwards. When I was a kid in the 60s there were no analgesic options and slower drills but we got ice-cream afterwards.
posted by BobTheScientist at 12:48 PM on February 12 [1 favorite]

If I have Novocain without epinephrine it takes a lot longer to numb but I don’t have the anxiety. Your dentist should be able to do that. On preview, what scrubjay said.
posted by Peach at 12:57 PM on February 12 [2 favorites]

Nitrous Nitrous Nitrous. also setup a gofund me and I am sure the community and/or friends and family can help out with the costs. or talk to the dentist about sliding scale?
posted by evilmonk at 1:23 PM on February 12 [2 favorites]

They do have local anesthetic that is not in an epinephrine carrier. It takes longer to work. Ask for that.
posted by shadygrove at 1:58 PM on February 12

I don't know if this will help with your immediate pain, and I am NOT a doctor, dentist, nurse or anything medical, but this IS a true story (but ***WARNING*** possible triggers ahead):

For reasons I once had to have my gums cut back (due to gingival hyperplasia). This involved them doing it in 4 sessions, a quarter of my teeth at a time, and when they stitch the gums they do it between the teeth. The dentist/sadist then told me that when I got home I was supposed to probe in between each tooth near each stitch with a rubber stimulator, twice a day). Tears were running off my chin to the point where I could barely see. So I went to the drug store and got Anbesol or Orajel (I forget which) which took the process from being agony to just very unpleasant). So for temporary relief you might want to consider that, but don't forget, there's definitely no such thing as a free lunch, especially with your teeth. Again, this is just one person's experience, not medical advice.
posted by forthright at 2:33 PM on February 12 [1 favorite]

My advice would be to find yourself a dentist you trust with this. There are lots of ways to manage dental anxiety and acute dental pain. The fact that you are willing to endure pain at a 6 0r 7 level in order to avoid the very short term (2 or three minutes in nearly all cases) effects of epi speaks to how your anxiety has been managed in the past.

With a dentist you trust you should have a conversation about nitrous. some patients only take nitrous for the injection, especially if it's an out of pocket expense.
You should talk about premedication with a mild sedative. there are several, and the conversation should cover them.
You should have a conversation about local anesthetics. I keep no fewer than 6 different preparations in my office. epinephrine is present in only some of them. none of them are called novocain. If you are in the US I would be shocked if you had received actual novocain in the past 30 years, as there are just other products that patients aren't allergic to. I use septocaine more and more and very few patients with the redhead gene have trouble getting numb when i use it. it's not for every case though.

Anxiety over the local anesthetic injection, the epi rush and the lingering feeling of numbness are all common, and you will want to work with a dentist who is willing to have these conversations with you.

You are already living with pain, now you need a strategy to live with the process of eliminating the pain. Find a dentist you trust and you can move forward in better health.
posted by OHenryPacey at 3:50 PM on February 12 [3 favorites]

Response by poster: I just want to clarify I'm not talking about the mental health kind of anxiety. I don't feel anxious about going to the dentist or speaking to them or sitting in the chair or anything. I don't feel anything at all until my brain decides it's seen enough and tries to get me out of a situation it doesn't like. I'm talking about a bodily process that I can't control. Just trying to trick my conscious brain into not caring about anything doesn't work, because it already does not care. I can't trick a part of my brain I have no access to.
posted by bleep at 3:57 PM on February 12 [3 favorites]

I also have problems with novocaine so I have all dental work using only nitrous (no sedation either) for over 40 years. I even had a root canal done with nitrous only. You can feel that there is pain, but you just don't care. Work out hand signals with the dentist to increase or decease the gas as needed. Another advantage is no numbness after the procedure and no residual nerve pain in the injection site.
posted by a humble nudibranch at 11:02 PM on February 12

So sorry that you are hurting bleep. When you call your dentist to see if he has the training and equipment mentioned above, also tell him that you need relief from pain NOW, and will continue to pay down your growing debt. You really can't do much else; you must end the problem to get to the solution.
posted by Cranberry at 12:51 AM on February 13 [1 favorite]

I am absolutely okay with pain and have put up with all kinds of painful things (I'm a sabre fencer and a broken blade went into my hand and through it into my wrist once and all I said was "Ah" so the coach thought I was celebrating a nice touch), but the normal anesthetic makes me weird out with anxiety and it's worse than mainlining caffeine. As OHenryPacey says, it's the epi rush.
posted by Peach at 8:11 AM on February 13

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