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Medical Forum / General / Dentistry / August 2005"Hot" tooth - Myths or Reality?
I came across the following posts on a dental board and was wondering what the general take on this subject is: -------------------------- MaryAnn posted 07-27-2005 10:09 PM I've heard stories of people who have had root canals on abcessed teeth that required up to 20 shots to barely get numb. I've also heard that dentists don't perform root canals until the infection clears up because the anesthesia won't work at all. Why is that? . Jeffrey L. Wissot, DDS posted 07-28-2005 07:07 PM Popular myths. RTCs can, and should be initiated despite acute symptoms for a safer, more predictable course of treatment. ---------------------------- Myths or reality? (I realize that the 20 shots statement is a bit of an exaggeration, but generally speaking?). > I came across the following posts on a dental board and was wondering > what the general take on this subject is: [quoted text clipped - 16 lines] > Myths or reality? (I realize that the 20 shots statement is a bit of an > exaggeration, but generally speaking?). By the time the tooth has abscessed fully, anesthesia is usually not too big a problem. The "hot" tooth is one with an acutely inflamed (but still vital) pulp. Some of these are very tough to numb conventionally, but if I must enter a tooth like this an injection directly into the pulp hurts like the devil but usually achieves instant anesthesia. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> I came across the following posts on a dental board and was wondering >> what the general take on this subject is: [quoted text clipped - 25 lines] > > Steve Maybe this will shed some light on the subject: http://www.nti-tss.com/mxv/53.html I had a bunch of trouble with my infected tooth. The root canal was miserable. The endodontist said it was cause the infection is alkaline, and the caine is acidic, or maybe the other way around. SignatureChristopher A. Young Learn more about Jesus www.lds.org www.mormons.com I came across the following posts on a dental board and was wondering what the general take on this subject is: -------------------------- MaryAnn posted 07-27-2005 10:09 PM I've heard stories of people who have had root canals on abcessed teeth that required up to 20 shots to barely get numb. I've also heard that dentists don't perform root canals until the infection clears up because the anesthesia won't work at all. Why is that? . Jeffrey L. Wissot, DDS posted 07-28-2005 07:07 PM Popular myths. RTCs can, and should be initiated despite acute symptoms for a safer, more predictable course of treatment. ---------------------------- Myths or reality? (I realize that the 20 shots statement is a bit of an exaggeration, but generally speaking?). >I had a bunch of trouble with my infected tooth. The root canal was > miserable. > > The endodontist said it was cause the infection is alkaline, and the caine > is acidic, or maybe the other way around. They're both acidic. An acidic anesthetic doesn't work well in an acidic atmosphere. Are you sure? Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >>I had a bunch of trouble with my infected tooth. The root canal was [quoted text clipped - 6 lines] > They're both acidic. An acidic anesthetic doesn't work well in an acidic > atmosphere. Hey Dr. Steve, I had suggested earlier that perhaps what Dr. Boyd has to say about patients that don't get numb might be worth considering. But had no response. Maybe this will shed some light on the subject: http://www.nti-tss.com/mxv/53.html Ciao, Tim > Are you sure? > [quoted text clipped - 7 lines] >> They're both acidic. An acidic anesthetic doesn't work well in an acidic >> atmosphere. I would venture to suggest that the anesthetic is not going to diffuse through a muscle which is in spasm very well, either. I don't want to be branded as a kook, but I seriously believe that the vast majority of what we treat is mediated or directly caused by parafunctional muscle activity. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > Hey Dr. Steve, > [quoted text clipped - 20 lines] >>> They're both acidic. An acidic anesthetic doesn't work well in an >>> acidic atmosphere. I don't believe that to be kooky thinking either. I think you have plenty of NTI guys who think just like you. Thanx for the response. Tim P.S. Hope you're having a great summer. >I would venture to suggest that the anesthetic is not going to diffuse >through a muscle which is in spasm very well, either. [quoted text clipped - 27 lines] >>>> They're both acidic. An acidic anesthetic doesn't work well in an >>>> acidic atmosphere. >I don't believe that to be kooky thinking either. I think you have plenty >of NTI guys who think just like you. [quoted text clipped - 3 lines] > Tim > P.S. Hope you're having a great summer. A hot summer this year. Another year without enough rain. The Great Lakes are down about 3-4 feet. >>I don't believe that to be kooky thinking either. I think you have plenty >>of NTI guys who think just like you. [quoted text clipped - 6 lines] > A hot summer this year. Another year without enough rain. The Great > Lakes are down about 3-4 feet. does that translate to good fishing? I wouldn't know. My idea of fishing is pointing to one inside a glass case. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >>>I don't believe that to be kooky thinking either. I think you have [quoted text clipped - 9 lines] > > does that translate to good fishing? Oh thats quite funny. >I wouldn't know. My idea of fishing is pointing to one inside a glass >case. [quoted text clipped - 11 lines] >> >> does that translate to good fishing? > Are you sure? Yes...sort of. Local anesthetics have pH's of approximately 7.9...making them a weak base. But hydrogen ions are added to make them acidic: " Local anesthetics are weak bases with pKa in the range of 7.9. This of course means that at a pH of 7.9 a population of local anesthetic molecules is equally divided between a charged and uncharged state. In order to keep the local anesthetic molecules in solution, hydrogen ions are added (that is, the solution is made acidic) or said another way, the pH of the solution is lowered. If the local anesthetic solution is made with epinephrine, the pH is made even lower. Lets turn our discussion now to a consideration of nerves. As most junior high school students know, nerve membranes are a lipid bilayer with protein channels. Local anesthetics act in the sodium channel, entering from the internal aspect. Now you may have noticed a bit of a problem. Positively charged local anesthetic molecules soluble in an aqueous solution will have trouble passing through a lipid membrane. This problem is overcome when the tissue surrounding the nerve accepts (or buffers) the hydrogen ion and the uncharged molecules are then free to pass through the axonal membrane. Once in the cell, the molecules must be recharged before they can effect a block of the sodium channel. OK, so what? What difference does this make clinically? Local anesthetics will not work in tissue that is unable to buffer the excess hydrogen ions. This is why local anesthetics injected into the acidic environment of an abscess will not cause numbness. Occasionally anesthesiologists will add NaHCO3 to local anesthetic to speed the onset of the drug effect. This additive is not a powerful enough base to overcome the acidity in abscessed tissue, however. " http://www.anesthesia.wisc.edu/med3/localanes/localhandout.html Are the hydrogen ions added to change the pH or to change the polar charge? Or, does that question make any sense? Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >> Are you sure? [quoted text clipped - 30 lines] > > http://www.anesthesia.wisc.edu/med3/localanes/localhandout.html > Are the hydrogen ions added to change the pH or to change the polar > charge? Or, does that question make any sense? It changes the pH...which changes the polar charge. > ~+--~+--~+--~+--~+-- > Stephen [What's a Temporary?], D.D.S. [quoted text clipped - 42 lines] >> >> http://www.anesthesia.wisc.edu/med3/localanes/localhandout.html Ah, the trickles of basic chemistry are beginning to flow back from the deep recesses. Thanks! Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >> Are the hydrogen ions added to change the pH or to change the polar [quoted text clipped - 51 lines] >>> >>> http://www.anesthesia.wisc.edu/med3/localanes/localhandout.html Not too sure about the "as most junior high school students know" bit, but this is the best explanation I've come across so far - thanks! > > Are you sure? > [quoted text clipped - 29 lines] > > http://www.anesthesia.wisc.edu/med3/localanes/localhandout.html > I came across the following posts on a dental board and was wondering > what the general take on this subject is: [quoted text clipped - 6 lines] > dentists don't perform root canals until the infection clears up > because the anesthesia won't work at all. Why is that? Tens or acupuncture is god also. |
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