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Medical Forum / General / Dentistry / December 2006strongest/most effective L.A. for wisdom extraction?
I'm scheduled for extraction of my fractured lower right wisdom tooth tomorrow (#17 I believe). He hasn't seen it yet so I'm going early for x-rays etc. and I really hope it's not too infected or anything that would prevent extraction tomorrow (pain is killing me). Are the locals available today any better than 10+ years ago? I suppose I'm partly a dentophobe but the only thing that bothers me most is extreme pain. My last filling took about 7 shots and I still felt pretty much everything even though my eyelids were numb which completely baffled my Dentist at the time. (not sure what he was using, lidocaine?) My extensive reading in this group seems to indicate that Septocaine/Articaine are the latest effective LA's around. Being that this is a last minute 'emergency' appointment the receptionist seemed to indicate that a local was the only option available. The Dr. I'm seeing is an O/Max.F. Surgeon btw, if I tell him that I was a very difficult to numb patient before, will he likely offer something more 'effective' to numb the molar? PS. I'm taking a couple Diazepam's in the morning to help with the anxiety (unless this is a really bad idea or could interfere with the Surgeons proceedure) TIA for any advice, Gary OMFS are usually very good at numbing patients. Mention that you're hard to numb to the surgeon and he may consider using alternative techniques if a traditional block won't do the job. You should also speak to him before taking any medication. Diazepam is probably ok, but you should never taking any medication on your own prior to an operation without informing the surgeon. Regards, George Septocaine is good, however there is a slightly increased risk of ligual paresthesia (usually temporary) when it is used for mandibular blocks (also true with Citanest Forte). Most modern local anesthetics work quite well *IF* they are placed in the correct location (which can vary between individuals). I like to use Marcaine with extractions because it lasts for hours. A Stabident is great for cases where the block is just not quite enough. Nitrous helps too. JME, D My extensive reading in this group seems to > indicate that Septocaine/Articaine are the latest effective LA's > around. > TIA for any advice, > > Gary Thanks for all the input.... I did phone to inquire and was told NOT to take any med's prior to the visit. They're calling it a consultation with the 'possibility' of extraction depending upon what they find I guess. I really want this thing out rather than trying to save it, something I wanted 20 years ago when they began to erupt. The anxiety is most likely worse than the whole procedure. Kinda makes me wonder why they're called wisdom teeth. Trying to keep my chin up, Gary > Septocaine is good, however there is a slightly increased risk > of ligual paresthesia (usually temporary) when it is used for [quoted text clipped - 14 lines] > JME, > D >I like to use Marcaine with extractions because it lasts for >hours. Are you able to get Marcaine now ? I looked it up awhile back, that's a brand name for bupivacaine, if memory serves. I had a dentist use marcaine on me a couple years ago, but I'm not sure about now. http://froogle.google.com/froogle?q=marcaine+&hl=en&btnG=Search+Froogle Yeps, it's available. http://froogle.google.com/froogle?hl=en&btnG=Search&q=bupivacaine And in generic.  SignatureChristopher A. Young You can't shout down a troll. You have to starve them. . On Wed, 13 Dec 2006 13:25:57 -0600, Dartos <tuthjockey@myturbonet.com> wrote: >I like to use Marcaine with extractions because it lasts for >hours. Are you able to get Marcaine now ? >I looked it up awhile back, that's a brand name for bupivacaine, if >memory serves. [quoted text clipped - 9 lines] > >And in generic. Thanks but I want it in a dental cartridge. I did notice that those were only multi use vials. You'd have to check wtih your dental supplier. I won't be much use for you there, I'm not a dentist, and don't have any dental suppliers. SignatureChristopher A. Young You can't shout down a troll. You have to starve them. . > >And in generic. > > Thanks but I want it in a dental cartridge. I've been using generic bupivicaine for a while and even used the multi-dose vials when I couldn't find any dental cartridges. I get it through regular suppliers. Best wishes, D > Thanks but I want it in a dental cartridge. Would it totally destroy your image to use a Tubercullin syringe wtih Luer-Lock needles? I've never had dental work done with a plastic syringe, but seems like it would work. Long needles are available, commercially. I do find those big metal jobs fascinating. What kind of syringe do you use for the generic bupivicaine? SignatureChristopher A. Young You can't shout down a troll. You have to starve them. . > I've been using generic bupivicaine for a while and even used > the multi-dose vials when I couldn't find any dental cartridges. [quoted text clipped - 5 lines] > > > Thanks but I want it in a dental cartridge. > Would it totally destroy your image to use a Tubercullin syringe > wtih Luer-Lock needles? I've never had dental work done with a [quoted text clipped - 4 lines] > > What kind of syringe do you use for the generic bupivicaine? Just a convention to have cartridges. When I was a resident we used multi-dose vials and disposable syringes in the ER for facial lacerations. Unfortunately the anesthetic was frequently procaine without vasoconstrictor, but the syringe wasn't a problem. I don't remember the guage of the needle--I think it was frequenly as large as a 25 or more, but sometimes smaller. You could use fine needles in the skin, but I doubt you'd want to use something as fine as a tuberculin needle in the mouth. I've never used anything smaller than a 30. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 The generic bupivicaine does come in standard dental cartridges. It was also unavailable for a time. For the multi-dose vials, I used a standard plastic syringe with a 25 long. I don't like the plastic syringes. The 'feel' is so different from the metal dental syringes, and the plunger precludes slow, steady infiltration. But, when nothing else was available, I did what I had to do. D > Would it totally destroy your image to use a Tubercullin syringe > wtih Luer-Lock needles? I've never had dental work done with a [quoted text clipped - 4 lines] > > What kind of syringe do you use for the generic bupivicaine? Thanks, gonna check into it. The Kodak site still says it's unavailable. (marcaine, that is) >I've been using generic bupivicaine for a while and even used >the multi-dose vials when I couldn't find any dental cartridges. [quoted text clipped - 5 lines] > >> Thanks but I want it in a dental cartridge. The last 0.5% bupivicaine came from Schein just a few weeks ago. Seems to work fine. D > Thanks, gonna check into it. > > The Kodak site still says it's unavailable. (marcaine, that is) Thanks, have been missing this option in my practice. >The last 0.5% bupivicaine came from Schein just a few weeks ago. >Seems to work fine. [quoted text clipped - 4 lines] >> >> The Kodak site still says it's unavailable. (marcaine, that is) Vould be time vor ush all to shay "Danka, Schein". Yah? Very very bad German accent, you know. SignatureChristopher A. Young You can't shout down a troll. You have to starve them. . > Thanks, have been missing this option in my practice. > > >The last 0.5% bupivicaine came from Schein just a few weeks ago. > >Seems to work fine. > Vould be time vor ush all to shay "Danka, Schein". Yah? > > Very very bad German accent, you know. I assume an imperfect transliteration of the German "schön" . I remember Henry Schein. To call him "schön" would be a slight exaggeration. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 The last oral surgeon I went to, used 1% lidocaine. Which did a terrific job, he knew right where to put the shot. Other dentists have used other caine drugs. I'd suggest to call the office ahead of time, tell em you're dificult to numb up, and ask about taking something extra. They may suggest some pills in addition to the local. Any infection (abscess) will really reduce the local's effectiveness. So, if you've got a tooth ache, please ask about antibiotics for a couple days before the extraction. Took me awhile to figure out why you keep mentioning Los Angeles! SignatureChristopher A. Young You can't shout down a troll. You have to starve them. . I'm scheduled for extraction of my fractured lower right wisdom tooth tomorrow (#17 I believe). He hasn't seen it yet so I'm going early for x-rays etc. and I really hope it's not too infected or anything that would prevent extraction tomorrow (pain is killing me). Are the locals available today any better than 10+ years ago? I suppose I'm partly a dentophobe but the only thing that bothers me most is extreme pain. My last filling took about 7 shots and I still felt pretty much everything even though my eyelids were numb which completely baffled my Dentist at the time. (not sure what he was using, lidocaine?) My extensive reading in this group seems to indicate that Septocaine/Articaine are the latest effective LA's around. Being that this is a last minute 'emergency' appointment the receptionist seemed to indicate that a local was the only option available. The Dr. I'm seeing is an O/Max.F. Surgeon btw, if I tell him that I was a very difficult to numb patient before, will he likely offer something more 'effective' to numb the molar? PS. I'm taking a couple Diazepam's in the morning to help with the anxiety (unless this is a really bad idea or could interfere with the Surgeons proceedure) TIA for any advice, Gary > The last oral surgeon I went to, used 1% lidocaine. Which did a > terrific job, he knew right where to put the shot. Other dentists have [quoted text clipped - 7 lines] > So, if you've got a tooth ache, please ask about antibiotics for a > couple days before the extraction. This is key, and likely to affect the depth of anesthesia more than which anesthetic is used. (That, and the ability of the operator and the versatility of the anesthetic techniques used--see the post by Dartos). Steve > Took me awhile to figure out why you keep mentioning Los Angeles! SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Just a quick update: Had the extraction yesterday under IV sedation and I have to say it was an amazing experience. I am finally not a dentophobe any longer! The Surgeon I found was extremely pleasant and informative and all of the staff were also amazing. Anyone who's skeptical or extremely anxious about oral surgery should def. consider IV sedation. Gary > I'm scheduled for extraction of my fractured lower right wisdom tooth > tomorrow (#17 I believe). He hasn't seen it yet so I'm going early for [quoted text clipped - 24 lines] > > Gary > Just a quick update: Had the extraction yesterday under IV sedation > and I have to say it was an amazing experience. I am finally not a [quoted text clipped - 33 lines] >> >> Gary Thanks for the report, and glad it went well. Steve Glad to hear it worked out well for you. I'm sure the dentists see plenty of people who don't like getting dental work done. I was really impressed with one oral surgeon who took the time to show me the X-rays. Told me a bit about the process, which was really good. SignatureChristopher A. Young You can't shout down a troll. You have to starve them. . Just a quick update: Had the extraction yesterday under IV sedation and I have to say it was an amazing experience. I am finally not a dentophobe any longer! The Surgeon I found was extremely pleasant and informative and all of the staff were also amazing. Anyone who's skeptical or extremely anxious about oral surgery should def. consider IV sedation. Gary
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