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Suppose that a dentist is doing a standard dental procedure, e.g. drilling out decay, on me, and I start feeling pain as he does it. Assuming that I can handle the pain silently, so I don't need to report it for my own sake, is it at all helpful to the dentist's work for me to report it? Is this feedback that the dentist can use to detect issues with the actual work as he goes along, or would the only purpose of reporting it be to try to get him to do something to mitigate it, for the sake of my immediate experience?

(Note: I'm using "me" as a stand-in for a typical patient.)

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Most dentists - for most procedures - aim for a painless experience. If there is reason to keep some pain sensation intact, the dentist will inform you, and ask at appropriate intervals if you can feel pain.

The efficacy of lidocaine and other local anesthetics depends on how closely your nerve distribution comes to the norm (they will inject the environs of the "normal" anatomical position of the nerve), how much anesthetic is injected, whether there are local factors which alter the local tissue pH (e.g. presence of an abscess or infection), how quickly it is removed from the site, etc.

Is this feedback that the dentist can use to detect issues with the actual work as he goes along, or would the only purpose of reporting it be to try to get him to do something to mitigate it, for the sake of my immediate experience?

Local anesthetics prevent pain sensation, but not vibration or pressure, which themselves can be unpleasant. Hypothetically, a dental procedure which should be painless with anesthesia can be carried out equally well whether the patient feels pain or not, so if you are stoic, feeling pain and not telling your dentist will not likely affect the outcome of that procedure. However, informing the dentist helps them to know if your anatomy is different (valuable information for the next time they need to do a similar local or regional block, your response to the anesthetic used (they might try another anesthetic or approach in the future), or if there might be an unseen infection altering the pH (and efficacy) of the anesthetic. Therefore it is probably wise to let your dentist know what you're feeling. They can reassess the situation, then offer you relief of some kind: a painless injection (the second injection into an already partially anesthetized region is truly painless), nitrous oxide (a gas), or other.

I would liken this for most instances to suturing a laceration. There is never a time when I wish the patient to feel pain while I'm addressing the repair. I address what I see. If a patient feels pain, I want to know that and address the situation.

An Update on Local Anesthetics in Dentistry

  • +1: good answer, and good analogy at the end. For the future, may I suggest: try to use plain English ("wound") instead of medical jargon ("laceration"). This might get you more upvotes in the future. – unforgettableid May 22 '15 at 16:19
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    @unforgettableid - but I don't close all wounds; 'wounds' covers a large variety of injuries. Most people understand "lacerations". It's not really jargon. Jargon is language that is purposely difficult to understand, a way of excluding others. I am not trying to do that. But I do thank for your concern. :) – anongoodnurse May 22 '15 at 17:52
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    Not really, my experience with professional cleaning of teeth is that you will almost always feel pain and bleeding. My dentist says is necessary and that only good hygiene habits will stop the bleeding and pain with floss. And i don't think they will use anesthesia just for that – Freedo Jul 5 '15 at 22:15
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It can absolutely give the dentist information which will help him identity potential problems. I recently had a root canal. It was a two-visit procedure, and on the first day, he drilled out the nerve fibers, tissue, and pulp, then placed a temporary crown over the tooth.

The second visit was supposed to be a simple matter of removing the temporary crown, filling the tooth, and inserting the permanent crown. When he began to work, it was quite painful. He was shocked, and immediately set about trying to determine the cause of the problem.

He spotted a bit of nerve fiber he had missed the first time, then completed the procedure.

In this case, the fact I was even able to feel pain was an indication that he had overlooked something earlier in the process. If I hadn't told him about the pain, another procedure would have been necessary.

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