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Dr. Andrew Rynne

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Gave Lidocaine Injection At Rear Of Mouth To Extract Lower Molar. Why? Stabbing Pain While Healing

After dental injection of lidocaine into the lower mandible, and very far towards the rear of the mouth (in fact it was to numb for an extraction of the left lower molar next to bicuspid, and I questioned "Why so far back?" to the student performing the injection [unsupervised, I might add]. I thought that healing processs was not right, developed severe (and I do not use thi word lightly) pain starting in lower left mandible, but much more intense (like someome were stabbing me with a knife in my left temple and left eye...I pride myself on not crying from pain, yet this pain, at 51yrs of age has me sobbing and in a fetal position, what is so terribly wrong?
Tue, 10 Sep 2013
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Dentist, Pedodontics,  's  Response
Thanks for sharing your concern in HCM forum. In the first part, the student, as you said, is not wrong in giving lignocaine injection at rear part of the jaw. The nerve that supplies all the teeth of lower jaw enters into the mandible through a hole from that area. It is called nerve block to anesthetized the whole side of the jaw. If the injection is given just beside the tooth it will not penetrate the thickness of the jaw bone to reach to the nerve for the particular tooth and that does not numb your tooth. It is generally done in child patients till 6 to 7 years of age when the jaw bone is much thinner . In the second part your suffering of pain is little unusual. Post extraction pain is generally not so severe. There are commonly three reason of sever pain after extraction of tooth. firstly there could be laceration or fracture of the tooth supporting bony part of the jaw, Secondly the area could be severely infected and lastly it turned to so called 'dry socket'. You should visit to your dentist as early as possible for diagnosis and get proper treatment. And nothing of these are 'terribly wrong' in their occurrences. Any such pain can be controlled by using analgesics. Until you visit your doctor you can start Aceclofenac 100 mg two times a day.Take this drug in full stomach or take 15 ml of any liquid antacid before this medicine if you have the problem of acidity. You can take paracetamol 1gm if you feel pain in between. Hope this will relieve your problem...get well soon.
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Dentist,  Dr. Prachi Mishra's  Response
hello
welcome to hcm
it is true that the injection given to anesthetise lower molars is given towards the rear of the mouth.. i think you are not completely clear about explaining your problem.. i will be more comfortable to answer your query if you explai it in a simpler way...
giving wrong anesthesia can affect the trigeminal nerve which may cause paralysis of the area but your symptoms are of pain .. it will be better if you consult an oral surgeon and describe the symptoms more clearly...
left temple and eye are supplied by a different nerve and if you have any paain related to them , please visit a general physician also...
thank you...
follow up is invited
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Dentist,  Dr. Bindiya Bhaskar's  Response
Hello,

Welcome to health care magic forum.

To extract lower molar,local anesthetic solution has to be injected at the Posterior most Pterygo mandibular Fossa.

This will numb inferior alveolar,buccal as well as lingual nerves.

The pain while healing may occur due to dry socket developed at the site of tooth extraction.

Irrigate the socket with iodine solution,apply Eugenol,Lignocaine as well as betadine into socket.

Gargle frequently with lukewarm saline.

Meanwhile,maintain oral hygiene well.

Complete course of Cap.
Amoxycillin has to be administered.

Hope this helps.
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Dentist,  Dr. Nirav Patel's  Response
hello, thanks for sharing your concern at HCM.
yes the injection for making the site of extraction numb is to be given at the rear of the mouth.
your problem suggest that, your tooth might have been fractured during extraction or there might be infection after extraction called ' dry socket'.
i opine you to visit a dentist and get it checked.
don't worry everything will be alright after taking medications.

thank you
take care
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Dentist,  Dr. Farah Hussain's  Response

Hi there,

Thanks for writing your query,


After reading your history i suspect you have developed Dry socket at the extraction site.
dry socket is the dull aching condition caused due to dislodgement of blood clot from the extraction site which exposes the alveolar bone to the oral environment leading to infection.
Traumatic and long standing surgical extraction also end up in forming dry socket.
dry socket along with super infection leads to terrible pain as you have mentioned.
i would suggest you to consult a dentist , as the socket needs currettage to remove the infection and induce fresh bleeding to accelerate healing .
Zinc oxide eugenol pack is applied as a dressing and it is replaced every 2 to 3 days till the symptoms subside.
please visit the dentist and get the treatment done.
i hope this helps ,

take care.
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Gave Lidocaine Injection At Rear Of Mouth To Extract Lower Molar. Why? Stabbing Pain While Healing

Thanks for sharing your concern in HCM forum. In the first part, the student, as you said, is not wrong in giving lignocaine injection at rear part of the jaw. The nerve that supplies all the teeth of lower jaw enters into the mandible through a hole from that area. It is called nerve block to anesthetized the whole side of the jaw. If the injection is given just beside the tooth it will not penetrate the thickness of the jaw bone to reach to the nerve for the particular tooth and that does not numb your tooth. It is generally done in child patients till 6 to 7 years of age when the jaw bone is much thinner . In the second part your suffering of pain is little unusual. Post extraction pain is generally not so severe. There are commonly three reason of sever pain after extraction of tooth. firstly there could be laceration or fracture of the tooth supporting bony part of the jaw, Secondly the area could be severely infected and lastly it turned to so called dry socket . You should visit to your dentist as early as possible for diagnosis and get proper treatment. And nothing of these are terribly wrong in their occurrences. Any such pain can be controlled by using analgesics. Until you visit your doctor you can start Aceclofenac 100 mg two times a day.Take this drug in full stomach or take 15 ml of any liquid antacid before this medicine if you have the problem of acidity. You can take paracetamol 1gm if you feel pain in between. Hope this will relieve your problem...get well soon.