Question:
This is the situation as it now stands. My neighbor just
went to have a cavity filled. At the time of the visit the
dentist injected novacaine and appears to have hit a nerve.
He at the time apologized for the mistake. After the woman went
home and the novacaine wore off she experienced severe
pain in the treated tooth with swelling. This prompted her to call the
dentist who prescribed painkillers (vicodan) The pain persisted
and after two days she returned to the dentist, who then treated her
for an infection (keflex) and prescribed demerol to help with the
pain. The pain and swelling persisted and she was refferred to
an endodontist (a friend of the first dentist) The endodontist was
keen to do a root canal and described a condition of necrotic
gas forming tissue in the vicinity of the tooth (under).
Now to cut to the chase. It appears that the dentist accidentally
killed a portion of the nerve when injecting novacaine. Does this
sound correct? This is not what she is being led to believe. She
is going for a third (independent) opinion, because this whole
situation feels kinda scammy. The onset of the pain the swelling,
and the gas forming anerobic infecting seems to point to an
incident with the first dentist. We need to have as much info
as soon as possible. If anyone can provide ANY help it
would br greatly appreciated.
Answer:
You can "hit a nerve" when injecting, but not a nerve in a tooth. He may
have hit a nerve in the tooth while drilling. Did he say it was a
mistake? Sometimes the decay may extend to the pulp, and the dentist may
have no choice. In this case a root canal treatment will be required if
the tooth is to be saved.
It is very difficult to "kill" a nerve with an injection of dental
anesthetic. The dentist would have to severe the nerve bundle with the
needle. Almost totally unheard of. It is remotely possible (happened to
one of my patients) that the needle can scrape the nerve bundle and damage
it. The patient then experiences numbness (similar to the injection) for
weeks to months until the nerve heals.
The necrotic pulp condition you describe is something which simply happens
from time to time. Last statistic I saw placed the percentage at 4% of the
*large* fillings (for the USA). Basically, these teeth are ready to die
when they get filled. Rarely, teeth with very small fillings placed in them
will die on the inside and require root canal therapy. Generally, the
larger the filling and the deeper the decay the greater the chance of this
happening.
Infection and gases sounds like a tooth which has died on the inside.
Sometimes the tooth is already dead on the inside. The gas and pus which
would have built up, "bleed" out through the hole in the tooth (or filling).
The patient is often very comfortable despite the dead tooth because the
pressure can constantly escape. The hole is discovered and it gets closed
up. Now the pressure has no where to escape and builds up in the tooth, or
squirts out the tip of the root into the bone. At this point the pain and
swelling begin.
Sounds to me (remember I was not there) that the dentist forgot the normal
warnings which we all give with large fillings. We recite the same warnings
all day long every time we do this stuff. We warn about sensitivity to
cold, and tell the patient that the tooth could still act up despite our
best efforts. We then tell the patient what to do if it does act up.
Unfortunately, there are times when we thought we had warned the patient,
but forgot or the patient left before we had a chance to explain it. The
subsequent lack of communication can be a real problem.
I don't know exactly what is happening to your friend. I hope she gets much
better real soon. From your rough description, I would wager that root
canal treatment is in her immediate future--the sooner the better. From
your description, I can think of no way the problem could have been
precipitated by her dentist. Wait,,,, if the dentist had been really
sadistic and intentionally cut right down the center of the tooth on
purpose, and put some contagion in there, I suppose he/she could have killed
the tooth. Fortunately, that only happens in the movies.
I may not have explained this process of tissue death inside a tooth
properly for you to understand.
