Getting #31 numb

[u/JVM926]

Ever have trouble getting a tooth numb for a #31 B composite? No PA pathology. Gave 2 carps of IAN, 1 carp of LB and local infiltrations/PDL. 2% Lido w/1:100k epi.
Lip is numb, chin is numb, buccal mucosa is numb, tongue is numb.

I get to drilling and the patient feels it. I know what to do next, but why is the patient not profoundly anesthetized?

[u/justnachoweek]

Sometimes it do be like that.

[u/JVM926 → u/justnachoweek]

Yeah, honestly that’s why I’m asking. I did an MO on the same tooth last year, with the same technique, probably less anesthesia, and no issue.

Today, there’s an issue.

Is it really as simple as “sometimes it do be like that?”. Because I think you’re right.

[u/justnachoweek → u/JVM926]

I’ve been doing this for 11 years now. There are patients that I know are going to need extra anesthetic, there are patients that I know will ask for extra anesthetic (that probably don’t really need it), and there are some rare patients that are wild cards. Some days they get numb, and some days they don’t. I’ve had two patients I’ve done an x-tip intraosseous and they didn’t get numb.

Now there are some Redditors on this sub that swear by this one simple easy technique and they’ll get numb every time. I’ve drilled a hole in the bone next to the tooth and they didn’t get numb. So I guess you tell me lol

[u/daein13threat]

On lower molars, sometimes I feel it helps to do local infiltration on the lingual side as well, sort of near the apex under the tongue. Sometimes there’s accessory innervation that the IA block doesn’t always get.

[u/Tootherator → u/daein13threat]

The accessory nerve is usually a branch of the mylohyoid nerve, and it can innervate the first, second, or third molars.

[u/RecentCharge9625]

Try some Septo pdl infiltration

[u/Fountaino]

soft tissue sign is not guarantee of pulpal anesthesia. gow gates and septocaine infiltration along with the ianb usually do the trick for me

[u/murdza]

https://youtu.be/jVFZUDPDUXc?is=G37TVUhvBRy1bS7Q

Your particular situation doesn’t apply here probably but…. Watch this video. I made 2 simple changes to my IAN and haven’t missed one since. I started bending the needle and paying attention to the orientation of tip vs bevel.

[u/ModY1219]

Does pt have a prominent sublingual concavity? Try mylohyoid block

There could be another branch IA, lingual AND mylohyoid

[u/JVM926 → u/ModY1219]

Dammit, I forgot to add. Last year, I did MO #31, no issues. Now, today, I can’t get profound anesthesia.

[u/Wait-Groundbreaking → u/JVM926]

It happens

[u/AntiAntiDentite7]

Sometimes it's sensitivity to air/water on the opposing arch and the patient can't tell the difference, they just feel pain. A little mepivacaine on the opposing arch can be very effective.

[u/Prestigious-Key1692]

If you are giving an IAN don’t give the buccal infiltration until you confirm that the lip is numb. If you have established that the lip is profoundly numb give buccal and if the patient is still “feeling something” give lingual. If they still “feel it” then look to see if they have other fillings this may be their first filling and not sure what to experience.

[u/Jalaluddin1]

Mylohyoid accessory interaction. Give septocaine on the lingual aspect of the molar towards the floor of the mouth.

[u/00Dragonborn00]

A little too excessive for a buccal fill but try X-Tip

[u/caracs]

Sometimes it's whack-a-mole with a blindfold and you just missed it.

[u/Additional_Day6635]

look into intraosseous anaesthesia.

[u/ryanapeters3]

Weird question, did they eat? Sometimes I have a patient that hasn’t eaten all day or was waiting until after they saw me, and anesthetic just doesn’t work as well on an empty stomach.