Wednesday, March 07, 2012

Nerve diversity

kw: experiences, dentistry, medicine

I had a permanent crown fitted on a lower molar yesterday, then spent much of the day in a daze, while the anesthetic wore off. I have a rare condition that makes it very hard to "numb" the molars in my lower jaw (the mandible). The nerve to the tooth's pulp enters the jaw far, far back behind the bend of the bone, where it is nearly impossible to reach with a needle full of xylocaine. In most folks (98-99%) the nerve enters just in front of the wisdom tooth, near the tip of its root.

As a result of this unusual innervation, the dentist first has to numb the gums and the tissue at the back of the mouth, then with a much longer needle, try for the nerve. He also used a faster-acting anesthetic in a ligament injector, which forces the stuff between the tooth and the ligament supporting it, so that some will reach the nerve where it enters the tooth—you hope.

The whole side of my head got numb, all right, but when it came time to grind off the temporary crown's cement, I could still feel it. I didn't tell the dentist, because he'd already spent half an hour getting me anesthetized. And we'd been through this before, when he ground off the tooth's enamel and formed a stub for mounting the crown in the first place. I toughed it out then, and did so this time. I could tell that the tooth was partly numbed, but I could still feel the work going on.

When everything was finished, I told him that if I ever need a root canal on a lower molar, it will have to be done under general anesthesia. I told him he had been able to remove most of the sensation, but not all, so I could bear it. Then I went home and to bed. A two-hour nap later, a little sensation had returned, so I had miso soup and some yogurt, neither of which required chewing. I wasn't confident I could eat without chomping out a piece of cheek until eight hours after the dental work. Not only had I had 2-3 times the normal amount of anesthetic, but I get over anesthesia slowly.

This isn't the first time I've encountered odd nerve hookups. When I began having cancer pain twelve years ago, I felt it in the center-left abdomen, where the stomach is, and thought it was an ulcer. Eventually, we found out it was appendicitis, from the cancer eating at the appendix (after growing to the size of a fist in the cecum). The locus of damage was eight inches from where I was feeling it. I just have a goofy nerve connection. Well, the cecum, appendix and a foot or so of both colon and ileum are now gone, so I hope the rest of my nerves are working properly. But there are no guarantees!

No comments: