[johnvaluk]

I started refusing local anaesthetic for dental procedures when I was teenager. I discovered the pain of the procedure itself (such as drilling a cavity) was the same, but I was spared the pain of the injection and lingering numbness afterwards. I was happy to leave my appointments alert and pain-free.

I imagine any color light or other type of distraction would provide the same results. It's not even a placebo effect, so much as the fact that a lot of these procedures are well within most people's pain tolerance and/or can be over in a minute.

I gladly went under general anaesthesia to have my wisdom teeth removed, however.

[nharada]

> the pain of the procedure itself (such as drilling a cavity) was the same

I've not had cavities filled without anesthetic, but are you sure someone wasn't just fucking up the procedure? I've had plenty of dental work and if it's done properly it definitely isn't painful, just uncomfortable. I've definitely had cases where they didn't give me enough, and they've re-upped me and fixed the issue.

[yojo]

I had a cavity filled without local anesthesia as a poor backpacker in Thailand. It hurt. Not as bad as I thought it would, but I’ve never felt the need to turn down local since.

I also had my wisdom teeth out under local. The pain was bearable, but it is a much more violent procedure than I would have guessed. Given that general comes with a non-zero risk of death, I’d still do local again on that one. Plus it’s kind of a trip to watch someone wrench a tooth out of your mouth.

[chris37879]

I went under for my removal and I vaguely have a memory of waking up during one of the wrenching sessions, and the doctor saying something like “sorry, this one’s being a bit difficult, up his anaaaaaaaaa” and then I woke up at home in a comfy recliner.

[rscho]

For an uncomplicated case, I think the difference in risk between local and general is so tiny it cannot be reliably measured, when performed by competent pros in the western world.

[yojo]

The most reliable number I can find for patients without comorbidity is ~.4/100k[0] (so about 1/250,000). A study specific to dental anesthesia produced a similar number (3 per 1,000,000)[1].

I couldn't find any mortality numbers for local anesthesia, but it would pretty much require an allergic reaction, and I know from past experience I don't have that allergy.

So yes the increased risk for general is very low, but not unmeasurably so.

[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3147285/ [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5535496/

[toast0]

> I also had my wisdom teeth out under local.

Me too, but it makes a big difference how far erupted they are. Mine were basically half way out, and were starting to cause problems, so pull them all. The top ones came out with like one yank each, but the bottom ones took a lot of tugging. The dentist said that was pretty normal, top teeth are barely hanging on.

[brandall10]

Mine were just beginning to come in and for some reason my dentist felt it was okay to remove them... trying to pull them was a joke, so he used a tiny reciprocating saw to cut each tooth into pieces. Took 3 hours, and given the amount of local used it would have been better to do general. Worst pain I ever felt was when the anesthetic wore off 30 minutes post procedure.

[vkou]

> for some reason my dentist felt it was okay to remove them

That reason is probably 'he stands to make a lot of money for getting to them before any other dentist'.

[brandall10]

The funny thing is he had been my dentist for 3 years to that point, and because of this my family moved on to someone else. And there were potential repercussions beyond as my face was crazy swollen for a couple weeks and dozens of teachers/students wanted to know WTF happened... like if I was in a car wreck and broke my jaw or something.

[bombolo]

I'm sure the local butcher would have costed you less.

[distances]

Is general anesthesia then offered somewhere as an option for wisdom tooth removal? That sounds massively excessive for what usually is just pulling a teeth out.

[irjustin]

Yes very common actually. Getting your wisdom teeth extracted at ~16 is also extremely common - a sort of rite of passage.

> That sounds massively excessive for what usually is just pulling a teeth out.

So with above in mind, the wisdom teeth are typically still inside the jaw's bone at that age so extraction is a full on surgery at that point. Drilling through bone and then the tooth is not for the feint of heart - so that's why it's so common to do general.

It does raise the question. Should wisdom teeth be extracted so early when it's not truly necessary yet?

Personally, having lived abroad now where a large percentage of people around me still have their wisdom teeth - I've seen the pain and problems having wisdom teeth can have and how expensive it is if you do have a problem. Doesn't seem worth not extracting at a younger age when you have "more freedom".

[distances]

That's how it works here indeed -- you get them pulled out when they are in the way or start causing problems. I didn't have any specific problems with them, mostly just annoying to clean and some were coming out in a bit weird angles.

I got mine out through my 20s and 30s, and they were all quite straightforward. Local anaesthesia, pull the tooth, done in 15 mins. And like the other commenter said, you're told to take some ibuprofen if you have pain afterwards.

[bombolo]

I have them in my mouth. Never had a problem.

Of course I haven't gone to a dentist, because I'm sure they'd think they are indeed a problem.

[Barrin92]

In the US apparently. I'm German and I also found it completely wild when I heard it. Over here they give you barely anything if they fix a cavity and for wisdom teeth you get local anesthetics, and afterwards they tell you to take an ibuprofen and an ice pack when you have some pain. People in the States even told me they got opioids from a dentist.

[dtech]

North-western Europe generally does a lot less for pain management than US and the rest of Europe. It's a big complaint of expats.

I've heard it explained as a cultural remnant "pain belongs with life, suck it up" from protestantism.

[bombolo]

Well mother theresa wasn't big in anesthetics as well.

[formerly_proven]

GA isn't uncommon there for wisdom teeth removal, either, standard insurance just doesn't pay for it so it's reserved for privately insured people.

[yojo]

Can confirm re:opioids, the dentist prescribed Vicodin (acetaminophen + hydrocodone) post surgery. It seemed pretty excessive.

[rscho]

It's not "just" pulling a tooth out. Depending on the case, it can become quite serious oral surgery.

[lazyweb]

Exactly. Depending on the location and "crookedness" of each tooth, the oral surgeon might grind down the inside of the jaw bone for a clean extraction.

Source: I've had three of my four wisdom teeth removed like that just a few weeks ago (mid thirties, local anesthetic). Chewing harder things like bread still hurts a little, otherwise it's fine.

[fsckboy]

iirc, the wisdom from long ago was getting your wisdom teeth out in a hospital would be covered by medical insurance, but not by the dentist. And general was part of that, but I don't know the timeliness or prevalence of that

some people have very strong (negative) reactions to having teeth pulled, my boss was out of work for days and swelled up like a chipmunk

[cafard]

The sound effects were impressive.

[saurik]

It's more than just the numbness: the actual numbing agent is often injected in combination with epinephrine (aka adrenaline), which acts as a vasoconstrictor and tends to keep the anesthetic in the right place longer... but some of that is eventually going to get into your overall bloodstream and the result is that you are now a bit anxious/nervous :/ refusing the injection (which I also started doing back about 10-15 years ago, when the mother of my at-the-time-girlfriend told me about her experiences doing that) also thereby leaves you chemically calmer (and likely thereby better able to deal with any pain that does result).

[cameronh90]

There shouldn't be any pain at all during local anaesthetic, but you'll still feel movement. The injection also shouldn't be particularly painful if done correctly; something like a mild pinch. They can use numbing gel prior to the injection if needed. It also shouldn't affect your alertness.

Are you perhaps a redhead or something else that would give you an atypical response to anaesthesia and pain? Some people do just need a higher dose of local anesthetic, and your dentist should provide it if you're still in pain.

[piceas]

If done correctly!

I was unlucky and it was extremely painful. It also resulted in a very minor permanent facial droop.

[skocznymroczny]

Similar here. I disliked the numbness and the fact that I can't eat food for few hours after the procedure, so I just go anaesthetic free now. I can definitely tell the difference. It is painful without, but it's just some pain. I am an adult, I can take it. And the fact that I can leave without any lingering effects is very nice. Would probably still go for anaestesia for harder procedures like root canal.

[cameronh90]

In the UK, I've never been told not to eat after local anesthesia, just to be careful with anything hot or sharp, because I won't be able to feel if something is burning or spiking me.

[lacrimacida]

I never had any issues with local anesthesia and usually get some novocaine gel as a local anesthetic prior to the local anesthetic. Maybe it is effective for some while not for others, I have no other explaination. I’d let a dentist drill anything, no matter how small without anesthesia.

[projektfu]

Infiltration techniques depend on the patient and, to some extent, the skill of the dentist. They're most common for single extractions and cavity prep, sometimes endodontics.

Nerve block techniques are more effective but also difficult for dentists to do properly, and some dentists have low success rates. There's no way to know a given dentist's success rate, but an oral surgeon has a lot more practice with nerve blocks.

Finally, some drugs have a very slow onset and patients aren't given enough time for the effect. You also don't usually get to choose the drug as a patient.

[chpatrick]

Same here for superficial cavities, I'd rather take milliseconds of pain over hours of numbness.