Case No. Four

A restorative dentist is preparing crowns on anterior teeth 6-11 in a young male with large pulp chambers and a history of difficulty getting numb.  Orlacaine is applied to the apex of each tooth 6-11 with a cotton applicator, no injectable anesthesia or nitrous oxide analgesia is administered.  A 5-minute wait time is observed.  The teeth are prepared for traditional ceramic crowns.  The patient reports no discomfort during the procedure on 7, 8, 9, 10.  Teeth 6 and 11 are treated with more Orlacaine and tooth 6 is prepared with no discomfort.  Tooth 11 is still slightly sensitive and the clinician uses an 1/8 of a carpule of lidocaine w/ epinephrine and the procedure is finished.

A restorative dentist is planning on several large buccal composite restorations on teeth 5,6,7,8,9.  Orlacaine is place high in the buccal vestibule where the infraorbital foramen is palpated, no injectable anesthetic or nitrous oxide analgesia is administered.  A 5-minute wait time is observed.  The teeth are prepared for composite restorations.  The patient reports no discomfort on teeth 6,7, 8.  Teeth 5 and 9 are slightly sensitive and clinician reapplies Orlacaine.  Tooth number 9 is still sensitive and 1/8 carpule of Articaine is administered and the procedure is finished.

- Dr Michael D Smilanich