10 days with a numb lip after a visit to the dentist

I was entering my second year of engineering. This transition year would take me from a broad-based general education to a more focused mechanical engineering course through advanced study in math, science, and systems. By all measures, I ranked well with my peers and my grades were above average. My first year was over and I was literally setting the pace for the complexity of the projects that would eventually see my skills put to use. At this stage of my studies, I was like a sponge in the ocean soaking up each and every lecture I attended. Being pulled and pushed with every movement of the tide around me. No clear route was calculated on my internal GPS; yet there was a steady wind that seemed to push me in a definite course. Or so it seemed to me.

It was difficult to hide my identity; I was from a small town in the Midwest and attended a private high school with my siblings, where we enjoyed comfortable lives as the children of parents who were professionals. My mother was a restorative hygienist and my father, Dr. Watson, owned a well established dental practice. I was now off campus and was lucky enough to share a modest third floor penthouse apartment with Steven, a student who was also in engineering, a year ahead of me. Our apartment was no more than 500 square feet. of living space but comfortable and spotlessly clean, with an unobstructed view of the city where the familiar golden arches could be seen and where many college kids caught up on notes, while enjoying the daily special burger. Steven was no exception. He loved to eat at MacDonald’s; He was addicted to his Big Mac and ate there at least four or five cloves a week. Our apartment consisted of a living room, a kitchen, a bathroom and a bedroom with two single beds. I was beginning to feel more in charge of my life and free to come and go as I pleased. My roommate was friendly but somewhat quiet and deep in thought about him, or so it seemed to me.

Our schedules were quite different, and we didn’t have much time together apart from the occasional small talk over coffee. We weren’t big on alcohol, but we did enjoy the odd beer. He had a part-time job at a small computer repair shop and usually came home at midnight. The rhythm and anonymity of the Northeast were very fascinating and every day I could feel that maturity was watching every move I made. I was comfortable with myself and happy, especially when I heard from my parents. Although I was never overtly pushed for it, the atmosphere at home during high school was subtly an expectation of going to grad school back East. I was the eldest of my siblings and now that I can reflect on it, my parents lovingly used me as their flagship. “If Jim sets the pace, the others will follow.” I was lucky not to have to work during the semesters away from home. My mother took care of that. There would be no excuses for failing grades. I lacked nothing. However, I was in no way pretentious. In fact, they often saw me and didn’t listen to me. Deep down I knew he was popular but shy. He wasn’t “Brad Pitt”, but he was confident, or so it seemed to me.

It was during our second semester of my sophomore year that I began to worry about my roommate. He suffered from bruxism, commonly known as teeth grinding, typically accompanied by clenching of the jaw. It is a functional Para-oral activity that is common in many humans. Bruxism (Wiki) is caused by activation of reflex chewing activity; it is not a learned habit. Through osmosis, I had learned a lot of dental terminology over the years from my parents. This condition (grinding) was not unknown to me; however the situation was causing me restless nights. I talked to my dad during one of our weekly “how are you?” and he suggested that Steven should see a local dentist, due to possible tooth damage. It wasn’t hard to share my concern with Steven, because his girlfriend also thought she should see a dentist.

We (Steven, his girlfriend Veronica and I) had now become much closer. Steven opened up a bit more and could be quite funny at times. I was seeing the other side of him. We started going out more regularly. Steven had appreciated my father’s professional advice and actually went to see a dentist associated with our engineering school. The diagnosis was confirmed. There was a little initial damage that had started to erode the enamel on his molars. The dentist was able to fit a dam into Steven’s mouth that he could sleep comfortably in at night. A follow-up appointment was scheduled in a couple of weeks to make sure the protective device was a comfortable fit. However, the dentist noticed that there was an old amalgam filling in his LR bicuspid that was sticking out and was a floss grinder. The dentist advised Steven that he should be replaced with a more modern white filling. The amalgams are mostly dated now. The trend is toward natural-colored composite fillings. This was good news for Steven because silver amalgam was a nuisance and unsightly for a young man. The date was set for the replacement filling and all would be fine, or so it seemed to me.

Steven showed up for his dentist appointment at 9:00 am, which would have given him plenty of time to get back to class, and by noon the anesthesia would have worn off, giving him plenty of time to enjoy his Big Mac. However, things did not go as planned. Steven’s jaw was still numb and, though he tried to ignore this lingering strange feeling, it was evident that he had lost all taste for his favorite Big Mac and his fries. On the third day, Steven called his dentist to jokingly explain that he had lost his taste for any food, and in particular his craving for a fix of the Big Mac. The dentist assured him that some people react that way to local anesthetics. , but that the numbness and tingling sensation would soon subside with a normal return to full sensation.

Steven took her at her word with apprehension, but after the fifth day, the condition had not improved and Steven was in a panic and wanted another opinion. With no knowledge of the total situation, my father only had the privilege of “hear-tell” and warned me that it might be a case of paresthesia, which is a potentially serious pitfall that dentists hope never to encounter during the life of their practice. My dad didn’t want to get involved for obvious reasons. He now he was on the horns of a dilemma. After all, Steven was my trusted friend and roommate.

unexplained paresthesia:

Steven was now withdrawn and depressed. He had lost weight and his trials were suffering. Veronica went with him to the guidance counselor and the decision was made that she should see a neurologist. In fact, paresthesia was the diagnosis. This condition was explained to Steven and the prognosis was good because he had a simple and uneventful infiltration of the anesthetic and was not exposed to a complete nerve block. There were still unanswered questions. Why would this happen?

Around this time, the FDA had approved a new local anesthetic for dental use in the US. Unlike most other anesthetic solutions that have a 2% concentration, this new one had a 4% concentration. In other words, theoretically and pharmacologically speaking, other things being equal, or as scientists would say, in vitro, one could use half the volume of the 4% solution to achieve what the 2% was capable of. For some unknown reason, dentists are in the habit of referring to volume (cartridges) instead of mg/ml. (actual mg administered).

It turned out that Steven woke up now on his tenth day to find that the paresthesia had miraculously reversed and full sensation had returned to the tongue and soft tissue around the lip. There is no point in mentioning where he went after finding out that there were no more pins and needles. All therapeutic compounds are accompanied by an index. The lesson to be learned is that the product monographs included with any medication emphasize the meaning of Minimum Effective Dose.