I have a lower left molar which has been filled on a number of occasions. Last time this was done, my dentist could not dull the pain with novocain. I had to have general anesthetic. Is there any new, more powerful local anesthetic which would do the job better than novocain?

There are actually two ways your dentist could accomplish a more comfortable procedure for you. The first way would be to use a different local anesthetic, and the second way would be to use a different technique for establishing anesthesia. You should understand that lower teeth are relatively more unpredictable for establishing good anesthesia due to differences in anatomy and the location of accessory nerves. Occasionally, it can be difficult to establish profound anesthesia.

Lidocaine is the most common local dental anesthetic. Generally, this allows for an oral procedure to be performed comfortably with anesthesia lasting for about 2-3 hours. There are some other local anesthetics which are shorter-acting (such as chloroprocaine), and some which are longer-acting (such as marcaine or bupivacaine). These longer-acting anesthetics can give a more profound anesthesia, but numbness can be felt for 6-8 hours.

When I experience difficulty achieving anesthesia on a patient, I will try to inject a different location or employ a different technique. Occasionally anesthetizing the main nerve for the lower teeth is not enough to obtain a comfortable level for the patient. When this occurs, an injection on the tongue side of the tooth and/or between the tooth and gum may prove successful.

There is also a fairly new technique on the market. It is called the Stabident system. It is purported to be effective. Cedeta is a type of transcutaneous anesthesia used by some dentists. This form of anesthesia requires no injection.

As you can see, there are other tools and techniques your dentist may use. You are not necessarily destined to have your dental work completed under general anesthesia. Research is being done to create instruments which may create painless dentistry. For example, the FDA recently approved the use of a certain laser in the United States for removing decay. There is some promising research which will lessen the necessity for local anesthesia in the future.