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10 Days With a Numb Lip After a Visit to the Dentist
I entered my second year of engineering. This transition year would take me from a comprehensive general education to a more highly focused course in mechanical engineering through advanced studies in mathematics, science and systems. By all measures, I was well placed with my peers and my grades were above average. My freshman year was now over and I was literally pacing myself for the complexity of projects that would later see my skills put into practice. At this stage of my studies, I was like a sponge in the ocean soaking up everything 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; however, there was a constant wind that seemed to push me in a certain direction. Or so it seemed to me.
It was difficult to hide my identity; I was from a small midwestern town and attended a private high school with my siblings where we enjoyed a comfortable life as children of parents who were both professionals. My mother was a restorative hygienist and my dad, Dr. Watson, owned a well-established dental practice. I was now off campus and fortunate enough to share a modest three-story loft apartment with Steven, a student who was also in engineering, a year ahead of me. Our apartment was no more than 500 sq.ft. of living space but comfortable and spotlessly clean, with a clear view across town where you could see the famous Golden Arches and where many university kids were catching up on notes, enjoying the burger special of the day. Steven was no exception. He loved to eat at the MacDonald’s; He was hooked on their Big Mac and ate there at least four or five bites a week. Our apartment consisted of a sitting room, kitchen, laundry room and one bedroom with two single beds. I began to feel more responsible for my life and free to come and go as I pleased. My roommate was friendly but a bit quiet and deep in thought, or so it seemed to me.
Our schedules were completely different, and we didn’t have much time together except for the occasional chat over coffee. We weren’t big on booze but enjoyed the odd beer. He had a part-time job at a small computer repair shop and would be home usually before midnight. The pace and the anonymity of the Northeast was very fascinating and every day I could feel maturity seeping into every move I made. I was at peace with myself and happy, especially when I heard from my people. Although it was never overtly pushed on me, the atmosphere at home during high school was subtly an expectation to go on to graduate school in the East. I was the oldest of my siblings and now that I can think back, both my parents lovingly used me as their flagship. “If Jim sets the pace, the others will follow”. I was lucky in that I didn’t have to work during my semesters away from home. My mother took care of it. There were no excuses for failing grades. I lacked nothing. However, I was not pretentious by any means. In fact, I was often seen and not heard. Deep down I knew I was popular even though I was shy. I wasn’t “Brad Pitt”, but I was confident, or so it seemed to me.
It was during our second semester of my sophomore year that I started to have some concern about my roommate. He suffered from bruxism, commonly known as teeth grinding, typically accompanied by jaw clenching. It is an oral Para-functional activity that is common in many people. Bruxism (Wiki) is caused by the activation of reflex chewing activity; it is not a learned habit. By osmosis, I picked up a lot of dental terminology over the years from both of my parents. This condition (grinding) was not unknown to me; however, the situation gave me restless nights. I was talking to my dad during one of our weekly “how are you” conversations and he suggested that Steven should see a local dentist, due to possible damage to his teeth. It wasn’t hard to share my concern with Steven because his girlfriend also thought he should see a dentist.
We (Steven, his girlfriend Veronica and I) have now become much closer. Steven opened up a bit more and could be quite comical at times. I was seeing the other side of him. We started hanging out on a more regular basis. Steven appreciated my father’s professional advice and actually went to a dentist associated with our engineering faculty. The diagnosis was confirmed. There was some minor initial damage that began to erode the enamel of his molars. The dentist was able to have a guard fitted in Steven’s mouth with which he could sleep comfortably at night. A follow-up appointment was scheduled in a few weeks to ensure that the protective device fit comfortably. However, the dentist noticed that there was an old amalgam filling on his LR bicuspid that was overhanging and was a floss picker. The dentist advised Steven that it should be replaced with a more modern white filling. Amalgams are mostly now dated. The trend is towards natural colored composite fillings. This was good news for Steven because the silver amalgam was a nuisance and unsightly for a young man. The date was set for the replacement filling and all would be well, or so it seemed to me.
Steven showed up for his 9:00 AM dental appointment which would have given him plenty of time to get back to class and by noon the anesthetic would wear off giving him plenty of time to enjoy his big Mac. However, things did not go as planned. Steven still had a numb jaw and although he tried to ignore this persistent strange feeling, it was apparent that he had indeed lost all taste for his favorite Big Mac and fries. On the third day Steven called his dentist to explain jokingly that he had lost all taste for any food and especially, his craving for a Big Mac fix. The dentist reassured him that some people react this way to local anesthetics but the numbness and tingling will soon disappear with a normal return to full sensation.
Steven timidly took his word, but after the fifth day, the condition did not improve and Steven was in a panic and wanted another opinion. Without knowledge of the whole situation my father had the privilege of only “hearsay” and warned me that it could be a case of paresthesia, which is a potentially serious fault that dentists hope never to encounter during the life of their practice. My father didn’t want to be involved for obvious reasons. I was now on the horns of a dilemma. After all, Steven was my trusted friend and roommate.
Steven was now withdrawn and depressed. He lost weight and his essays suffered. Veronica accompanied him to the counselor and it was decided that he should see a neurologist. Paresthesia was actually the diagnosis. This condition was explained to Steven and the prognosis was good because he had a simple and uncomplicated 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 a new local anesthetic was FDA approved for dental use in the U.S. Unlike most other anesthetic solutions that have a concentration of 2%, this new one was a 4% concentration. In other words, theoretically and pharmacologically speaking, all things being equal, or as the scientists would say, in vitro, you could use half the volume of the 4% solution to achieve what the 2% is capable of. For some unknown reason, dentists tend to refer to volume (cartridges) rather than mg/ml. (actual mg given).
As it turned out, Steven awoke now on his tenth day, to discover that the paresthesia had miraculously been reversed and full sensation had returned to his tongue and soft tissue around his lip. No point mentioning where he went after he discovered there were no more pins and needles. All therapeutic compounds are accompanied with an index. The lesson is that the product monographs included in any medication emphasize the importance of a Minimum Effective Dose.
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