Any dentists could advise me what happened with this failed extraction?

[Tumty]

Tried to extract my daughters tooth. Initially she said she was numb when dentist tested by scratching her etc. but when dentists tried to pull tooth she said absolutely no way, I can still feel that. they tried more anesthetic but still the same.

from what i can gather possible reasons are :

incorrect technique of dentist
anxiety of patient means local anesthetic less likely to work
infection means local anesthetic less likely to work
patient actually was numb but didn’t like the feeling of “pressure” - she was adamant this wasn’t the case, but perhaps could be

which of these do we think is most likely? We are now at a new dentist and I can’t decide if we should attempt the extraction again under sedation this time.

my dd does have some flexibility in joints which could indicate hypermobility and I believe this perhaps impacts local anesthetic also?

When you have the nitrous oxide you don't have the local anaesthetic as well.

So what are your concerns about her having the NO instead of the LA?

You do not use iv sedation on young teenagers as the effects are unpredictable and can actually make them more jumpy.
Nitrous oxide is excellent it has both a small pain relieving element and a much larger relaxing element .
One of the problems with taking teeth out on children or anyone who is anxious is as anxiety increases the nerve receptors get overloaded and pressure starts to be felt as pain.
Community dentists are excellent in dealing with anxious/difficult to numb up children . Talk to them but the other thing they may suggest, depending on your child's medical history other than hypermobility , is to take a certain type of pain killer at a certain dose an hour before treatment. The anti inflammatory effect can often help .

Members of my family have a weird problem in that the nerve that supplies the jaw is not in the usual place. This means that a dental anaesthetic injection in the normal place doesn’t work where it is supposed to. Fortunately I have very good teeth, so any treatment is very rare. Many years ago, the dentist gave me three shots and numbed the whole side of my face and my shoulder, and I could STILL feel the tooth he was trying to fill. He eventually had to inject the anaesthetic into the root of the tooth. So it may not be the dentist’s fault at all - perhaps your daughter has a similar issue.

Sorry this is wrong. Nitrous oxide only has a very small pain killing element , it is mostly anxiolytic ie relaxing. In dentistry you ALWAYS give local anaesthetic as well as nitrous oxide.
Often , if an extraction has not gone ahead before you may use a different anaesthetic with a different vasoconstrictor ( a vasoconstrictor closes of blood vessels so anaesthetic stays in place longer ) leave it longer and perhaps give a larger dose to start with.

Randommess you do need local anesthetic with nitrous oxide. The nitrous oxide is just for reducing anxiety and they still need the local.

lollygaggle that’s interesting I hadn’t heard the pressure can be felt as pain in that way. Maybe that could explain

Blimey obviously I had it back in the early 90s if I was given an injection it must have been after the NO was given! No memory of injections with teeth extractions.

Yes randommess I had that too in the 90s . I am not entirely sure what that was though. I remember being gassed and completely knocked out for extraction. Perhaps it wasn’t nitrous oxide though, did they use something else in those days maybe? Or were we numbed after the gas so we just don’t remember

Believe me you cannot take a tooth out with nitrous oxide alone, unless it was so loose you could take it out with your fingers.
One of the other effects of nitrous oxide can be amnesia. In other words you may not remember well or zone out for part of the proceedure. This effect is much stronger with IV sedation where there is no pain killing effect but people just don't remember , in general, what happened.
IV is not used in children as it's effects are unpredictable and may make things worse.

In the 90s we were still doing chairside general anaesthetics in general practice . It hasn't been allowed since 2001.
For children we used to induce with nitrous oxide then swap to halothane ,(another gas) although most anaesthetics would have been for a minute or less. For adults would have started with nitrous and then used an intravenous agent , but again they would have been out for no more than a couple of minutes.

Well quite my only memory of my many tooth extractions was the gas mask coming and a tunnel like thing similar to the Dr Who opening credits 🤣

Remember plenty of injections for root canal work though 😳

My 16 year old had 3 removed with Midazolem. No problems and no memory of it.

4 teeth is a lot. I think it should be done under sedation.

We paid in the end as the waiting list at the dental hospital was silly. £550. Best £550 ever spent.

In general in young teenagers iv sedation eg midozalam is avoided as its effects are unpredictable and can actually cause more agitation.

Yes we have only been offered nitrous oxide. Next ste if that doesn’t work is general anesthetic. This is all nhs. Nobody around where we live seem to do this privately for children

The difficulty is nitrous oxide requires scavenging systems (special systems which suck nitrous oxide out of the air ) which are very expensive and most dental practices , unless they specialise in paediatric dentistry , are unlikely to have this.
Private paediatric dental practices are few and far between , I can only think of some in the London and Home Counties area.
IV sedation is not , generally , used in dental proceedures for children , and this is the type of sedation that private practices that provide sedation will offer. Some will be happy to offer to older teenagers depending on size and medical history , but many are not happy to treat children .
As with everything your own dentist will be the best person to ask about private provision in your area.

Yes private doesn’t exist here. I have considered if we may need to travel to london though if the wait list for general is too long.

You will not get a private option for general anaesthetic for a child as this needs to be in hospital , a private hospital would need a max fac surgeon with admitting rights, there are all sorts of extra regulations regarding general anaesthetics for children .
I think there might be one private hospital in the U.K. that possibly could offer , but in terms of cost you would be looking , probably , at a couple of thousand. The day rate for a private hospital bed would be £1200 plus for a start plus surgeon and anaesthetist fees

Dd was offered nitrous oxide. That was much cheaper. I think it was about £175 cheaper.

My NHD dentist found the practices for her. She was referred to the dental hospital but the wait was 18 months.

Unfortunately , in one of the areas I've worked the waiting time for a child general anaesthetic , even if they are in pain, is two to three years and climbing.

Dental decay is the number one reason for a child to need hospital treatment in the U.K.

It’s really terrible the length of the waiting times for this especially for children in pain

I refer to Helen Peterson in the northwest for paediatrics. Private, does GAs, accepts private healthcare plans.

Thanks declutteringmymind that’s great I might make some enquiries there. Much appreciated

It's been like this for years , precovid.
For some reason , for those in power locally as well as nationally , for years dental pain is seen as acceptable in the way that pain in another part of the body isn't. Eg from our local health board I quote "dental pain , no matter how severe , is not an emergency".

The last figures I saw had 480,000 children per year having a general anaesthetic to extract teeth. That figure will be wrong as there has been a massive increase in number of children having general anaesthetics for tooth extraction . https://www.dental-nursing.co.uk/news/huge-rise-in-childhood-tooth-extractions-under-general-anaesthetic

Such a shame.

Has she got admitting rights for paediatric general anaesthetics at a private hospital , do you know? The problem I've had referring is that many cannot admit for paediatric ga.