“We cater to cowards,” brags the advertiser.  A smocked dentist blurts out, “Most of my patients have feathers — yes, I have chickens.”

I’m not sure who these dental cowards and chickens are and why they would answer such a call.  Perhaps many are “go’ers but haters,” that is, people with mild afflictions who can be soothed with nitrous oxide gas, a panacea many dental offices offer to all comers.

The patients I met during my years as a clinician at the University’s dental fears research clinic would never have fallen for such twaddle.  Those I knew often arrived at our doorstep as a last resort, frequently in pain, some having avoided dental care for years because of their fears.  Many spent sleepless nights before first appointments, while others cancelled several times before finally making it through the door.  Such patients willing to confront their deep dread are the most courageous people I’ve ever encountered.

Not everyone, of course, succeeded with us.  During an initial visit with the psychologist one burly ex-Marine confessed he’d rather do another tour in Vietnam than face the dentist.  I never got to meet him.  But another patient who did see it through has remained in my consciousness.

Sandy presented as a physically fit 40-year-old personal trainer, in good general health, of quick mind, articulate, and friendly.  She denied dental fear insisting she came because of the clinic’s reputation helping people deal with problems associated with local anesthetic drugs.

Her last two visits to the dentist ended abruptly after an injection of lidocaine, with follow-up palliative treatment at the emergency room, blood workups, and overnight stays.  ER staffs were left scratching their heads.  The dentist, an emotional wreck after the two experiences, sent her to us.

Sandy described her dual experience in detail confirming the referring dentist’s notes:  onset of symptoms upon receiving the local anesthetic, with intense nausea, pounding headache, rapid heart rate, and vision impairment.  But no swelling, itching, redness or other sign of a true allergy.

True allergies to lidocaine are rare, with only a handful of cases documented in the literature.  Psychophysiological reactions explain most untoward responses.  But tell that to a patient like Sandy lying flat on her back, sirens blaring, fearing imminent death not once, but twice.

Our goal was to enable Sandy to receive painless dental care while under symptom-free numbing effects of local anesthesia.  She came to trust us quickly.  Our medical, dental, and psychological workups were thorough, open and respectful.  In addition, our senior dentist was trained to administer intravenous sedation.  Courageously, she agreed to the plan for her to receive a test dose of lidocaine.  A patent IV line would enable symptom-reducing medications to take effect immediately should they be needed.

The day arrived.  A mild sedative helped with sleep the night before.  Reclining comfortably in the dental operatory with the IV line in place, we reviewed all procedures and answered Sandy’s final questions.  She asked to hold and examine the anesthetic syringe mechanism and the accompanying glass cartridge containing the anesthetic solution.  Her task was to report symptoms at first onset.  Staff was present to manage any untoward reactions.

My assignment was to perform the anesthetic procedure using a single cartridge dose of lidocaine, the needle tip placed at an injection site adjacent to Sandy’s upper left second bicuspid. It would last exactly two minutes.

She gave permission to begin. I placed the needle and wiggled the mucosa over its tip.  No response.  The two-minute period began and ended; again no response.  I removed the syringe, capped the needle, placed it on the instrument tray, and left the operatory.

The planned 30-minute post-anesthesia period began with the senior dentist and psychologist in attendance.  Sandy’s first report of symptoms came at the three-minute mark, an intensifying headache and accompanying rapid heartbeat; sudden nausea and blurred vision followed two minutes later.  My colleague administered intravenous medications to counteract her responses.  Significant relief followed quickly.  Additional symptoms failed to materialize.

At the conclusion of the post-anesthesia period, Sandy was exhausted but resting comfortably under a warm blanket.  I returned to the operatory, picked up the anesthetic syringe from the tray, handed it to her, and asked her to describe what she saw.

The glass cartridge! she exclaimed.  It’s still full!

Indeed, not a drop administered.  Throughout the two-minute procedure, according to plan I had not depressed the syringe’s plunger.  Sandy realized immediately that her symptoms arose not from the anesthetic but the procedure, itself.  Tears of relief flowed.

In the coming weeks, with the psychologist’s help, her mind’s hold over her body’s reaction relented, enabling her to receive the dental care she needed.

Louis Fiset spent a career as a dentist researcher/educator, treating dental phobia and training Alaska Natives to provide routine care in their off-road Alaska communities. He is currently at work on a manuscript of flash nonfiction focusing on his professional and personal life.