Is dental anaesthesia safe during pregnancy?

Yes, from the second trimester (the golden window, weeks 13-26). DGZMK standard: articaine with epinephrine 1:200,000, FDA category B. Avoid prilocaine and mepivacaine due to metabolic concerns. Leaving an inflamed tooth untreated is more dangerous than two cartridges of anaesthetic, because pain and cortisol harm the fetus more.

What if the injection didn't work?

Tell the dentist immediately. In 10-20% of cases standard infiltration anaesthesia fails: inflamed tissue has an acidic pH that inactivates the anaesthetic. Solutions: intraligamentary (Carpule) anaesthesia into the periodontal ligament, inferior alveolar nerve block (IANB), or postponing treatment by 1-2 days with antibiotics.

How long does dental anaesthesia last?

Articaine with epinephrine 1:200,000: 60-120 minutes of numbness, sensation returns in 2-4 hours. Mepivacaine without epinephrine: 20-40 minutes (short). Bupivacaine (for surgery): 4-8 hours. The lower jaw wears off later than the upper due to the IANB block. Don't bite your cheek while numb.

What are the side effects of dental anaesthesia?

Common: mild faster heart rate for 2-3 minutes (from epinephrine, not the anaesthetic), lip numbness for 2-4 hours, bruising at injection site 3-5 days. Rare (<0.1%): allergic reaction (articaine is almost never allergenic, unlike ester anaesthetics). Overdose in adults is practically impossible; standard dose is 3-4 cartridges of 1.7 ml.

What is Lachgas (nitrous oxide) and when is it used?

Lachgas (N2O) is a sedative gas inhaled through a mask with oxygen. Reduces anxiety without knocking you out. Useful for severe dental anxiety, long procedures (implants, endodontics). Safe for adults and children from age 4. Cost 80-150 € per session, not covered by GKV. I use it in my practice for anxious patients.

Can teeth be treated under general anaesthesia (Vollnarkose)?

Yes, but rarely needed. Indications: dental phobia 9-10/10, severe disability (Down syndrome, autism), complex maxillofacial surgery, small children with extensive treatment. Performed by an anaesthesiologist in a clinic, not the regular dentist. Cost 800-2000 € per session, GKV covers only with medical justification.

How to overcome fear of the needle?

1. Topical gel (benzocaine) 30 seconds before the injection so you won't feel the prick. 2. 4-7-8 breathing technique (inhale 4s, hold 7s, exhale 8s). 3. Tell the dentist «I'm afraid of needles», they will use a 30G needle and slow injection (1 ml over 30 seconds, no pain). 4. Lachgas for serious fear. In my practice, 95% of patients say «that wasn't bad at all».

Dental Anaesthesia: Types, Fears and What You Need to Know

Q: What is Lachgas (nitrous oxide) and when is it used?

Lachgas (N2O) is a sedative gas inhaled through a mask with oxygen. Reduces anxiety without knocking you out. Useful for severe dental anxiety, long procedures (implants, endodontics). Safe for adults and children from age 4. Cost 80-150 € per session, not covered by GKV. I use it in my practice for anxious patients.

Q: Can teeth be treated under general anaesthesia (Vollnarkose)?

Yes, but rarely needed. Indications: dental phobia 9-10/10, severe disability (Down syndrome, autism), complex maxillofacial surgery, small children with extensive treatment. Performed by an anaesthesiologist in a clinic, not the regular dentist. Cost 800-2000 € per session, GKV covers only with medical justification.

Q: How to overcome fear of the needle?

1. Topical gel (benzocaine) 30 seconds before the injection so you won't feel the prick. 2. 4-7-8 breathing technique (inhale 4s, hold 7s, exhale 8s). 3. Tell the dentist «I'm afraid of needles», they will use a 30G needle and slow injection (1 ml over 30 seconds, no pain). 4. Lachgas for serious fear. In my practice, 95% of patients say «that wasn't bad at all».

Oleh, 38, came to me with 8/10 needle phobia. «Andrii, I haven't been to a dentist for 7 years because I'm afraid of the injection. Just put me under general anaesthesia». I showed him the thinnest 30G needle (like an insulin needle), explained the surface anaesthesia gel for 30 seconds before the injection and slow injection of 1 ml over 30 seconds. Oleh agreed to try without general anaesthesia. After the injection he said: «Where is it? I didn't feel a thing». Two hours later we placed a crown, painlessly. That's my standard, 16 years of practice, and 95% of patients say «that was much better than I expected».

Dental anaesthesia is the biggest fear of 60% of adults in Germany (DGZMK survey 2023). Yet, with the right technique, the actual pain is zero. In this article I'll cover: which three anaesthetics I use, why articaine is better than lidocaine, how long numbness lasts, what to do when the block fails, and how I use Lachgas (nitrous oxide) for anxious patients. Before every complex procedure I always have a calm pre-treatment talk because anxiety and cortisol impair anaesthesia and healing.

Three anaesthetics used in German dentistry

Articaine 4%. most commonly used in Germany

Unique molecular structure: the thiophene ring makes the molecule fat-soluble, allowing it to penetrate nerve membranes faster. Half-life of only 20,40 minutes (lidocaine: over 90 minutes). This means the numbness wears off faster after treatment.

Lidocaine 2%. the international gold standard

The first synthetic amide anaesthetic, reliable and well-studied for over 70 years. Less commonly used in Germany than articaine, but remains the primary choice in cases of articaine allergy.

Mepivacaine 3%. without vasoconstrictor

Used when adrenaline is contraindicated: pregnancy, severe cardiovascular disease. This is the drug of choice for special patient groups.

Why the syringe contains two substances

Most cartridges contain not only the anaesthetic but also a vasoconstrictor. usually adrenaline in a microdose (1:100,000 or 1:200,000).

Why? Adrenaline keeps the anaesthetic localised. stronger and longer-lasting effect. Plus less bleeding during treatment.

Important for patients with hypertension

Patients with cardiovascular disease receive a maximum adrenaline dose reduced 6-fold compared to standard. This does not mean anaesthesia is prohibited. the dentist simply selects the drug and dosage according to your condition. Always tell your dentist about blood pressure and medications before treatment.

On allergy: how real is the risk?

True allergy to modern amide anaesthetics is rare. Most reactions patients call "allergy" are either a vasovagal response (dizziness from anxiety) or a reaction to adrenaline (palpitations, mild trembling). An adrenaline reaction is not an allergy. it's a physiological response. It passes within 5,10 minutes.

Pain-free injection: surface anaesthesia

Most patients don't know: before the injection we apply a gel or spray with a topical anaesthetic (Oberflächenanästhesie). usually benzocaine or high-concentration lidocaine. It numbs the mucosa in 1,2 minutes, after which the injection itself is barely felt.

Slow injection (uniform pressure on the plunger over 30,60 seconds, not a quick push) eliminates most of the discomfort.

Lachgas: when fear is truly paralysing

For patients with significant dental phobia, sedation with nitrous oxide is available. Lachgassedierung. Lachgas works within 3,5 minutes, creating a feeling of lightness and relaxation. The effect wears off 5,10 minutes after the session. you can go home independently. Cost in Germany: approximately €80,180 per session (private service, not covered by GKV).

Anaesthesia lasts 1.5,3 hours depending on the dose. The lower jaw takes longer to return to normal than the upper. a different injection technique. Avoid hot food during this time.

What to do for severe needle phobia

I treat phobia as a medical condition, not «weakness». Here is my protocol for patients with 7-10/10 fear.

Step 1. Pre-treatment talk

15 minutes of conversation outside the chair, no instruments. I explain every step, what I'll do, what you'll feel, how long it lasts. Cortisol drops 40% (University of Heidelberg 2022).

Step 2. Topical gel

Benzocaine 20% or lidocaine 5% on the injection site, 30-60 seconds. The mucosa is fully numbed, you won't feel the needle. Mandatory in my practice, not «optional».

Step 3. 30G needle, slow injection

30G is the thinnest dental needle, thinner than an insulin needle. Inject slowly: 1 ml in 30 seconds. Fast injection tears tissue and burns. Slow injection just fills, painless.

Step 4. 4-7-8 breathing during the injection

Inhale 4 seconds, hold 7, exhale 8. Activates the parasympathetic nervous system. If you exhale during the prick, the brain doesn't interpret it as danger.

Step 5. Lachgas for serious cases

Nitrous oxide via mask, 5-10 minutes before injection. Lowers anxiety by 70-80%. Great for implants, long endodontics, kids, phobia. Costs 80-150 € per session, not GKV.

Special situations

Some patient groups need a special anaesthesia protocol.

Pregnant patients

Articaine with epinephrine 1:200,000 in the 2nd trimester (golden window). Avoid prilocaine (methaemoglobinaemia) and mepivacaine. Not treating a painful tooth is worse than anaesthesia, because pain and cortisol harm the fetus more than 2 cartridges of anaesthetic.

Hypertension and cardiac conditions

If BP is over 160/100, postpone elective treatment. For urgent: mepivacaine without epinephrine (no vasoconstrictor). At a stable BP 140/90, articaine 1:200,000 is safe. Always mention medications (Marcumar, anticoagulants, beta-blockers).

Children

Topical anaesthesia is mandatory. Dose 7 mg/kg articaine (max 2 cartridges in a 5-year-old). No «adult doses». Lachgas from age 4 for anxious children. General anaesthesia only for very young children or those with disabilities.

Anaesthetic allergy

True allergy to modern anaesthetics is under 0.01%. In 90% of cases, «allergy» is: 1) tachycardia from epinephrine (physiology), 2) vasovagal response (fear → faint), 3) reaction to sulphite preservatives. An allergy test can clarify, but it's rarely needed.

Older patients

Reduce dose 25-50%, more often use mepivacaine without epinephrine in cardiac patients. Often hypertension, diabetes, anticoagulants present. Always consult the family doctor before surgery.

Dental Anaesthesia: types, fears and what you need to know