February 1, 2023

I was entering my sophomore year of engineering. This transition year would be taking me from broad-based general education to a more highly-focused mechanical engineering course through advanced studies in mathematics, science and systems. By all measurements, I was well positioned 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 which eventually would see my skills put into practice. At this stage in my studies, I was like a sponge in the ocean soaking up all 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 steady wind which seemed to be pushing me on a definite course. Or so it appeared to me.

It was difficult to conceal 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 was fortunate to share a modest third story attic-like apartment with Steven, a student who was also in engineering, one 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 one could see the familiar Golden arches and where many a university kid caught up on notes, while enjoying the special burger 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 tines a week. Our apartment consisted of a sitting area, a kitchen, a washroom and one bedroom with two single beds. I was beginning to feel more in charge of my life and free to come and go as I wanted. My room mate was friendly but somewhat quiet and deep within his thoughts, or so it appeared to me.

Our schedules were quite different, and we did not have a lot of time together other than the occasional small talk while having a coffee. We were not big on booze but enjoyed the odd beer. He had a part time job at a small computer repair store and would be home usually by midnight. The tempo and the anonymity of the North East were very fascinating and everyday I could feel maturity was seeping into every move I made. I was at ease with myself and happy, especially when I heard from my folks. Although it was never overtly pushed on me, the atmosphere at home during high school was subtlety an expectation of going on to undergraduate school in the East. I was the oldest of my siblings and now that I can reflect, both my parents were lovingly using me as their flagship. “If Jim sets the pace, the others will follow”. I was fortunate in that I did not have to work during my semesters away from home. My mother saw to that. There were to be no excuses for failing grades. I lacked for nothing. However in no way was I pretentious. In fact I was often seen and not heard. Deep within me I knew I was popular albeit, shy. I was no “Brad Pitt”, but confident was I, or so it appeared to me.

It was during our second semester of my sophomore year that I started to have some concern about my room mate. He suffered from bruxism, commonly known as grinding of the teeth, typically accompanied by the clenching of the jaw. It is an oral Para functional activity which is common in many humans. Bruxism (Wiki) is caused by the activation of reflex chewing activity; it is not a learned habit. Through osmosis, I had picked up many dental terminologies over the years from both of my parents. This condition (grinding) was not unknown to me; however the situation was causing me restless nights. I talked to my dad during one of our weekly “how are you” conversations and he suggested that Steven should see a local dentist, because of possibly damage to his teeth. It was not difficult to share my concern with Steven, because his girlfriend also thought he should see a dentist.

We (Steven, his girlfriend Veronica and I) had now become much closer. Steven opened up a bit more and at times could be quite comical. I was seeing the other side of him. We started to hang out on a more regular basis. Steven had appreciated my father’s professional advice and did in fact go to see a dentist associated to our engineering faculty. The diagnosis was confirmed. There was some small initial damage which had started 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 couple of weeks to make sure the protective appliance was fitting comfortably. However the dentist noticed there was an old amalgam filling on his LR bi-cuspid which was overhung and was a floss shredder. The dentist advised Steven it should be replaced with a more modern white filling. Amalgams are for the most part now dated. The trend is to natural color composite fillings. This was good news for Steven because the silver amalgam was a nuisance and unsightly for a youngster. The date was set for the replacement filling and all would be well, or so it appeared to me.

Steven showed up for his 9:00 AM dental appointment which would have given him ample time to get back to class and by noon the anesthetic would have worn off giving him ample time to enjoy his big Mac. However things did not go as was planned. Steven still had a numb jaw and although he tried to disregard 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 in particular, his craving for a Big Mac fix. The dentist reassured him that some people react that way to local anesthetics but the numbness and tingling sensation would soon disappear with a normal return to full sensitivity.

Steven apprehensively took his word, but after day five, the condition had not improved and Steven was in a panic and wanted another opinion. Without knowledge of the total situation my father was privileged only to “hear-say” and cautioned me that it could be a case of paresthesia, which is a potentially serious pitfall for which dentists hope never to encounter during the life of their practice. My dad did not want to be involved for obvious reasons. I was now on the horns of a dilemma. After all Steven was my trusted friend and room mate.

Unexplained paresthesia:

Steven was now withdrawn and depressed. He had lost weight and his essays were suffering. Veronica accompanied him to the guidance counselor and a decision was made that he should see a neurologist. Paresthesia was in fact the diagnosis. This condition was explained to Steven and the prognosis was good because he had a simply and uncomplicated infiltration of the anesthetic and was not exposed to a full nerve block. There were still unanswered questions. Why would this occur?

Around this time a new local anesthetic had been approved by FDA for dental use in the U.S. Unlike most other anesthetic solutions which 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, one could use half the volume of the 4% solution to achieve what the 2% was capable of. For some unknown reason, dentists are in the habit of referring to volume (cartridges) rather than by mg/ml. (actual mg given).

As it turned out, Steven awoke now in its tenth day, to discover the paresthesia had been miraculously reversed and full sensitivity had returned to his tongue and soft tissue around his lip. No point of mentioning where he headed after he discovered there were no more pins and needles. All therapeutic compounds are accompanied with an index. The lesson to be learnt is that the product monographs included in any medication stresses the meaning of Minimal Effective Dose.