I actually lived through all the stages described here (I'm mid 20's) and I live in the Eastern Europe. When I was a child 20-15 years ago, local anesthesia/numbing would not even be even put on the table as an option, then good 10 years ago the doctor would ask if I wanted the numbing - I haven't refused once since then because I knew what the experience was like with no anesthesia. Recently they have been giving anesthesia without asking, which is good.

It really matters at what stage the tooth is in. If the tooth is dead (e.g. you have pain that intensifies to heat, and cold helps)[1] then anesthesia won't make much difference you won't feel a thing anyway.

If you're getting root canal, because cavity is close to the nerve and your dentist don't want to use amalgamated filling then you will need anesthesia, because the nerves are alive.

[1] It gets a bit complicated with molars, which have multiple nerves, if one nerve dies, you'll still need anesthesia for the remaining ones, and you do need root canal, since you can't save part of the tooth and you do need anesthesia, because the tooth is not completely dead yet.

Hmm. Both of mine were on molars and certainly alive, so that explains that.

But I don't know how a dentist could possibly tell the nerves are dead before drilling in. And the way they know is that you say ouch that fucking hurts.

They do hurt you but they don't use a drill at first. I had a root canal done recently and the dentist briefly touched a piece of dry ice to my tooth. He did to a an undamaged tooth first, I guess to see if I could feel pain?

Correct. The doc did it to me.

I had a very dead tooth, and a very alive tooth. Worked like a charm.

My mother had a few done without any kind of anesthesia just few years ago. Painful, but definitely possible to take.

I've had one done without. It's definitely not pleasant.