Ouch! That hurts….!
Ask any patient as to what he considers a good dental experience, and the response will be immediate – “that which is painless “.So how do we as dentists go about eliminating or minimizing pain? The key here is to know what can cause pain. The answer is that almost everything that is done in Dentistry can be potentially painful.
Take for example, the simplest of actions like the position of the headrest. An extended neck for prolonged periods can be very painful. Starting from here, let’s move on.
Keeping the mouth open for procedures is uncomfortable and tiring. Mouth props can be of great help here. We need to give due thought to our every move and it is then that we realize that the head and neck – our domain of work- is undoubtedly, the most vulnerable and delicate part of the body.
Minor procedures like cheek retraction or placement of impression trays are all capable of causing pain. Among others, the needle is dreaded by one and all. Compounded by previous experiences and present fear, an injection is not something anyone will look forward to.
This article focuses on techniques and locations for local anaesthesia for a host of commonly performed procedures.
To begin with, it is important to choose to administer L A for almost every procedure. This avoids the element of surprise for the patient.Removal of a provisional crown, scraping away cement from a tooth, crown preparation for even an endodontically treated tooth or for crown and bridge cementation procedures all need to be numbed. The routine use of a topical anaesthetic gel prior to injecting is highly recommended. Care is to be taken to avoid those locations where the gel could be swallowed and cause temporary numbness in the throat. This will create a panic reaction.
The gel can be rubbed in with a gloved finger or applied with a cotton bud and then wait for at least 2 minutes to allow penetration. The needle itself – the thinner the better- is advanced very slowly so as not to stretch the tissues .and cause pain.
The cheek or surrounding area is moved up and down or jiggled to divert attention. Draping or pulling the muscle over the tip also minimises pain of the advancing needle. It is necessary to also note the direction of the needle. Patients have experienced numb noses and ears due to angulation errors.
As pointed out earlier, when is LA to be given? The answer? Almost every time!
Here is my preferred location / situation list:
- All carious lesions, from buccal pits to complex lesions: The Dentino- enamel junction is a sensitive zone. Administer buccal infiltration for the maxilla and a block for the lowers.
- Vital teeth preparation: Maxilla: Buccal infiltration only. Mandible: Inferior alveolar nerve block.
- Non vital teeth preparation: Buccal Infiltration only, for both upper and lower jaw.
- Root canal therapy: Maxilla: Almost 95 percent of the time, buccal infiltration is needed. Mandible: Inferior alveolar nerve block.
- Periodontally affected mobile teeth: In addition to standard protocol, a crestal anaesthetic (CAT) directly into the PL allows for a pain free extraction. Such infected teeth are often not completely numb on account of ParaAmino Benzoic acid present.
- Deep scaling, Removal of temporary or permanent cements, treatment for cervical erosions all need to receive infiltration in both jaws.
- Contrary to popular claim by laser manufacturers, an anaesthetic is absolutely necessary for non-invasive laser assisted procedures as well. I routinely inject for all hard and soft tissue laser procedures. It also puts patients at ease.
- Extraction and other surgical procedures: The recommended and appropriate blocks are to be administered.
Post-operative instructions during the recovery to normal state are very important. Many traumatic painful ulcers occur from a lack of instructions.
Local Anaesthetics are great adjuncts for us to practice painless and perfect Dentistry. Why not adopt it for a better experience for both the dentist and the patient?
Try it!
-Dr. Vijailakshmi Acharya
February 1, 2022