 I have recently changed my residence and I found it necessary to also change my dentist. My new dental office is noticeable different from my old one. The first obvious difference is the building which is located on a street with other houses probably built 70 or so years ago. I had been accustomed to a mall or medical/dental building. It is a beautifully well kept house and probably was a dental office in that village for a number of years. The house with its well appointed 9 ft. ceiling moldings and persian rugs covered the beautiful dark oak floors. My new dentist is also much younger than my old dentist. He probably graduated in the nineties and I would guess his age to be in the late thirties, but not yet 40 and he was dressed in a standard shirt and pants rather than the traditional green surgical tunic. In spite of the busy waiting room he was quit relaxed and an air of pleasantry as he went through his patients. My waiting time was about 20 minutes after which I was accompanied in by a middle aged dental assistant who sat me and prepared my bib etc. My appointment was due to a persistent ache in one of my premolars irritated mostly by cold drinks or a cold air. As my first visit there was the usual introduction with notes and a welcome to his office. The operatory was well equipped with pretty well all new gadgets and his background music was classical. Monitors mounted in the ceilings and very modern comfortable chairs. The buzz and chatter was at a minimum as he moved through his diagnostic probing. The usual X-ray was taken digitally and I could see by the ceiling mounted monitor the interior of my mouth as he moved the instrument back and forth within my mouth. He explained an old filling had failed and would have to be replaced with the help of a bit of local anesthetic. The next few processes were unique. I am a gagger and his approach to handle this was quite different. His delivery system of the local anesthetic was nothing I had experienced before. It was prepared by the assistant and I felt nothing. He explained he was against the use of topical anesthetics because they hardly worked and can frequently induce slight allergic reactions such as hives or a rash. He continued to administer the anesthetic but through an instrument similar to an electric tooth brush. There was a tiny sensation of vibration as he held the instrument for about just over a minute. I felt nothing and before the instrument was removed my complete jaw was frozen. I did not feel anything, but my lower jaw felt like a piece of wood. I was solidly frozen. He did not leave my side like my other dentist who would explain that the anesthetic will take about 10 to 20 minutes to work. He continued to remove the old filling and I only knew because he told me so, because I heard nor felt anything like the shrill of a drill. It may have been ablated by laser. A final once over was done to check for a perfect occlusion and I was at his receptionist's desk all completed within a half hour. What was most interesting was the return to full sensitivity in time for lunch although my appointment was at 10:00 AM. The numbness of the lip changed into pins and needles after about an hour and very strangely it disappeared completely in about a couple of minutes although I did have a total block. With my old dentist I usually had a fat lip for about four hours. Now I could enjoy my lunch. My last dentist normally gave me a little pill under my tongue about half hour before I went into the chair because I am very anxious before getting the needle. At my new dentist the pill was not given. He also informed that an effective way to treat gaggers is to use a dab of table salt on the tongue. Salt serves to distract the patient and salted snacks as we all know are pleasing to most taste buds. He also uses oil of cloves rather than the costly cherry flavor benzocaine topical gels since their use is more problematic than the good they offer clinically. The smell, attractiveness and salesmanship of topical benzocaine is very appealing to dental assistants, but what do they do clinically, was his explanation? The question is what does fizzy water do over and above just plain water other than increase your restaurant bill? What was strange about my new dentist was the confidence that exuded. My first impression was that he was not about to get on the tread mill. He was obviously a leader and felt quite confident to break away and practice in a mature community. As a General practitioner it is probably, I am sure he has his back up for specialties of endodontics, periodontics and prosthodontics. He is also very skilled with the computerized delivery system of local anesthetics which delivers at a rate which causes the patient no discomfort at all. As I assessed the situation pharmacologically and there are some in-bred or bad habits practices that need to be worked on by most clinicians. - 1. Like any drug, local anesthetics should be administered by mg/kilo rather than by the numbered of cartridges, since not all cartridges are of the same concentration. E.g We write ibuprofen by mg B.I.D. Not by pills per day.
- 2. Relative maximum dose should be reviewed especially for patients who are less than average weight.
- 3. Absolute maximum dose for patients who are overweight must be strictly followed and never exceeded.
- 4. The urban legend that a bolus injection of a local between 19 and 25 seconds is less painful because a quick in and out is less discomfort. The opposite is true when anesthesia is occurring ahead of the needle. (Dr. Malamed)
- 5. The preferred gage needle is 27 since there is less deflection, aspiration is more easily seen and of greatest importance, patients cannot tell the difference between gage 25, 27 or 30. (Dr. Dan Haas YouTube).
- 6. Slow injections allow for better buffering of the variances in pH values.and greater diffusion.
- 7. Time saved by starting to work immediately adds up to seeing more patients per day and cuts the cost of consumables.
- 8. The stress factor of rushing between operatories carries a cost which cannot be valued.
Comments to localanesthetics@yahoo.ca M.Sc. PharmD. CCPE Please visit WWW.AnestheticNews.com
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