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Dentistry in transition! At face value this is a rather positive impact statement, given the general opinion held by the populace at large. However one must admit there are certain phrases, which our thought processes will not allow our brains to compute. It is like the parent being ambivalent about their kid’s promotion to a higher grade, yet being well aware Johnny’s skills are realistically one or two grades behind. There is the standard form letter, which accompanies this report card. ”It would be psychologically damaging to the kid if we had a ten year old sitting with eight year olds.” That is a fact of life, of which there is little we can do outside of cry victim. I accept that. However the term profound anesthesia is a dental term, referred to in any edition of Dr. Malamed’s handbook on local anesthesia or any other similar textbook. It is as explicit as the term pregnant. One is either pregnant or not. My question obviously then is, why do we hear the explanation, “were it not for the dream team, O.J. would not be playing golf today”. There is an assumption that being completely numb, is like picking a lotto ticket or a good lawyer. To put it bluntly, a hypothesis consists either of a suggested explanation for a phenomenon or of a reasoned proposal suggesting a possible correlation between multiple phenomena (Wiki). For a dentist to truly eliminate residual sensation or even the slightest evidence of pain to the patient requires a pharmacological intervention which is achieved by reversing the polarity charges across the nerve sheath and by so doing, will block sodium transport. In a nutshell that is how the dentist freezes you. There is no magic; smoke, mirrors or even cartridge warmers. In fact, nothing other than the skill and the years of training and understanding certain biochemical interactions and of course the anatomy of one’s mouth. Some dentists can also arrive at the end result, (namely your comfort), by using other techniques to block sodium transport in either one specific area or to one or all quadrants of the mouth. This can be achieved at one sitting. For those patients who still suffer through a dental appointment, you should seek out one of the many thousand of dentists who have mastered that technique. Remember you are either pregnant or not. The same rule applies for being frozen. Now to be fare, the patient can be confused and equate pain with pressure. Pain is felt along the nerve, it is persistent and very recognizable. On the other hand pressure is transient. Its can quickly disappear as it appeared. Pressure will not follow you home and the slight soreness will disappear even without medication in most cases. However, one must accept that we are dealing with variables. Anatomical variables compounded by the ever presence of Murphy’s Law can and does throw a spanner in the works. There will be those challenging days in any dental operatory. Ah! Think of the beauty and the protection for our teeth. Never has our world been so versatile as it is today. Times were when people conversed, it was common practice to place their fingers to cover their teeth or an attempt to conceal mal odor. Dentists have collectively deleted that era with their skills of art knowledge of gum disease. Especially at this time of the year where folks get together to celebrate, it is the confident radiance of wide smiles across the room as though they were saying, “look at the work my dentist did”. These smiles are as fashionable today as it is to tote around a 450 ml of Evian water. Let us not change that trend. The patient must be frozen. Not only soft tissue. However what continues to be unexplainable is the ever-increasing incidences of trauma resulting from achieving profound anesthesia. This is the conflict that one has to deal with when they hear the term “Dentistry in transition”. As one popular dentist explained this scenario to me, “It is this expanding team based reconstructive approach which mandates the use of convergence technologies in order to ensure timely and accurate continuing education. His final tip was to concentrate on moving records, not patients.” If this terminology is aimed at a trend towards cosmetic dentistry and away from the traditional drill and fill, it does not negate the increasing failure to achieve profound anesthesia and the accompanying problems of physical trauma. It should never be a question of how much pain is the patient willing to endure to finally toss the bed-side glass with their dentures to have a permanent set of implants. Pain should never be a bargaining factor. Of course there is a price to be paid, but the patient has already made that decision, whether it be Whitening, Bonding, Porcelain veneers or crowns. The objective should be the same as it was in dental school when you delivered your first ever injection to a fellow student and he/she reciprocated. You made sure you did not cause pain to your buddy and that you did indeed freeze your fellow student. If this situation has changed and failures seem to be on the increase, what has changed? Is it the converging technologies and the accompanying stress of entering un-chartered waters? Why is this? The ability to achieve anesthesia should not be relevant. At any addictive or compulsive behavior center, your first bit of advice one receives is that you are on your way to recovery simply by admitting there is a problem. If this problem is on the rise it may be completely out of your hands, however it still has an impact on your daily activity and unfortunately in dentistry, the denial to communicate will continue to fray that weak spot on the line and one day it will snap. Andy Warhol is credited with the following: “An artist is somebody who produces things that people don't need to have”. Dentists are frequently referred as being artist. Earlier I referred to the beautiful smiles by which we are surrounded today. However there is no need to have to go through hell to acquire this. The action potential of local anesthetics and other agents are the domain of bio-chemistry and pharmacodynamics. While respecting the inevitable convergence of technologies in dental offices in this dynamic profession and life styles, Be kind, take your time. "It sure was good while it lasted". Now it's time to pay the piper. It's all over but the crying. Too late to do anything but moan about it now.” (Chris Kristofferson.) localanesthetics@yahoo.ca M.Sc. PharmD. CCPE
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