Spot-On Local Anesthesia Technique by Richard L Lepard, DDS

 

One of the most frustrating aspects of dentistry for even the most experienced e xperienced of practitioners is difficulty attaining attaining local anesthesia with the the mandibular teeth. It is commonly known that, according to the study you read, only 80 - 85% of mandibular blocks are successful. When they are not it:

1. Create Createss anxi anxiety ety in the patien patientt 2. Frus Frustr trat ates es the the den denti tist st 3. Puts undue undue pressure pressure on the the daily schedule schedule of of the patient patient and the dentist dentist due to "having "having to wait on it". 4. Requires Requires the dentist dentist to to try to achieve achieve the requir required ed level of comfor comfortt by the addition addition of  of  much more medication which is not helpful to the patient. I have actually had patients come to me with stories of the dentist de ntist dismissing the patient to reappoint to another day due to the patient not getting "numb". 5. Gives additiona additionall risks of increas increased ed heart rate due due to inadvertent inadvertent arterial arterial infection infection or   paresthesia from mandibular nerve trauma. 6. Increa Increases ses the risk risk of a hemat hematoma. oma. Advantages of the "spot on technique" are:

1. Instant Instant anesthesia anesthesia,, therefore therefore you can can begin treatmen treatmentt immediately immediately.. 2. Less Less medicat medication ion is admin administ istere ered d to the patien patient. t. 3. It is more more comfortabl comfortablee than the the mandibular mandibular block. block. Many times times a patient patient will ask "Did "Did you give me a shot?" 4. A more more profound profound anesthesi anesthesia. a. Many times times patients patients will will exclaim exclaim that this this is the the first first time they have been truly numb on that side. I commonly hear that a previous previous dentist had told them that "it is just them, and that they are hard to numb." 5. Fewer traumas traumas than intrao intraosseus sseus techniques. techniques. I have seen seen tissue tissue sloughing sloughing with this this route. route. Armamentarium:

1. An intraliga intraligamentar mentary y syringe. syringe. My choice choice is the the style style that is is index finger activated activated vs. the the

2. 3. 4. 5. 6. 7.

 pistol grip.doses It tends to be easier to control and seems to be easier to get the "clicks" indicating administered. A 30 30 gauge gauge extr extraa shor shortt needl needlee 4% Arti Articai caine ne with with 1:100,0 1:100,000 00 epineph epinephrin rinee 4% Pr Pril iloca ocain inee HCl HCl plai plain n A stan standar dard d syring syringee with with a 30 gauge shor shortt needle needle Possibly Possibly most most important important is is a compounded compounded triple triple topical topical anestheti anestheticc mix of benzocaine, benzocaine, lidocaine and tetracaine. A ca carp rpul ulee war warme mer  r 

The Technique Technique is as follows: Give five minutes to allow the topical to do its its job. Apply to the vestibule as well as the entire buccal gingival margin of the tooth. With the S Standard tandard syringe, slowly inject 4% prilocaine prilocaine plain in the vestibule. This should be practically imperceptible to the

 patient. Next slide the 30 gauge needle under the free gingival margin. margin. The idea is literally literally to

 

drip the anesthetic into the area with a slight pressure. pressure. Increase this action to moderate pressure going from line angle to line line angle of the buccal of the tooth. tooth. Be sure to keep aspiration active the entire time as leakage will occur and to avoid the bitt bitter er taste. Copious water rinses help here as well.  Next using the intraligamentary syringe with 4% Articaine with 1:100,000 epinephrine slowly engage the bifurcation on the buccal. The feeling you should have is moderate pressure or  squeezing that is required to force the solution into the space of the periodontal ligament. You should get a click as each dose is administered. Normally 4 to 5 clicks per site are sufficient. It is very important to get the feel as the technique requires you to get into this specific area. Anatomical differences in the height of the furcation relative to the free gingival margin can require you to adjust the angle to approximately 45 degrees. Picture the needle as sl sliding iding into the area. I prefer to to repeat the process process at the line angles in a similar fashion. Again, if done  properly,, with lighter pressure to start increasing pressure in the last couple of clicks the patient  properly should have little difficulty noticing any of the traditional feelings of a "shot". On rare occasion, the tooth may require the same process on the lingual repeating the steps outlined above. It is a wonderful feeling to be able a ble to achieve patient comfort without their lips and tongue feeling swollen for 3 to 4 hours. We all dislike hearing our patients say "I just hate that numb feeling". The majority of the time our patients are referring to the after effects effects of the traditional mandibular block - and it may have been only 90% effective! It is a difficult process process to get a referral from one of our patients who had to endure pain of any kind during dental treatment. In summary the Dr. Richard Lepard Spot-On Local Anesthesia T Technique echnique gives you profound anesthesia with less medication, freedom from anatomical areas of complication, i.e. hematomas or parathesis in the mandibular nerve complex. co mplex. It further removes the variance of the angle of the mandibular as influence of "missing the block." It is a way to WOW your patients and de-stress your day with another successful local anesthesia experience. You can read more of Dr. Lepard's articles through his website TravisWalkDental.com or his  blog  DallasDentistBlog.com  blog Dr. Dr. Richard L. Lepard has been practicing for 30 plus years here in  practice, Travis Walk Dental, Walk is among the dentistry leading cosmetic dental offices in Texas. Dallas,His TX.dental Dr. Lepard is an expert in cosmetic c osmetic and sedation dentistry with thousands of hours in continuing education from leading dental societies.