Today I had to assist a young patient in my practice with the removal of deciduous teeth A & J. The permanent premolars were erupting to the buccal and the lingual roots of the primary teeth had not dissolved. One of the challenges of many procedures that are otherwise straightforward is the need to establish palatal anesthesia. It is amazing to me how many years patients will remember and comment on an injection in the roof of their mouth. Because of this I have been in search of more patient friendly techniques for palatal anesthesia for years. Often I will give the patient the buccal infiltration. Once the labial is profoundly numb I will inject into the facial papilla slowly advancing the needle until the lingual papilla and the gingival tissues blanch indicating palatal infiltration. This approach works great to gain anesthesia for SCRP, crown preps and placing cord on the lingual. However, since the numbness is limited to a cuff of tissue at the sulcus it is not sufficient for an extraction.
Palatal anesthesia is often necessary and one of the most unpleasant things we do for patients. There are a number of ways today to reduce the stick of a palatal injection from using the “Wand” from Compudent to buffering your anesthetic from Onpharma. Even with all this new technology I still find patients hate even the idea of a palatal injection. many years ago I learned a method for obtaining palatal tissue anesthesia without the stick. I follow my routine of beginning with topical gel. I inject a quarter carpule of carbocaine plain as an infiltration. I
I recently received an e-mail from a Dentist in Canada after he read the post I did on October 20, 2011 entitled “Inferior Alveolar Nerve Block”. What prompted the original post was a wave of missing this block in my office. I went back and did some research on how the block works, how often it is effective (or not), and shared some technique tips for increasing how often it works the first time. I will say that incorporating the things from the post made a huge difference for me, and I have not had a “spell” of missed blocks since, just the usual one here and there that doesn’t work.
When I first read Andrew’s E-mail I have to confess in my head I said “Actually I haven’t noticed this.” Of course one of the things that I know about learning is that once I learn something it seems to show up all the time and I wonder how often in the past I simply didn’t see the signs before. Andrew’s e-mail worked the same way. I started observing the tension in the muscles, the feel of the needle penetration, and sure enough it seemed to correlate to the times I had to go in and block a second time.
So the trend in my life for the past week or so has been circling around inferior alveolar nerve blocks, both managing when I miss and answering questions for other dentists about this technique. Periodically over my twenty plus years in practice I hit a spell where I miss this block more often than usual. I have learned over the years that when this happens going back to basics, and reviewing the technique and the current thoughts always helps get me back on track, so that’s what I did this week.
One of the things that helps grow my practice more then any other, is the lengths I go to making sure it is as comfortable as possible when I give anesthesia. Whether patients are anxious about getting the “shot” or not, not one looks forward to it. and all of us brace ourselves in anticipation. Over the years I have continued to refine my anesthetic technique, because over and over patients comment on how surprised and pleased they are by how comfortable it is. When new patients arrive in our office on a referral, we hear over and over that their friends couldn’t believe how little our shots hurt, and how much effort we went to making them comfortable.