Dental Tribune Untited Kingdom Edition

I n the 25 years since I quali- fied, there have been incred- ible advances in dentistry, the equipment we use and the tech- nology that is readily available. However, despite the media-hype that surrounds the latest needle- free dental injections (and there have been several) one has yet to be developed that is as effec- tive at penetrating bone. It is hardly surprising then that most patients’ anxiety is based on the double fear of pain and the injec- tion. Ultimately a local, delivered neatly and carefully will go a long way to dispelling such anxieties and can help build a prac- tice’s reputation for empathetic treatment. Of course, many patients will have suffered a bad experi- ence which, in some cases will be because a local anaesthetic was given too quickly and in the wrong location to an already stressed patient. Some patients even say they are allergic to adrenaline when in all probabil- ity they were given an injection too fast with the adrenaline go- ing intra-vascularly and leading to an uncomfortable tachycardia. The pain of the actual injection varies according to the technique and the anatomical area; infil- trations in the posterior maxil- lary can be almost imperceptible while those in the anterior region or palate can be very tender and much of the pain can be caused by tissue tearing especially in the tightly bound periosteum of the palate. There are many techniques for delivering good local an- aesthetics that also help calm anxious patients and while it would be easy to dismiss some of these techniques as mere place- bos, I firmly believe that patients have the right to be pain free and, as clinicians, we have a duty to fulfil that whenever possible. Topical anaesthetic Studies suggest that the most significantly beneficial factor in using a topical anaesthetic gel is that it helps relax and reassure patients. Although there is some superficial numbing from the gel being placed against the mucosa, the level of penetration is small and of course, there is also the potential for allergy. However, many patients ask for a topical and it may help relax them. In- deed, some dentists often place the topical, then inject a few drops of local and wait before giv- ing the full anaesthetic. Warming the solution There is little evidence that this actually helps ease the sting- ing discomfort of an anaesthetic. This is more likely caused by the pH rather than the tempera- ture. However, it is very simple to warm solutions in special heaters and once again, this approach will help reassure patients and project a caring attitude from the clinician and dental team. Distraction techniques Many practitioners have their own tricks to distract patients during actual treatment, but for a local, there is some evidence that suggests vibrating the lip may reduce pain. There are even several special devices designed specifically for just this task, such as the Vibraject – a vibrating de- vice attached to the syringe. Needle-free systems It is the needle itself that is the most common, overarching rea- son for patient anxiety about injections. Needle-free devices have been developed and are used effectively in other forms of medicine but the problem with dentistry is that the anaesthetic has to penetrate bone, so it has to be delivered under higher pres- sure. The inject system devel- oped for children some years ago, proved unsuccessful as the actual delivery was quite a shock and there could be prolonged bleeds. Slow injection with low pres- sure In my opinion this is the key to delivering great locals for the very simple reason that inject- ing very slowly into an area that is numb can cause very little discomfort. This really is a drip- drip approach as a few drops are injected before the needle is advanced a millimetre or two followed by another few drops. Slowly, slowly advance the nee- dle until it is in the ideal loca- tion. I usually wait a short while before giving the full local. Giv- ing a slow injection very calmly also prevents cardio-vascular problems from giving a local too fast. The Wand, a computer as- sisted local anaesthetic delivery system, can help administer very slow locals under low pressure. Whatever techniques you use, the most important aspect of delivering a local is to calm and reassure the patient, listen to and empathise with their anxieties theninjectcalmlyandslowlymak- ing sure you allow plenty of time for the anaesthetic to work. DT Dealing with injection anxiety Michael Sultan discusses the different types of infections Patients tend to have fear and pain of injections About the author Dr Michael Sul- tan BDS MSc DFO FICD is a specialist in Endodontics and the Clinical Direc- tor of EndoCare. Michael qualified at Bristol Univer- sity in 1986. He worked as a gen- eral dental practitioner for 5 years be- fore commencing specialist studies at Guy’s hospital, London. He completed his MSc in Endodontics in 1993 and worked as an in-house endodontist in various practices before setting up in Harley St, London in 2000. He was admitted onto the specialist reg- ister in Endodontics in 1999 and has lectured extensively to postgraduate dental groups as well as lecturing on Endodontic courses at Eastman CPD, University of London. He has been in- volved with numerous dental groups and has been chairman of the Alpha Omega dental fraternity. In 2008 he became clinical director of Endocare a group of specialist practices. Dr Michael Sultan can be contact- ed for advice regarding patients or any issues raised by his articles on info@endocare.co.uk. For more information please go to www.d-p-s.uk.com To order please contact info@d-p-s.uk.com In four short months our website for the public has attracted more than 500 people who are prepared to leave their present dentist and travel in order to find one with The Wand STA. The Wand STA allows you to easily, quickly and predictably anaesthetise a single tooth, with no collat- eral lip tongue or cheek numbness. Our studies have shown that more than 80% of people prefer The Wand STA to the syringe and are happy to pay a supplement making LA a profit centre. Therefore by investing in The Wand STA you will be able to provide this new standard of service, retaining existing patients and adding new ones. “The Wand really does give great injections in a slow gentle and very comfortable way” - Dr Michael Sultan 40 million injections prove that The Wand works! Do you need new patients? 17CommentMarch 5-11, 2012United Kingdom Edition