welcome to the local anesthesia strategies module it's pretty tough to do anything in crown and
bridge without first giving some local anesthesia and so hopefully we will get profound anesthesia
and it would also be nice if it didn't hurt the patient or stress out the patient too much
all the surveys i've seen when they ask people what are your stressors
about going to the dentist it's the injection and and it's the handpiece um we're going to have to
use the handpiece and we are going to have to give objections but there's probably some ways we can
reduce injection pain uh at a base minimum i saw what my dad used to do i remember coming down from
dental school and watching him practice and he would grab the patient's lip and he didn't use
any topical i mean certainly topical it existed for we were using it in dental school up in
dental school but he would just grab their lip and he was pretty violent about the shaking that
that he would do there i mean it wasn't just you know some kind of gentle shaking it was
you know violent like stretching the lip almost to its limit so i didn't see him tear many freenums
as he was doing this when i give multiple carpools this one minute per carpel is really just for the
first carpool and then i go much quicker on the second and third carpools because at this point we
don't have to take quite so much care is that same pathway as our anesthetize and the patient's not
feeling it my dad on the other hand was far closer to one second per carpel and you think i'm kidding
but he really he had this uh amazing ability to just empty a carpool very quickly during the show
you'd have the earth the oral earthquake going on from him and then he would just quickly go to the
hub the needle's in and as the needle penetrated and went to the hub that's when you would give
the anesthetic and kind of come back out in one movement it's remarkable if you ever try
that technique it's very difficult to do he was left-handed as well but had a very talented left
hand and so he could just go and boom and then out again and it was done i've tried it too many times
end up squirting the anesthetic too soon onto the patient's face or other times i go in and out and
i go that was pretty good and i realized i didn't move the anesthetic at all i just went in and out
during the shaking so it's tough to do i was taught one minute and that's what i stick by i
feel that's a much easier way to be able to do it than that one second technique that he would use
so let's look at some devices for possibly reducing injection pain
this is the denta vibe pretty much all of these are are doing the same thing my dad was
but in a much less violent way so you know rather than grabbing someone's lip and attempting to tear
it off the periosteum and their skull these are also going to stimulate those fibers and
hopefully so that they can't feel it through the pain fibers i was really worried about giving
painless injections long before there were yelp reviews of dentists online and you know when it
comes to things like that or asking patients for positive reviews i think this is a really good way
to be able to do something like this the wand by milestone scientific it basically forces you to
give a slower injection i don't have the heart or the intestinal fortitude to give three separate
injections on a patient and that's kind of become my technique for not missing blocks i just don't
think i was using enough local anesthetic for the first 15 years of my career so being able
to actually give three cartridges of light two percent lidocaine one to a hundred thousand epi
but only have one penetration with the needle is certainly a patient friendly strategy there's
also buffered local anesthetics and these are not something that you're gonna probably need every
day that you're in your practice but when you do need them you're going to be really glad that
you have them and so when do i like to use this my mother was a great example and maybe that's
the reason why i feel passionate about these she was very difficult to numb she was fair-skinned
she was red-haired i've seen in the literature sometimes that these people are difficult
it's heartbreaking with your own mother you're trying to show off and look like you know what
you're doing and it's not working very well as you'll see with with all these buffered anesthesia
cost is one of the reasons why people probably don't use it on more of a daily basis because
otherwise it's hard to find really anything negative to say about these except for the
cost and there there is a significant cost here's another one this is a nutra from a nutra medical
and in this one you're actually doing batches of buffered lidocaine for example instead of
just doing it carpool by carpool the gal gates technique i didn't learn it in dental school
and the more dentists that i talk to i don't find that many dentists that have learned it
um in dental school even today and one day here at the laboratory we had kathy bassett who is a
local anesthesia instructor for a dental hygiene school up in washington and as we were talking
um she had heard of the lab and wanted to take a tour and i was asking her about injections
and i i mentioned the gal gates and uh i said you know i'm sure you don't teach that to your
hygienist and she said no we do i said you do she said oh absolutely everybody for years everybody
who's graduated from there all the hygienists know how to give a gal gates and there was
another dentist here at the time and she had just graduated from dental school two years earlier
and i said you just graduated did you learn how to give a gal gate she said no i did not i was like
this is crazy that the hygiene why are the hygienists being taught this
not that that's anything wrong with that but why aren't we as dennis being taught this i can see i
got out in 88 that's one thing but this dentist who graduated two years ago i thought it was
crazy and so i had this idea i turned to kathy i said will you teach me how to give a gal gate she
said sure and i looked at the dentist i said will you let me give you the gal gate she said love to
and it was just kind of this serendipitous moment where we decided that i would learn live
on camera how to give a gal gates injection for the first time which has a miss rate of you know
one to three percent at most compared to the 25 percent with the halstead technique so what i'd
like to share with you right now is kathy bassett instructing me and teaching me and i want you to
watch me give my first gal gates injection and how easy this seems so when i come in i want to
choose the height of my penetration in respect to the mesiolingual cusp of the molar okay well i'm
really happy i got a positive aspiration on my first one a with you here and b um
you know just to see how to you know just a little nice refresh on how to handle it well
wow look at that i got bonus maxillary anesthesia in addition to the gal gates that's no more
difficult to give than a a standard ia technique that we're taught in school so as long as kathy
was here and i had my willing participant of a dentist in the chair i asked her if she would
show me or teach me how to do the anterior middle superior alveolar injection and here's how that
went well kathy the great part about you being here is i get to do another new injection for
the first time with your guidance and uh you didn't even grab my hand during the gal gate
so it was pretty awesome so purrier instructions we're looking for where the curvature meets the
flatter aspect of the pallet right across or right in between say the two bicuspids so right in here
and you mentioned pushing around and so again we're coming we just want we kind of as you said
park the bevel against the bone so it's not coming across like this where we would hit the tip first
and the bevel wouldn't be against the bone we want to kind of make sure that that angle the bevel is
going to be right against the bone as you met as you mentioned and if you can turn it this way we
can get it and you can see the blanching from the mesial per second through to her first bicuspid
look at that have you ever blanched a pallet like that that's pretty cool that made me feel powerful
for some reason we should have the blanche palette challenge where maybe we can all kind of like the
ice bucket challenge or something but so as we close out this module on on local anesthesia
you know i'd ask you to take a look maybe starting with your topical technique you know could you be
more precise if you use the varnish or the patch or would you like to upgrade to the stronger one
because you're not happy with your benzo canes and maybe get the one that's got the tetra cane
in it and are you gonna look into things like upgrading your lower block technique you know
are you missing it kind of 20 to 25 percent of the time like the literature says where you're having
to come back and give multiple carpools and now you're behind schedule waiting for somebody goes
uh i can't tell if i'm i'm number not that gal gates technique it might seem scary initially
you know for where we're heading for the condyle with that injection but i'm here to tell you it's
no different than that lower block and you you get to have the confidence of knowing that the success
rate is much higher at 97 98 so why wouldn't we use something like that rather than having to
go back again and if you do anterior cases with multiple teeth take a look again at that amsa
injection what a fantastic way to get profound anesthesia on multiple teeth so when it comes
to crown and bridge certainly local anesthesia is a big part of it and i hope you're going to
spend the time and and find the ways to make it less painful and more effective for the patient
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so when we take a look at the cost of buffered low end it look