Optimal Local Anaesthesia for Dentistry

Abstract

Dentistry is unique in that high-volume surgery is undertaken efficiently on conscious patients, an anathema to most other surgical specialties, who predominantly operate on unconscious patients. Local anaesthesia (LA) provides an efficient block to nociceptive pain (the first stage of the pain pathway) but only addresses one small part of the pain experience. Currently the inferior dental block is the “go to” standard for dental LA for mandibular dentistry, despite its significant short comings. Unfortunately, habit means that we continue to practise what is taught to us at dental school, thus, not developing safer modern LA practice. The dental syringe and deep injections are also the main triggers for fear and anticipated pain by patients expecting their dental appointment. The uptake of infiltration dentistry has been swift in implant dentistry, despite lack of an evidence base, and now other branches of specialty dentistry, general practice is awakening to the advantages of infiltration or “smart” local anaesthetic practices. Inferior dental blocks are inefficient in providing swift pulpal anaesthesia. Stanley Malamed stated: “The rate of inadequate anaesthesia ranged from 31% to 81%, which when expressed as success rates, indicates a range of 19% to 69%. These numbers are so wide ranging as to make selection of a standard for rate of success for inferior alveolar nerve block (IANB) seemingly impossible”. Any block injection is also associated with an increase in the risk of systemic and local complications (including nerve injury), possible heightened medical complications and patient discomfort and fear. Fear of deep dental injections is a key factor in dental anxiety and phobia.