Nusstein Reader Successful Drum Local Anesthesia Successful Local Anesthesia FOR RESTORATIVE DENTISTRY AND ENDODONTICS About the Authors Dr Al Reader received his DDS from The Ohio State University Col- lege of Dentistry in 1971. He com- pleted his endodontic training at The Contents FOR RESTORATIVE DENTISTRY AND ENDODONTICS Fear of pain is the number one reason people give for not making regular visits to the dentist. At Second Edition the same time, a majority of dentists report ex- 1 Ohio State University in 1975, earn- periencing anesthesia-related problems during ing his certificate in endodontics and an MS for research involving pulpal Clinical Factors Related to Local Anesthesia restorative dental procedures. If dentists are able nerve innervation.
Dr Reader is a to administer successful local anesthesia, patient 2 Diplomate of the American Board of Endodontics and has served as its director. He currently is a professor Mandibular Anesthesia Al Reader, dds, ms compliance and satisfaction are likely to improve. emeritus and a past program director Pulpal anesthesia is a vital part of the delivery of the Advanced Endodontic Program in the Division of Endo- dontics. He has authored more than 150 scientific articles and 12 chapters in the leading endodontic texts.
His main focus of 3 Maxillary Anesthesia John Nusstein, dds, ms Melissa Drum, dds, ms of dental care for restorative dentists and en- dodontists. Administration of local anesthesia is invariably the first procedure they perform and it 4 research is local anesthesia and pain control. Dr John Nusstein received his Supplemental Anesthesia affects everything they do thereafter. If the pa- tient is not adequately anesthetized, difficulties DDS from the University of Illinois College of Dentistry in 1987.
He inevitably arise. served in the United States Air Force and completed his endodontic train- ing at The Ohio State University in 5 Clinical Tips for Management of Routine Restorative Procedures This book will help you successfully anesthetize your patients using the newest technology and 1995, earning his certificate in en- dodontics and an MS for research drugs available. It presents the rationale, advan- involving intraosseous anesthesia. Dr Nusstein is a Diplomate of the American Board of Endodontics.
6 Endodontic Anesthesia tages, and limitations of the various anesthetic agents and routes of administration. A special emphasis is placed on supplemental anesthetic He currently is a professor and holds the William J. Meyers techniques that are essential to the practice of 7 Clinical Tips for Management of Specific Endowed Chair in Endodontics at The Ohio State University College of Dentistry. He has authored more than 85 scientific dentistry.
articles and 8 chapters in the leading endodontic texts. His main focus of research is local anesthesia and pain control as Endodontic Situations well as ultrasonic irrigation. Dr Melissa Drum received her DDS from the University of Minne- sota School of Dentistry in 2004. She completed her endodontic training at Second Edition The Ohio State University in 2006, earning a certificate in endodontics and an MS for research in pain con- trol.
Dr Drum is a Diplomate of the American Board of Endodontics. She currently holds the Al Reader Endowed Professorship in Endodon- tics at The Ohio State University Col- lege of Dentistry, where she is an associate professor and the director of the Advanced Endodontic Program. She has authored more than 60 scientific articles. Her main focus of research is local anesthesia and pain control.
Successful Local Anesthesia for Restorative Dentistry and Endodontics, Second Edition www.com Successful Local Anesthesia FOR RESTORATIVE DENTISTRY AND ENDODONTICS Second Edition Al Reader, dds, ms Emeritus Professor and Past Director of the Advanced Endodontic Program College of Dentistry The Ohio State University Columbus, Ohio John Nusstein, dds, ms Professor and Chair of the Division of Endodontics College of Dentistry The Ohio State University Columbus, Ohio Melissa Drum, dds, ms Associate Professor and Director of the Advanced Endodontic Program College of Dentistry The Ohio State University Columbus, Ohio 97% Chicago, Berlin, Tokyo, London, Paris, Milan, Barcelona, Istanbul, Moscow, New Delhi, Prague, São Paulo, Seoul, and Warsaw www.com Dedication This book is dedicated to the current and former endodontic graduate students who shared our goal of profound pulpal anesthesia. Library of Congress Cataloging-in-Publication Data Names: Reader, Al, author. | Nusstein, John, author. | Drum, Melissa, author.
Title: Successful local anesthesia for restorative dentistry and endodontics / Alfred Reader, John Nusstein, Melissa Drum. Description: Second edition. | Hanover Park, IL : Quintessence Publishing Co Inc, [2017] | Includes bibliographical references and index. Identifiers: LCCN 2016045951 (print) | LCCN 2016046585 (ebook) | ISBN 9780867157437 (softcover) | ISBN 9780867157505 () Subjects: | MESH: Anesthesia, Dental | Anesthesia, Local--methods | Dental Restoration, Permanent | Root Canal Therapy Classification: LCC RK510 (print) | LCC RK510 (ebook) | NLM WO 460 | DDC 617.9/676--dc23 LC record available at https://lccn.gov/2016045951 97% ©2017 Quintessence Publishing Co, Inc Quintessence Publishing Co Inc 4350 Chandler Drive Hanover Park, IL 60133 www.com 5 4 3 2 1 All rights reserved.
This book or any part thereof may not be reproduced, stored in a retrieval system, or transmit- ted in any form or by any means, electronic, mechanical, photocopying, or otherwise, without prior written permis- sion of the publisher. Editor: Leah Huffman Design: Erica Neumann Production: Angelina Schmelter Printed in the USA www.com Contents Preface vi Acknowledgments viii 1 Clinical Factors Related to Local Anesthesia 1 2 Mandibular Anesthesia 41 3 Maxillary Anesthesia 93 4 Supplemental Anesthesia 121 Clinical Tips for Management of Routine 5 Restorative Procedures 153 6 Endodontic Anesthesia 165 Clinical Tips for Management of Specific 7 Endodontic Situations 213 Index 227 www.com Preface Why do patients avoid going to the dentist? According to a survey by the American Dental Associa- tion,1 fear of pain is the greatest factor that prevents patients from visiting their dentist. Additional surveys2,3 have found that 90% of dentists have some anesthetic difficulties during restorative den- tistry procedures. Because adequate pulpal anesthesia is a clinical problem, we and other authors have performed a number of research studies on local anesthesia over the last 30 years.
We are excited to present some of these findings in this book. From the Latin word patiens, the word patient in English originally meant “one who suffers.” Unfor- tunately, some patients may still “suffer” when visiting the dentist. Our goal is to reduce pain and manage it successfully. That being said, profound pulpal anesthesia is a cornerstone to the delivery of dental care.
Administration of local anesthesia is one of the most common procedures in clinical practice. It is invariably the first procedure we perform, and it affects almost everything we do dur- ing that appointment. If the patient is not adequately anesthetized and you have some extensive restorative work planned, difficulties arise. The information in this book explains why problems oc- cur and offers clinical solutions to help clinicians stay on schedule.
Fortunately, local anesthesia has evolved tremendously over the last 25 years just as the materials and techniques have evolved in restorative dentistry and endodontics. The current technology and drug formulations used for local anesthesia have made it so much easier to treat patients success- fully. We now have the ability to anesthetize patients initially, provide anesthesia for the full appoint- ment, and reverse some of the effects of soft tissue anesthesia if desired. Priceless! This book covers the research-based rationale, advantages, and limitations of the various anes- thetic agents and routes of administration.
A special emphasis is placed on supplemental anesthetic techniques that are vital to the practice of dentistry. However, this book does not cover the basic techniques utilized for the delivery of local anesthetics because that information is readily available elsewhere in textbooks and other publications. In addition, this book emphasizes information for the restorative dentist and endodontist because the requirements for pulpal anesthesia are different than those for oral surgery, implant dentist- ry, periodontics, and pediatric dentistry. Eighty-five percent of local anesthesia teaching in dental school is done by oral and maxillofacial surgery departments,4 and while they do an excellent job, it is sometimes difficult for oral surgeons to appreciate the requirements for pulpal anesthesia in re- storative dentistry and endodontic therapy.
Furthermore, we should value our experience. Whereas education is what you get during your training, experience is what you get afterward. A young prac- titioner knows the rules, but an older practitioner knows the exceptions. Experience is a wonderful thing that enables us to recognize a mistake when we make it.
Throughout the book, the information has been divided into specific topics so it is understand- able and easy to reference. When indicated, summary information has been provided. References to published literature are included in the chapters because clinicians within the specialty of end- odontics (of which we are members) communicate with each other by quoting authors and studies. We also think it is important to credit the authors for their contributions to the literature on local anesthesia.com This book is a clinical adjunct to help you successfully anesthetize patients using the newest tech- nology and drugs available.
Indeed, the information presented here will help you to provide painless treatment. Pulpal anesthesia is emphasized throughout this book. That is, pulpal anesthesia is re- quired by the restorative dentist and endodontist in order to perform painless treatment. We think that is a worthy goal for the dental profession.
However, as Will Rogers once said, to be successful, you must know what you are doing, like what you are doing, and believe in what you are doing. Influences on dental visits. Kaufman E, Weinstein P, Milgrom P. Difficulties in achieving local anesthesia.
J Am Dent Assoc 1984;108:205–208. Weinstein P, Milgrom P, Kaufman E, Fiset L, Ramsay D. Patient perceptions of failure to achieve optimal local anes- thesia. A survey of local anesthesia course directors.com g Acknowledgments We want to acknowledge the time spent away from our spouses (Dixie Reader, Tammie Nusstein, and Jason Drum) in completing this work.
We are so grateful they were willing to help us produce a thoughtful addition to local anesthesia. As the senior author, Al Reader would like to thank his coauthors for all their help: “My associates and I always compromise. I admit I’m wrong and they agree with me.” All royalties from the sale of this book will be equally divided between the American Association of Endodontists’ Foundation and The Ohio State University Endodontic Graduate Student Research Fund to support further research on anesthesia and pain control.com Clinical Factors 1 Related to Local Anesthesia After reading this chapter, the practitioner should be able to: • Discuss the clinical factors related to local anesthesia. • Provide ways of confirming clinical anesthesia.
• Describe issues related to local anesthesia. • Explain the effects anxiety has on local anesthesia. • Discuss the use of vasoconstrictors. • Characterize injection pain.
• Evaluate the use of topical anesthetics. • Discuss alternative modes of reducing pain during injections. Clinical pulpal anesthesia is dependent on the interaction of three major factors: (1) the dentist, (2) the patient, and (3) local anesthesia (Fig 1-1). The dentist is dependent on the local anesthesia agents as well as his or her technique.
In addition, the dentist is dependent on the interaction with the patient (rapport/confidence). How the patient interacts with the administration of local anesthesia is determined by a number of clinical factors. Confirming Pulpal Anesthesia in Nonpainful Vital Teeth Lip numbness A traditional method to confirm anesthesia usually involves questioning patients by asking if their lip is numb (Fig 1-2). Although lip numbness can be obtained 100% of the time, pulpal anesthesia may fail in the mandibular first molar in 23% of patients.1–16 Therefore, lip numbness does not always indicate pulpal anesthesia.
However, lack of lip numbness for an inferior alveolar nerve block (IANB) does indicate that the injection was “missed,” and pulpal anesthesia will not be present. IN CONCLUSION, lip numbness does not always indicate pulpal anesthesia.com 1 Clinical Factors Related to Local Anesthesia Fig 1-1 The relationship of pulpal anesthesia to the patient, dentist, and local anesthesia.