And, painless, too! Promise!
I’ve learned a lot of tricks over the years, and the internet has been my go-to source. For at least 20 years, I’ve been an active participant in online forums. The ability to access the minds of hundreds and even thousands of my colleagues has proved invaluable throughout my career.
A friend of mine, Dr. Michael Nugent (aka the “Shooting Dentist“) from the Great State of Texas, has been cajoling me about writing this particular article for at least a year. He finally and unabashedly resorted to bribery by sending me a 40-round AR-15 Magpul magazine.
And, it worked. So… all my readers… take note!
I’m still feeling it!
One frustrating aspect of daily dental practice for many dentists is consistent and profound anesthesia for lower molars. We were taught to administer an inferior alveolar nerve block… aka “IANB.” And, many of us have run into situations where the patient exhibits the classic signs of anesthesia, yet they still feel pain. So, we give them another block. And, wait. And, then HOPE that we got it that time.
Mind you, administering a “painless” IANB is quite the challenge. It’s not a fun injection to receive.
There are other techniques such as Gow Gates and Akinosi techniques, sworn by some to be very effective. And, in their hands, I’m sure they are. I’ve never felt comfortable with either.
Years ago, I briefly tried the intra-osseous technique branded as the “X-tip.” With this gizmo, you actually punch a hole through the gingiva and cortical plate with the needle mounted on a slow-speed handpiece. It works, but it can be a bit scary / traumatic to both the patient and the dentist! You’ve got to make sure your aim is good and not running into a root. I had a couple of cases that ended up sloughing some tissue and bone post-operatively. I abandoned the technique shortly thereafter. I consider it more an issue of my own shortcomings, not the product or technique.
Another fall-back technique, after all else has failed, is the PDL (periodontal ligament) injection. For some reason, this has been long held as the technique of last resort. And, by the time you get to it (after trying multiple blocks), the patient is pretty weary and probably losing confidence. And, chances are that many dentists are not doing the PDL injection correctly.
Make your life easier and patients’ experience better with PDL (intraligamentary) injections.
Why not make it the PDL technique of FIRST resort? If it can work when all else fails, why not use it routinely… first? OMG! FIRST? Well, yeah… sorta. Read on. Continue reading
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