An Education in Pain Control: Sisters Making It Possible in Dental Hygiene Care

November 28, 2007

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By Margaret J. Fehrenbach, RDH, MS
Dental Hygiene Educational Consultant
margaret@dhed.net
http://www.dhed.net/

It now has been more than two years since Trish Toma, RDH, BS, started successfully performing local anesthesia on patients before her nonsurgical periodontal therapy procedures. She is licensed in Michigan where the dental practice act allows dental hygienists to perform local anesthesia following certification and examination. She was one of the first to take the NERB written examination in local anesthesia after receiving her continuing education certificate at a local seminar.

After receiving her certification, she was allowed to perform the full range of local anesthesia injections and, most importantly for dental hygiene treatment, the safer and more effective anesthetic blocks. Trish attended a seminar presented by Margaret Fehrenbach, RDH, MS, who is the primary author of Illustrated Anatomy of the Head and Neck (3 ed, WB Saunders/Elsevier, 2007).

Trish and Margaret are also sisters.

Margaret currently resides in Seattle and has been enjoying expanded-duty practice skills since 1981. That past seminar was the first time the sisters have been able to meet as fellow dental hygienists. Margaret is also an oral biologist.

Now they have since expanded their professional relationship since Trish has moved over the border to Ohio, which has recently allowed local anesthesia certification. Trish has been assisting as an instructor in Margaret's seminars which feature the "Velvet Touch" approach in patient care. Not only is emphasis placed on correct background in pain control for dental hygiene practice, but also on how anesthesia is administered since many dental patients fear pain control procedures. Margaret has presented these seminars across the United States.

For Trish, at her last private practice position before the move for Dr. Patrick Sweeney (Lakeshore Periodontics and Dental Implants), the procedure has meant a workable daily schedule for patients needing nonsurgical periodontal therapy. "I think having Trish as our hygienist who is able to give anesthesia to our patients has been an incredible asset. Patients just love the way that Trish gives anesthetic," Dr. Sweeney stated.

Trish recommends that other hygienists take on this added responsibility and enjoy the full care they can give patients who are free of pain. Dr. Sweeney added, "Trish, who is an energetic and enthusiastic team member, has definitely enhanced her value to our practice by assuming this added responsibility. I have no hesitation and highly recommend that all hygienists pursue this new avenue now available to them."

Trish, like other dental hygienists, feels that this increased level of patient care has helped them renew their commitment to their profession; one past seminar participant likened it to having a "wind under her wings." And there is no real downside to this advancement since there has never been a malpractice claim filed against a dental hygienist in the United States for administering local anesthesia.

Margaret feels strongly that local anesthesia should be a standard procedure performed before all nonsurgical periodontal therapies. The clinician can inform the patient that most patients need it for comfort and to allow for the best treatment. Margaret states that "the short amount of time for local anesthesia allows much more time for the actual treatment on a patient."

Her faith in pain control is based not only on her experiences but also on the informative reference by Dr. Stanley Malamed, in which he states: "Not all patients need local anesthesia for scaling ... but many do. The periodontal tissues being treated are normally sensitive to stimuli and are even more so when inflammation is present. Such is the case when a patient is treated by the dental hygienist ... Same depth of anesthesia as that obtained by the doctor doing restorative dentistry or surgery ... Root(s) ... without discomfort requires pulpal anesthesia, along with soft-tissue and osseous anesthesia."

Currently, the 40 states allowing dental hygienists to administer local anesthesia require extensive coursework by the licensee. Dentists would be wise to look into their state's licensure practice acts to see if their state allows this expanded duty and then support this much needed change in the profession of dental hygiene in their own offices and statewide.

References for pain control in dental hygiene practice

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Fehrenbach MJ. Stress reduction for the oral health care patient at high risk for medical emergency. Access (ADHA) July 2004.

Fehrenbach MJ, Herring SW. Illustrated Head and Neck Anatomy, 3 ed. W.B. Saunders/Elsevier; 2007.

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