By Ann-Marie DePalma, RDH, MEd, FADIA, FAADH
Many states allow dental hygienists to perform local anesthetic injections. Requirements for training and certification differ from state to state, with didactic and clinical training varying. Each program covers armentarium, landmarks, pharmacology, and emergency management with a clinical component. The clinical components usually involve administering injections on fellow students in a controlled environment. Once a hygienist leaves the program, she or he may not feel totally comfortable with various injections. The only way to become truly proficient in local anesthesia administration is with practice and review.
Andrew Johnston, RDH, BSBM, in collaboration with Dental Development Seminars, has developed a program that assists hygienists with the practice and administration of local anesthesia. This is in conjunction with serving an underserved population. "Hands-on Anesthesia" gives hygienists the opportunity to mix education with humanitarian aid each January in Guatemala.
Drs. Tommy Murph and Gayle Fletcher are the attending dentists from Dental Development Seminars. Along with Andrew, they provide 48 hours of continuing education for the weeklong program. The humanitarian program occurs several times per year, although Andrew provides the full didactic and clinical program in January only.
Initially, hygienists participate in didactic lecture with multiple one-on-one opportunities to learn the science and technique of local anesthesia delivery. After the didactic portion, hygienists are paired for four days with doctor teams and deliver hundreds of block injections prior to extractions.
By the end of the week participants should be able to:
- Identify armentarium used in local anesthesia
- Understand properties of local anesthetic agents
- Explain indications and contraindications to local anesthetic use
- Review the pharmacology and neurophysiology of local anesthesia
- Identify oral landmarks and anatomical variances
- Discuss and demonstrate maxillary and mandibular blocks, infiltration techniques, and other supplemental techniques
- Recognize and be able to treat emergency situations associated with local anesthetic delivery
In addition to the tangible benefits of learning and practicing local anesthesia, hygienists will become more confident that their injections will be effective. Andrew estimates that on average, when participants enter the program, they are approximately 50% to 60% effective with their IA blocks. Upon completing the program, the doctors who work with the hygienists report 90% to 95% accuracy.
Nothing is better in determining the depth and accuracy of injections than having surgery performed immediately after the injection. Andrew believes that keeping an open mind and repetition are the keys to success during the program. The program covers all of the basics for hygienists who are new to local anesthesia, and advanced blocks are taught for the more experienced local anesthesia hygienist.
There is something for every level from the collaborative team headed by Drs. Murph and Fletcher. During the trips that Andrew does not attend, there is still a limited didactic portion, and there are usually 20 to 30 dentists who are more than willing to work with hygienists to bring them up to a high level of competency.
The program is set in various cities and towns in Guatemala and is held in conjunction with a hands-on extraction course offered to general dentists. Drs. Murph and Fletcher determine the locations in collaboration with the local Lions Club International and other volunteer organizations. Participants travel to Guatemala City for the first two days of lecture. Teams are then transported by bus to the area selected for the humanitarian work.
The hotels are chosen prior to the trip and provide comfortable accommodations. Andrew and the team believe that although humanitarian work is being provided, the accommodations need to be enjoyable because of the hard work provided in the clinic. Costs for the course are divided into two groups-the CE program itself and personal expenses, which include all travel expenses, meals, and miscellaneous items. The money spent on the program is an investment that will carry well past the week spent in Guatemala.
Beyond the clinical aspects for hygienists, other dental team members can also benefit from the program. Dentists are invited to take the extraction course. In fact, many dentist/hygienist teams participate. Assistants, business team members, and even family members can support the humanitarian portion of the program by sterilizing instruments or assisting in the setup and breakdown of units.
During his early clinical positions, Andrew was required to anesthetize patients before their restorative or surgical procedures. Doing local anesthesia on multiple patients per day required him to become extremely proficient in his techniques and led him to take numerous courses on local anesthesia. He began presenting CE programs after traveling abroad for multiple mission trips. As he continued to post photos on social media and dental forums, interest in the program grew from there.
Andrew didn't set out to teach other clinicians because he is introverted by nature. But education is important to him because it helps him stretch himself while providing a good service for others in the profession. Beyond the anesthesia course, he presents programs on "Charitable Dentistry," "Becoming a Better Clinician Through Making Mistakes," "Restorative Hygiene," and "CAMBRA."
Andrew's passions are family and dentistry. He is married with three children. Family is the most important thing in his life, and dentistry is a great vehicle to be able to support the lifestyle his family prefers. Andrew considers himself a dental dork, taking CE whenever he can. He is involved in the State of Washington's Dental Hygiene committee, and he cohosts a podcast for dental hygienists. He enjoys the podcast because talking a lot and being opinionated are two things he is known for.
If he were not a hygienist Andrew might become a general dentist or oral surgeon. It was actually his older brother who chose the professional path for both of them. Andrew was originally going to be an oral surgeon and his brother a periodontist. But Andrew found out after he started school that he couldn't do it all, and he decided he could provide for his family and have the quality of life he wanted as a hygienist.
He regrets not becoming an ADHA member earlier in his career, when he did not see or understand the big picture of the profession. He understands that there are times we have to come together as a profession and put forth initiatives that prove that hygienists are highly educated and trained individuals who want to further the profession by making the nation healthier. As an educator, he enjoys seeing the light bulb moment, traveling and making an impact on large groups of people.
One of his workshop participants said, "Andrew took away the anxiety I felt about giving injections. As I became more comfortable in providing care, he would step away and let me work independently, but he would appear whenever I had a question. He has an uncanny ability to do that. His support, education, and encouragement are priceless! Invest in a priceless experience for yourself, your patients, and those in need in Guatemala."
For more information about Andrew, Dental Development Seminars, or a Tale of Two Hygienists, e-mail [email protected], or visit weteachextractions.com.
A Tale of Two Hygienists podcast is available on iTunes and other media.
Thought for the month: The most wonderful study of mankind is man. Relieving human suffering and diffusing universal knowledge is humanitarian. Daniel D. Palmer RDH
ANN-MARIE C. DEPALMA, RDH, MEd, FADIA, FAADH, is a Fellow of the American Academy of Dental Hygiene and the Association of Dental Implant Auxiliaries, as well as a continuous member of ADHA. She presents continuing education programs for dental team members on a variety of topics. Ann-Marie is collaborating with several authors on various books for dental hygiene and can be reached at [email protected].