by Delia Vazquez-Fernandez, RDH, BS
Back in 1992, I remember being terrified, excited, and shocked, when our dental hygiene program director announced that we would be preparing for the administration of local anesthetic. It was then that I learned that Illinois was not one of the states allowing hygienist to administer local anesthetic at that time.
Loyola University's excellent dental hygiene program prepared us anyway, just in case we were interested in practicing in other states such as California, where it is routine to administer local anesthesia. I remember it was one semester of lecture and clinical practice.
Ten years later, I had to pay more than $600 to another course on local anesthesia. I subjected myself again to being anesthetized by a very nervous person, and I lost income during the week I was in class.
It was worth it!
It has always been time consuming to wait for the doctor to anesthetize my patient. After the doctor is done, you then have to break all your barriers and call the doctor back into the room, because your patient feels pain on the lingual aspect, the buccal, the anteriors, or all of the above.
I know where my patients are the most uncomfortable, and this local anesthesia course has taught me how to achieve the most comfort for my patients, stressing landmarks, amount of anesthetic, and technique. I am happy to say I have been very successful so far, especially with my inferior alveolar block injection — basically a blind injection.
My patients have been the most encouraging. I have received many positive responses: "I didn't feel a thing." "It was better than when the doctor did it," and "You're really good at this."
I admit that I was pretty nervous for my first injection in the dental office. It was a "real" patient, and I was giving a block injection. My hands were shaking, I could feel my body temperature rising, and my goggles were fogging up. I thought, "What have I gotten myself into?"
But I had to prove to myself and to the doctor that I could do this. I did. Now I don't even think about it.
Documentation and liability were also very well addressed in the course. I remember the instructor, an oral surgeon, telling the class that our disadvantage was lack of continued supervision and practice. Dental students have two years of practice and supervision, but we have to rely on the doctor to help us with our technique.
This leads me to a topic dental hygienists talk about among themselves. Sometimes hygienists discuss obstacles to bringing the additional expertise of administering local anesthesia into an office. Doctors may be reluctant about reimbursing dental hygienists for the local anesthetic course, even as a continuing education benefit. Doctors also are not receptive, helpful, or even encouraging. Some doctors even state that they don't care whether the hygienists know how to give anesthetic or not. We have to talk among ourselves to iron out any problems we may encounter when administering a local anesthetic. I find this discouraging. Doctors should help us when we need help or have a question.
Other hygienists have told me that their doctors will only allow them to administer infiltration injections, while others will not allow hygienists to administer any type of injection.
On the other extreme, another colleague has told me that her doctors encourage her to even administer the Gow-Gates injection if they want - something that was discouraged at my course. She and the other hygienists in that office are also encouraged to anesthetize the doctors' patients, so that the patient is anesthetized when the doctor walks into the operatory. The doctors in this suburban office regard this delegation as being very productive and efficient.
Putting it all in perspective, I think that it all depends on what opinion the doctor has on the idea of a hygienist administering local anesthesia, the confidence the doctor has in the hygienist, or simply the lack of knowledge doctors have on the educational background of the registered dental hygienist.
I will say that any doctor who feels their title or ego is bruised because the hygienist can now perform a task is missing the purpose of this expanded function. After all, hygienists are educated, licensed, and also carry malpractice insurance.
Delia Vazquez-Fernandez, RDH, BS, is a part-time dental hygiene instructor at Kennedy-King University in Chicago.