To numb or not to numb?

Dec. 1, 2002
Do you remember your first car? You got along fine without one, getting rides from family and friends. Your outlook was to use other options — walking, bike, or bus.

Do you remember your first car? You got along fine without one, getting rides from family and friends. Your outlook was to use other options — walking, bike, or bus. All things considered, you got along just fine without wheels. Do you also remember wondering, after having your own car for just a short time, how you ever managed without it? We only see how much we will use a car after we have one. It does not take long for us to realize we would never go back to the days before car ownership. Today it might be more relevant to remember your first computer or cell phone. How did you get along without these conveniences?

Along with remembering my first car — a 1963 blue Chevy Impala — I also remember giving my first injection. After 25 years, you would think I could forget that. As a matter of fact, I still remember quite vividly giving that first injection. All these many years later, the complications of that first experience seem quite a comedy of errors, rather than the huge trauma I first imagined. No needles were broken, but both my partner and I had problems. At the time, the complications confirmed in my mind all the reasons why I really did not want to learn local anesthesia in the first place and was sure I would never use it anyway.

Before I could give my first injection, I was the recipient of my partner's inaugural anesthesia experience. We started with maxillary injections, and my partner did fine on the PSA, MSA, and NP. But the GP is the one that I will never forget. It was not painful. We learned all the tricks with the pressure of a cotton tip applicator making the insertion essentially painless. It was the fact that not only was my hard palate numb, so was my soft palate! It was an awful feeling, and even with the small amount of anesthetic solution used, the numbness seemed to last forever, accentuated by each and every swallow.

As miserable as I felt, the numbness of my soft palate distracted me from the apprehension of giving my first injection. I figured it could not be any worse than what I had just experienced, so I just went ahead and did it. I palpated the soft tissue, locating all the hard tissue landmarks, practicing my approach with a cotton tip applicator several times for each injection. There were so many things to watch for on the PSA injection, primarily related to geometry. I concentrated on the "in-up-and-back" approach, while watching to be sure the needle was at a 45 degree angle to the midline and a 45 degree angle to the occlusal plane — all at the same time, mind you, and with my hand shaking like a metronome gone wild.

I remembered to aspirate; no problem — it was clear, and then proceeded to deposit the assigned amount of anesthetic solution before withdrawing the needle. As the needle slowly slid out, I was already breathing a sigh of relief that my first injection was over and all had gone smoothly. Suddenly, blood appeared in the carpule. I was surprised and puzzled. What had I done wrong?

I was not aspirating; I was simply withdrawing the needle. Aspiration is when blood should appear, not when I was all through. Obviously, I nicked a vessel and that is what caused the bleeding. I finished the other injections and then noticed the hematoma forming. I applied pressure and ice to my partner's quickly swelling cheek. Because of the location, there was sufficient space for a large hematoma to form, complete with bruising.

It is a wonder I ever gave another injection! Looking back, I was convinced I did not need local anesthesia, did not want to give injections, and generally thought that using anesthesia meant my instrumentation technique was "rough." It was not even my idea to take anesthesia — it was part of the ten-week Arizona Expanded Functions Program in which I enrolled. We learned root planing, surgical curettage, and suturing.

Anesthesia was definitely necessary. With each injection, my technique improved, my confidence increased, and my hands shook less. It did not take long for me to see I would continue to use the local anesthesia. As the program came to a close, we all wondered how we would integrate our newly acquired skills into practice.

That was easier than expected. Our employers all received a letter from the program director outlining our skills and how best to implement them into general practice. Not only did I anesthetize my patients when needed; I also provided anesthesia for the restorative patients. If the patient was scheduled with me first and then the dentist, they were anesthetized before leaving my chair.

Many times, the dentist asked me to anesthetize his patient while he did an exam on my patient. The assistants also tapped into this new resource for staying on schedule, coming to me if I had time or offering to clean and set up my room if I would anesthetize the next restorative patient. When you can administer local anesthesia, you have more to offer the team.

Before taking the course and becoming certified, I did not want to give local anesthesia, and I was sure I did not need it for my patients. But I found out differently. It is just like owning my first car. I used both the car and the local anesthesia much more than I ever imagined I would. You will too.

Trisha E. O'Hehir, RDH, BS, is a senior consulting editor of RDH. She also is editor of Perio Reports, a newsletter containing news about periodontics for dental professionals. The Web site for Perio Reports is She can be reached by phone at (800) 374-4290 and by e-mail at [email protected].

Sticking notes

Here are a few suggestions for gaining practice:

• Offer it to your patients. Do not be hesitant — some people prefer to be numb. Of course, others do not and will do anything to avoid local anesthesia.

• Talk with the dentist to see how you can make a contribution to the restorative side of the practice.

• If you do not feel confident in your technique, ask for some tutoring. Be sure your skills are on par with the dentist. If they are not, tutoring will help. Dentists and hygienists can share tips and tricks, making both better clinicians.

• The actual insertion of the needle is what puts most hygienists off. In the classes I have taught, the injections were repeated as soon as the injectee was numb. It is much easier to insert the needle if the tissue is numb and you are not worrying about hurting the person.

• Ask the oral surgeon to whom your office refers for some tutoring and tips on local anesthesia. Ask if you can spend a half-day observing local anesthesia technique and perhaps anesthetizing some of oral surgery patients. Patients receiving general anesthesia also receive local anesthesia, after the general is started. This reduces the level of general anesthesia needed and provides immediate postoperative pain control.