Understanding Anesthesia Guidelines for Improved Patient Awareness
THE NEXT DDS
Although anesthetics are designed to minimize patient discomfort, the
overall perception of pain associated with these procedures often causes a
degree of anxiety. Pre-existing phobias regarding the use of anesthesia may
cause a patient to decline administration of anesthetics or, in some extreme
cases, forego the procedure altogether. While the use of localized, sedation,
and/or intraosseous anesthesia allows clinicians to deliver optimal restorative
care with minimal patient discomfort, the need for anesthesia must be clearly
communicated to the patient before restorative treatment is initiated. The
inevitable postoperative sensitivity must also be clearly addressed prior to
restoration to ensure that the patient is fully versed on anticipated treatment
effects. Effective preoperative communication preceding anesthetic delivery is,
therefore, critical to both ensure patient comfort and secure treatment
acceptance.
There are several methods available to achieve pain
management depending on the procedure itself, the patient’s ability to tolerate
pain, his or her medical history, and any medicaments that may be in use. Thus,
it is important for one to ask the patient about his or her history to ensure
safety. Analgesics—both narcotic and non-narcotic—can be used to alleviate post-procedural
pain. Patients should understand that although drilling the surface of the
enamel is relatively painless, once the dentin layer is reached, the level of
discomfort increases and more complex procedures may call for the use of
anesthesia.
Patient Considerations
It is important for a patient to understand
that the injected local anesthetic may also include several other components
such as a vasoconstrictor to prolong the duration of the anesthetic action, an
antioxidant (often containing sulfites or methylparabens) to prevent tissue
damage, and sodium hydroxide or sodium chloride to minimize toxicity. Patients
should also be aware that the initial injection will sting, not from the needle
itself, but from the pressure as the anesthetic moves through the tissue. New
technologies have been developed to more effectively control the delivery of
the anesthetic and can benefit the patient accordingly. Such technologies
include:
- Contemporary
localized systems;
- Wand-based
local anesthetics;
- Intraosseous
anesthetics; and
- Computer-controlled
anesthetic delivery systems.
Side effects from local anesthesia are rare,
but should be clearly communicated to the patient prior to treatment. Such
effects include hemotoma, numbness outside the targeted area, increased heart
rate caused by the vasoconstrictor, and prolonged numbness due to the needle
injuring a nerve. These provisionary side effects are generally no cause for
concern and will subside over time.
To avoid further
interference in a patient’s daily activities, depending on the clinician’s
skill, the patient has the option of intraosseous anesthesia, a localized
injection that involves drilling into the cortical bone and injecting the
anesthetic near the apex of the targeted tooth.
The advantages here are that the patient does not experience numbness in
his or her lips or tongue.
Seeing a syringe can arouse suspicion and
inspire fear that may cause the patient to decline treatment altogether, along
with subsequent care. Injection-free anesthetics, can be utilized in scaling
and root planning procedures, putting trypanophobic patients’ minds at ease
while maintaining the ability to target a specific location, thereby avoiding
residual numbness of the lips and tongue. It should be noted, however, that though topical
anesthetics sufficiently numb the soft tissue, they have no affect on the
nerves in the teeth, for which an injectable local anesthetic is required.
Sedatives and anti-anxiety agents, such as
nitrous oxide, can be administered orally, by injection, or by inhalation to
help nervous patients relax. More complex treatments, however, may require deep
sedation or general aesthesia. This is recommended for children and
particularly anxious patients who have difficulty controlling their movements.
Conclusion
By ensuring a patient’s comfort, a clinician increases his or her
chances of being able to finish a given procedure in a single visit and the
likelihood of securing a relaxed, cooperative patient. Awareness of anesthetics
prevents the patient’s fear from taking over and causing him or her to make
decisions that could be detrimental to his or her oral health.