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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. 

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