Most practicing dentist experience a similar problem. The dentists administers local anesthetic to a patient, and, after several minutes, the patient says he or she feels "really numb." The dentist then proceeds with restorative care such as the preparation of a tooth for a crown. As soon as the dentist begins the procedure, however, the patient suddenly jumps and informs the dentist that his or her teeth are not fully anesthetized after all.
This is a lose-lose situation. The patient has a bad dental experience and may spend the remaining time in the chair anxiously waiting for another jolt of discomfort. For the dentist, there’s the stress of a patient’s jumping during care and the added time required to administer more local anesthetic and wait for it to take effect.
I have implemented a fast, effective, safe and inexpensive way to prevent the majority of experiences in which everything seems to be anesthetized but the tooth.
I have implemented a fast, effective, safe and inexpensive way to prevent the majority of experiences in which everything seems to be anesthetized but the tooth. Instead of checking for profound anesthesia by simply asking the patient if he or she feels numb and then picking up the handpiece, I explain to the patient that I will test for profound anesthesia using a simple test.
THE TEST
I thoroughly spray a 6-inch cotton-tipped applicator with Frigi-Dent (Ellman International), which contains tetrafluoroethane. I immediately place the cold cotton (–54 C) firmly on the tooth being tested for five seconds; I selected this interval because it is long enough to deliver a safe, but significant, cold stimulus to the dental pulp. I tell the patient to let me know immediately if he or she feels a cold sensation on or pain sensation in the tooth.
If the patient still feels a cold sensation or pain in the tooth being tested, I administer additional local anesthetic to the patient and repeat the testing process.
If the patient does not feel a cold sensation or pain, I believe that profound anesthesia has been achieved, and I can perform restorative care without the patient experiencing pain.
There are exceptions. In a few cases, the patient does not feel cold or pain in the tested tooth but later experiences pain when restorative care is being performed. In my experience, these exceptions occur erratically.
CONCLUSION
I have found this fast, effective, safe and inexpensive technique to be a useful addition to my treatment protocol. It has been well-received by my patients, who would much rather feel cold on their teeth than the pain of the drill. My patients have experienced no adverse reactions or postoperative sensitivity attributable to this testing.
While I choose to use this technique routinely, other clinicians may prefer to employ such testing only on their more nervous patients who require confirmation of their "numbness" before they feel comfortable proceeding with treatment. And still other practitioners may choose to use other means of pulp testing to ascertain profound anesthesia.
DO YOU HAVE A TIP TO SHARE?
Do you have a time- or work-saving clinical technique to share with your colleagues? Submit it to JADA’s Clinical Directions department. A Clinical Directions item should be a maximum of two double-spaced typed pages and should include no more than one figure or illustration. Submit items to Clinical Directions, JADA, 211 E. Chicago Ave., Chicago, Ill. 60611.
