Hit Me With Your Best Shot-Hit Me With Your Best Shot – making local anesthesia more effective and more comfortable

Video Transcription

Video Summary

Dr. Stanley F. Malamed delivered a webinar on improving local anesthesia in dentistry by making injections both more effective and more comfortable. He began by contrasting general anesthesia, which renders patients unconscious but does not eliminate pain signals, with local anesthesia, which blocks pain at the nerve level and is the foundation of modern dentistry.<br /><br />He reviewed the five dental local anesthetics used in North America, their typical durations, and their safety. He emphasized that the biggest barrier in dentistry is often the injection itself, especially fear of needles and palatal injections.<br /><br />A major topic was computer-controlled local anesthetic delivery (CCLAD), such as the Wand and Dentapen, which allow slower, more controlled injections and reduce discomfort, especially on the palate.<br /><br />He then discussed buffering local anesthetics with sodium bicarbonate, explaining that epinephrine-containing anesthetics are acidic and can sting. Buffering raises the pH, producing faster onset, more profound anesthesia, less injection pain, and less post-injection soreness. He noted that buffering is especially useful for mandibular blocks.<br /><br />Another focus was phentolamine mesylate (OraVerse), the “off switch” for local anesthesia, which shortens lingering soft-tissue numbness and can reduce accidental lip or cheek biting.<br /><br />Finally, he gave strong support to articaine, describing its rapid metabolism, high lipid solubility, and usefulness for mandibular infiltrations and some maxillary palatal anesthesia. He concluded with practical recommendations for mandibular anesthesia, including buffering and adjunctive articaine infiltrations.

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Stanley F. Malamed, DDS Subject: 340 Anesthesia and Pain Management Credits: 1.5 Audience: Dentists, Hygienists Fee: $125 (nonmembers); $75 (members); $37.50 (students) Description Local anesthesia forms the backbone of pain control techniques in dentistry. Local anesthetics are the safest and most effective drugs for the prevention and management of peri- and postoperative pain. Yet, for many patients — and dentists — the local anesthetic injection is the most stressful part of the dental experience. This program will discuss the means of making dental local anesthetic injections both more effective and more comfortable. Topics include: buffering (the local anesthetic “on switch”), phentolamine (the local anesthetic “off switch”) and the local anesthetic — articaine HCl. We will conclude with an algorithm for more successful (and comfortable) mandibular anesthesia. Learning Objectives · Discuss the advantages of articaine HCl compared with other dental local anesthetics. · List three advantages of buffered local anesthetics. · Discuss the pharmacology behind phentolamine mesylate and its ability to reverse local anesthesia. · Discuss the algorithm for more successful mandibular anesthesia. Speaker Bio Stanley F. Malamed, DDS, is a dentist anesthesiologist and emeritus professor of dentistry at the Ostrow School of Dentistry of USC (formerly the University of Southern California School of Dentistry).

Keywords

local anesthesia

dentistry

computer-controlled delivery

CCLAD

buffering

sodium bicarbonate

phentolamine mesylate

OraVerse

articaine

mandibular block

palatal injections

Dr. Stanley F. Malamed