DENTAL HACKS FOR DELIVERING (MORE) COMFORTABLE LOCAL ANESTHESIA

Transcription

1 DENTAL HACKS FOR DELIVERING (MORE) COMFORTABLE LOCAL ANESTHESIA Jade Gan, DDS A LITTLE ABOUT ME Graduated from Seattle University in 2009 Graduated from NYU College of Dentistry in 2013 Working at CHC of Snohomish County since

2 INTENTION BEHIND PRESENTATION Not representing my workplace in community health Not sponsored by company/vendor We re not exposed to the same CE coursework/reading materials One collective place for all the information gathered Love for teaching/different way of thinking about the material The importance of the anesthetic portion of the procedure as make/break moment APPLICATIONS FOR THE PRESENTATION Anxiolytics are not available Innovative equipment for comfortable anesthetics not available Not in charge of future financial decisions Outreach opportunities with limited supplies Pick and choose techniques to apply in office 2

3 THINGS TO KEEP IN MIND The focus is on COMFORT, not necessarily accuracy Applicable for general population Still select individuals who need something more No expected to complete each item every time THREE PRONG APPROACH Armamentarium Technique Psychological Component What materials you choose to have to begin the procedure The way you use the materials that you have Added layer of the patient s mental status/mindset Tangible Tangible Intangible 3

4 ARMAMENTARIUM (AKA THE STUFF ) TO TOPICAL OR NOT TO TOPICAL? Topical gel (20% Benzocaine) Gauze 4

5 CHOICE IN ANESTHETIC 3% Carbocaine Plain 2% Lidocaine w 1:100K epi 4% Septocaine w 1:100K epi ph ~ 5.9 ph ~ 3.5 ph ~ 3.5 ONE OF THESE THINGS IS NOT LIKE THE OTHERS 5

6 TEMPERATURE OF THE ANESTHETIC Anesthetic warmer Can buy relatively inexpensively through online merchandisers The more sophisticated option Coffee warmer Inexpensive Easy to clean/sterilize Rapid to warm Warming in your hand Most simplistic option we all have hands Need to make sure your hands are warm CHOICE OF NEEDLE Needle Gauge Length of Needle 6

7 TECHNIQUE (THIS IS HOW WE DO IT) USE OF TOPICAL (WITH GAUZE) Need to dry with gauze first Need to make sure tissue is dry for absorption Use gauze to wipe down tissue (until tissue no longer shines) Rub topical gel into tissue Keep gel in mouth for 1-2 minutes 7

8 GETTING READY TO INJECT Check your needle tip Always engage plunger (to control pressure) Make sure liquid comes out Tell your assistants to pay heed in setting up syringe (not to bump the needle tip) Fresh injection site? Change the needle tip! MOMENT OF ENGAGEMENT Want taut tissue for less force on engagement Pull tissue out until tissue is taut Use gauze if tissue is too slippery Less obstructions, less force, less trauma Enter in only 1-2 mm (effective zone of topical gel) If they move away from you, guide the tissue/mouth toward you (can use finger to guide) 8

9 THE EFFECTS OF VIBRATION Possible distraction for patient Stimulates special receptors in the cells that block the transmission of pain Can vibrate/shake directly in the area for overstimulation (vs. shaking at the side) RATE OF ADMINISTRATION This gets bigger Gauge of Needle As this gets smaller Any Bend in Needle 9

10 SPOTTING TO TRACK YOUR PACE PIGGY-BACK TECHNIQUE 10

11 PIGGY-BACK INSIDE THE MOUTH PSYCHOLOGICAL COMPONENT (ARE YOU THINKING WHAT I M THINKING?) 11

12 CONFIRMATION BIAS The receptionist was mean to me. The assistant seemed really rude. The dentist just came in and talked business, didn t even get to know me like I was a real person. The dentist pulled really hard on my cheek. They didn t say anything when I said it hurt. I saw the needle! It looked like she was going to stab me! NOT SO SCARY ANYMORE 12

13 HOW TO CHANGE THEIR PERCEPTION OF THE APPOINTMENT Be EXTRA friendly and compassionate (even if you re having a bad, stressful day Laugh or tell a joke or two during the appointment Beek Beek Beek when giving small little injections around the PDL on palate Zoop! A little mosquito bite! Softer tone of voice A VERY ENGAGING DISTRACTION Needs to make sure it keeps the attention of the patient to work Talking about a favorite topic of the patient s Have person listen to audiobook, movie in the background, or comedic scene Listening to a song where they re focusing on lyrics Calming song may help, but may not engage Telling an interesting, innovative story 13

14 POSSIBLE OBJECTIONS Don t have time to wait too long Uses too many materials Don t have the energy to regularly have conversations with the patients My face just naturally looks like this Use of topical in general Insertion of 1-2 mm only POINT SYSTEM Use of 3% Carbocaine Plain first 4 Warming the anesthetic 2 Using a larger gauze needle 1 Going really slowly 4 3 Giving time between injections for piggy-backing 3 Shaking their cheek 2 Having a personal conversation with them before treatment 2 Making animated sounds when injecting 2 Having taut tissue at moment of injection 3 Fresh needle point for every new injection site 2 3 Medium High Low Score:

15 MY ANESTHESIA FLOW Wipe down cheek with gauze and place topical Pull out cheek (usually with gauze) Inject with Carbocaine Shaking cheek/quickly wiggle thumb near insertion point Inject with Lidocaine If inject in new place (palate), switch to new pink needle (30 extra short) THANK YOU! Contact: Jade Gan 15