Local anesthetic news

Summer was once again approaching and while unlike the anticipation and eagerness I usually enjoyed each November, as I journeyed to my
Caribbean retreat for my fix of ultra violet rays, yet there was something almost homeopathic and  calming about the aging hammock with a good book and the almost deathly silence of summer by the lake.

On my usual November trip south, the captain would put us through  the “g force” as he challenged the physics of gravity prior to lift-off. I often thought how Albert Einstein could have ever imagined what it would have been like to travel along side the speed of light when my main concern was focused on whether this de-iced 700,000 lbs monster would continue to gain altitude. However as true to form the falling leaves of red and gold faded into white fluffy cumulus which seemed to be void of density as the shining machine sliced through them as effortless as a knife through butter. There you go.  

Life above the 49^th parallel had lasting memories for me. I lived the best of both worlds. Snow shoveling was replaced by an early walk where I summonsed my younger balancing skills at playing hopscotch through the sharp edged seashells being caressed by each gentle wave. In contrast, summer was spent mostly reclining in a hammock which over the years had formed itself like a large latex glove around my girth with each increasing year.  This posture allowed me together with my book of the day to blend in with the sparsely placed pine furniture in the large and opened verandah which surrounded the cottage on three sides. open and almost oblivious to the distant hum of a power boat on the lake.

Winter, albeit relaxing and therapeutic, was in deep contrast to the silence one experienced on most lakes north of the 49^th parallel. The mere experience for most northern tourists to afford a
Caribbean vacation was seen as a right of passage to gave way to any Freudian inhibition which may have not been completely resolved. In addition, there was the cooling and refreshing rum punch mixtures added to the rhythmic sound of the “steel band” made it a powerful prescription of feeling entitled to shed not only one’s pent-up stress, but at times parts of their already skimpy apparel. This resulting atmosphere is what most scholars of psychology refer to as the emerging passive-aggressive behavior. There you go.

In preparation for my summer retreat during the month of June, I was like the proverbial bull in the china store as I maneuvered my mini shopping cart from aisle to aisle through my favorite book store. This store offered an atmosphere not unlike a trade show with rows and rows of draped individual small tables throughout the aisles which seemed to add that much more square footage to advertise and promote authors and new releases. These arcades and display tables were managed independently by their own sales associates, a title by which they preferred to be addressed. There you go. 

It was noticeably busy for a mid week morning in June. I carefully rechecked my BlackBerry organizer which for the most part tagged along with me like a faithful poodle with its unconditional love. From to time it would vibrate or other times it would emit a childlike whine to inform me of some event I had previously entered and may have completely forgotten about it. I lovingly referred to it as my dementia levee which faithfully protected any memory cells from overflowing my aging brain’s levee. A tap or two on  the sensitive touch screen revealed  nothing exceptional or urgent other than a memo to remind me to make a date to see the movie “Sex and the City” With Sarah Jessica Parker, Kim Cattrall. There you go. 

Why then was this excessive marketing atmosphere so evident throughout the store? Did the book industry secretly generate a Tiger Woods’ moment of mass marketing?  This certainly would have been the best kept secret, yet the solution was facing me right between the eyes. Historically, increased activity at book stores and movie houses has proven to be an accurate and reliable early leading indicator of impending recession as people at large have more free time. Ironically some business benefit from recession in the same way as the demand for steel increases during periods of war. 

Suspense novels are my passion and among others there were two on my short  list – namely “A prisoner of birth” by Jeffrey Archer and “The Pillars of the Earth” by Ken Follet. I also keep in touch and have a burning desire to be current with professional journals and especially editorials which, with some basic writing skills and strategetly placed references can be confused as scientific material. 

Over the many years of reading, I have developed an almost Sherlock Holmes analytical personality for articles. No more so than dentists are impulsively attracted to “the work” on one’s teeth or an architect inspecting the symmetry of a well placed keystone. These editorials/articles can often be detected by the format of their presentation, which is usually in the form of a question rather than the more accepted form of peer reviewed scientific study complete with investigating phenomena or purpose, an accepted methodology protocol and a conclusion. The pure sciences are becoming more and more diluted as such editorials begin their long “hear-say” or gossip walk through the hallowed corridors of famed teaching institutions.  Such articles presented under the guise of scientific material are for the most part self serving and do little to advance clinical efficacy with less unforeseen mishaps.  

However, there are the pundits of an evolving world where analytic jurisprudence is popular and where asking questions like, “What is law?” “What are the criteria for legal validity?” or “What is the relationship between law and morality?” and other such questions that legal philosophers may engage. (Wiki). 

An article this summer caught my attention under the heading of ethics and jurisprudence.  Here goes that question format - “Informed consent for Local Anesthesia - is it necessary?” There is implied dictum which takes the blame away from the operator and places it on a compound (amides) which dentists have been using successfully since 1947 to induce local anesthesia. If ever there was a case for longitudinal and sample size data, our stats people would have a heyday.   

Life styles through all aspects has changed and dental offices were no exception. I was as attentive to my oral health as I was to my physical health and over the  years I had noticed gradual subtle changes such as more pre clinical involvement with hygienists but perception is reality. I also noticed the office in greater detail. The Italian leather couches, slate tile floors and backlit etched glass in the patient lounge, exuded a definite warmth and elegant atmosphere. My dentist was considered to be one of the best, hence the ambience to go with her status. 

From the patient lounge I  was taken into a room with soft music and current magazines like Ophra, Vogue, Sports Illustrated, which all appeared to have been delivered that very morning. The dentist greeted me and after some small talk, asked me to place a tiny pill under my tongue which she explained would dissolve in a few minutes. Her assistant returned in about half an hour and led me into the operatory. By this time I was feeling very relaxed and comfortable.The local anesthetic solution was delivered through a computer-like electric tooth brush (minus the brush tip) and I felt absolutely nothing…no stick, not anything. I felt very relaxed throughout the procedure.  

This is where, in my humble opinion, and together with my graduate degree in pharmacy, may leave room for a clinical study to determine the use of oral or even intravenous sedation in general dentistry. The question is whether to circumvent the pain associated with what some dentists refer to as “pumping”. Is there need for added pharmacological interventions ( use of muscle relaxants) when a slower delivery ( 60 seconds) would have proven just as effective and with reduced cost to the office?  The term “ Infants practicing on mom’s high heels’ is probably not inappropriate here.  

To suggest a case for advocating informed consent for the use of local anesthetics after 60 years of successful clinical use in dentistry appears less substantive phenomena to identify such rare sequellae such as temporary amaurosis, paresthesia and even death which would seem to be classified as operator error rather than of a biochemical origin.  All clinical evidence would seem to beg the question. “Does this track record reasonably qualify to put local anesthetics (amides) under curfew or to “throw them under the bus?”

There is without doubt in general dentistry, a need to address the needle phobic patient, however a sudden move to give patients a “high” may increase patient traffic  prone to chemical addictiveness as the word get around, but with consequences not every dentist is willing to spend time, effort, legal and peer review in their selective associations. 

Anesthetics and aesthetics — they even sound as though they work together. Informed consent seems rather like infants practicing on mom’s high heels.  However for general dentistry with limited experience of these  powerful opioid analgesic with a potency approximately 81 times that of morphine (wiki) may increase the traffic you may live to regret.

Comments to author.  mailto:localanesthetics@yahoo.ca    M.Sc. PharmD. CCPE   WWW.Anestheticnews.com

When did this all happen? To my astonishment there were Toto toilets and a spa? This has got to be one of the best kept secrets…WOW!  Times were when your twice a year visits to the dentist were the most nerve shattering and fearful experiences with which one had to endure. Just to look at the red asterisk on my calendar followed by Dr. Watson, automatically drove up my blood pressure.

Recently I developed an acute pain in my lower right jaw and had to get to the dentist in a hurry. Yes! the diagnosis was a seriously infected molar and a root canal, AKA,  an endodontic procedure had to be performed ASAP. I must admit I had not been getting regular check ups, so I had no one to blame but myself. A few painkillers kept me through the night until my appointment the next morning.

When I arrived for my appointment, feeling less pain because of the painkillers, I noticed the office in greater detail. The Italian leather couches, slate tile floors and backlit etched glass in the Patient Lounge, exuded a definite warmth and elegant atmosphere. My endodontist was considered to be one of the best, hence the ambience to go with his status.

I was taken into a room with soft music and current magazines like Ophra, Vogue, Sports Illustrated, all appeared to have been delivered that very morning. I thought to myself, “where have I been”?  The dentist greeted me and after some small talk, asked me to place a tiny pill under my tongue which he explained would dissolve in a few minutes. His assistant returned in about half an hour and led me into the operatory. By this time I was feeling very relaxed and comfortable.

The local anesthetic solution was delivered through a computer-like electric tooth brush (minus the brush tip) and I felt absolutely nothing…no stick, not anything. I felt very relaxed throughout the procedure. When he was finished about one hour later, all I felt was a tiny residue of the anesthetic but was quite awake without any pain.I was escorted back to the ante room and relaxed with a magazine for about 15 minutes.

Here is where the surprise and fun started.This Dental Practice in which every aspect of its facilities had been intentionally designed to reflect a much more relaxed, serene and contemporary environment for the patient and which incorporated both a series of Dental Spa like services as well as Non-Dental Spa Services was extremely well planned. The more traditional Spa services such as massage, manicures, facials and pedicures was performed in a dedicated, private Spa Treatment room separate from the rest of the clinic.

I had written the day off because I knew I would be in no condition to return to work. I was offered a complementary spa-like services which included a wide variety of treatments and services. It was as if I had entered into the 22^nd century. I walked out of that office feeling like a million dollars. This experience has stayed with me ever since.  I have been told that such facilities are quite the trend even in small towns. I have already booked my follow up appointment, this time the asterisk is in Green. Comments to localanesthetics@yahoo.ca 

Author: M.Sc. PharmD. (patient’s story on file).