Administration of Local Anesthetics

 An Overview  

Why use anesthetic?

Mastering anesthetic techniques maximizes success in the dental office for you and your patient. It enables clinicians to provide better and more comfortable treatment to patients.

Proper administration of local anesthetics can minimize the occurrence of complications, but nothing can absolutely guarantee they will not occur. However, proper patient evaluation before the start of the procedure, including a review of the medical history, dialogue history, and monitoring of vital signs, can help identify patients who are at greater risk of developing problems.  

Treatment may either be deferred until a patient at risk for complications becomes healthier or treatment modifications may be instituted to minimize the risk. Vital signs should always be recorded prior to any drug administration, including local anesthetic via injection, non injection or even topically.  

Proper positioning of the patient is helpful in preventing psychogenic reactions such as fainting. Slow administration of the local anesthetic following two negative aspirations can prevent or minimize an adverse reaction to intravascular injection. When treating lighter weight patients (either pediatric or geriatric), knowing the weight of the patient and limiting the dosage of both the local anesthetic and vasoconstrictor can minimize the occurrence of overdose.  

Dental procedures can usually begin within 3-5 minutes after correct administration of a local anesthetic.  

As a dental hygienist you are responsible for obtaining proof of certification, indicating successful completion of a local anesthetic course.

Types of local anesthetic injections:

There are two types of local anesthetic injections used for dental procedures. You will determine which injection to give by the length and type of treatment you will be providing as well as the patients medical history.

- Local infiltrations anesthetize a small area usually one or two teeth and surrounding tissues. For this type of local anesthetic injection you will deposit the anesthetic solution near the terminal nerve endings.

-  Nerve blocks affect a larger area and the anesthetic solution is deposited near large nerve trunks.

There are many different ways to safely and successfully administer most local anesthetic. There are also other options we can now offer our patients for safety and comfort, such as non injectables.  

How to utilize proper techniques for all injections:

  • Use tell- show-do with a positive attitude
  • Keep anesthetic equipment out of patient view to reduce anxiety
  • Place patient in supine position
  • Dry tissue and place topical for one or two minutes
  • Establish a fulcrum
  • Pull tissue taut to allow easy penetration and better visibility.
  • Orient bevel of needle toward the bone.
  • Pentrate tissue at desired location.
  • Aspirate to prevent intravascular injections change bevel position and reaspriate.
  • Inject slowly to reduce painful pressure of solution entering tissue at least 60 seconds per carpule.
  • Observe patient before, during and after injection.
  • Document in patient record, what injection you gave, who gave it, what kind (2% Mepivacaine with levonordefrin 1:20,000) how much (1.8 cc), negative aspiration no complications, ect.
  • Give post op instructions (i.e. no biting on cheeks or tongue)

 

Giving local anesthetic to patients requires the knowledge of anatomy of the skull, nerves and tissues.

 

 There are many variations of anatomy among patients. 

 

To increase the success and reliability of administering local anesthetic you must learn to rely on the visualization and palpation of landmarks and tissues while injecting.    

 

For more information and references:  

Handbook of Local Anesthesia by Stanley Malamed  

http://www.dimensionsofdentalhygiene.com/ddhright.aspx?id=800

Comments are closed.