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Interview of Dr. James Dower – INTERVIEW of James S. Dower Jr., DDS, MA by Michael C. DiTolla, DDS, FAGD As the local anesthesia instructor at the University of the Pacific School of Dentistry, Dr. James Dower watched me panic through my first injection in 1987. Judging by the sweat pouring down my forehead, you would have thought I was performing open heart surgery on a mafia boss, not infiltrating over tooth #9 on the student unfortunate enough to have a surname that alphabetically follows mine. Dr. Dower continues to lecture on local anesthesia at University of the Pacific, and I wanted to touch base with him to gauge his thoughts on some anesthesia issues; to hear what injections are being taught in school today; and to see whether 4 percent anesthetics really do have higher paresthesia rates. Interview of Dr. James Dower29
Dr. Michael DiTolla: Let me start off by saying that ever since you taught me local anesthesia when I was a dental student, it has been a really important focus in dentistry for me. I vividly remember giving my first injection in dental school; it was an infiltration over tooth #9, and I remember the sweat pouring down my forehead. That first injection is one of the more stressful moments in dental school, and we get slightly more used to it; but as we continue to practice, the administration of local anesthesia has the potential to be one of the more stressful things we do. What are your thoughts on that? Dr. James Dower: It’s funny you bring that up because we just finished our first week of the local anesthesia block. We started this method of practicing injections during the spring quarter, and as you mentioned it creates a lot of stress for the students. Many have never had a dental injection in their life, so getting an injection for the first time from their lab partners who can’t mix alginate, well, it creates stress on both sides. But stress is a huge component for practitioners who are having trouble in their block injections. Of the courses I teach, that is probably the group of dentists with the most emotion because many of them have such difficulties they are actually thinking of getting out of practice, as hard as that is to believe. MD: Wow, yeah, it’s never been quite to that extreme for me. About three years ago I purchased the STA System (Milestone Scientific; Livingston, NJ), and I purchased it because I love the idea of single-tooth anesthesia on lower molars for crown preparation, for example. I loved the idea of not having to potentially miss a lower block, especially because patients don’t like lower blocks. I didn’t want to give a lower block to do a single crown on a lower molar, and I’ve had really good luck giving injections with the STA System. But the funny thing is, the biggest difference the STA System has made in my life has been for the esthetic cases where we’re giving multiple maxillary infiltrations. The ability to set this device on its lowest speed and to give injections with the carpule being changed at the device itself removes so much stress from my life. More than 20 years into practice, I realized how stressful it was for me to give maxillary infiltrations, for example, in that sensitive area under the nose. But with the STA System, a computer controls the device at a very slow speed, so I can give nearly painless injections. I didn’t realize how stressed I was until I got the STA System and all of my anxiety disappeared. JD: The knowledge of doing the PDL injection to give anesthesia is really a good thing for a person to have. Had I not learned the PDL injection and the mylohyoid injection early in practice, I would’ve had a real tough time because I can’t work on a patient who is in pain. The term I really like for PDL, which I read in a study from Israel, is the trans-ligamentary injection. It describes the process of the needle in the periodontal ligament 30 chairsidemagazine.com
Page 3 and 4: Contents 9 Dr. DiTolla’s Clinical
Page 5 and 6: Publisher Jim Glidewell, CDT Editor
Page 7 and 8: Dear Robert, Thanks for the kind wo
Page 9: Daniel J. Melker, DDS Dr. Daniel Me
Page 12 and 13: Dr. DiTolla’s CLINICAL TIPS PRODU
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Page 17 and 18: Figure 1: The Rapid Anesthesia Tech
Page 19 and 20: Figure 9: You can clearly see the 2
Page 21 and 22: Figure 15: I can see that the BioTe
Page 23 and 24: The BruxZir bridge is solid zirconi
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Page 27: Figure 37: A look at the bite regis
Page 32 and 33: from the solutions going to that cr
Page 34 and 35: get sort of comfortable doing one t
Page 36 and 37: penetration of the mandibular block
Page 38 and 39: of their lip back. So if you’re g
Page 40 and 41: dentist would reuse prophy cups and
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Page 45 and 46: Rubber DaM Haz rds - Article and Cl
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Page 54 and 55: Contours of shaped teeth are shown.
Page 58 and 59: Alginate Substitutes: Rationale for
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Page 63 and 64: Patient Product Review Dr. DiTolla
Page 65 and 66: “That damn lab — I wrote freest

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