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injections for handling accessory innervation issues. It doesn’t matter how many
mandibular blocks you give and how thick the root feels; if there are accessory
nerves coming in, you have to handle those to be effective in anesthesia.
MD: You know, it’s funny: The PDL technique you just mentioned is pretty much
how I give it, too. I never really gave it a lot of thought, though, I just knew that I
put the needle in and that I didn’t want to go into the attachment until I gave a
couple drops of anesthetic. But I was thinking, well, what am I expecting? Am I
expecting this to anesthetize the base of the sulcus on contact? It didn’t necessarily
make a lot of sense to me, but I knew that if I put it in like it was a perio probe, gave
a couple drops, advanced a little bit into the attachment, gave a couple drops and
moved along, most patients will say, “I didn’t feel a thing” — especially compared
to a lower block, where you’ve got to get across a couple muscles to get back where
you’re going.
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.
For dental phobics — who I’ve never really enjoyed working on to be honest, but
you still find them in your practice — the ability to give what’s almost a closedmouth
injection for a lower molar versus a wide-open lower block will really win
over some patients. Patients who feared injections suddenly become brave because
what they really hated was that injection, and it’s so much easier to hide it with a
pleasant injection without all the soft tissue anesthesia that goes along with a lower
block. I’ve found it to be a fantastic technique.
I can tell you that when I was in dental school, we did not learn the Gow-Gates.
That’s one of the things about local anesthesia I find to be a little intimidating. To
learn the Gow-Gates in dental school, when you’ve got an instructor standing next
to you helping you through it, would be ideal. In private practice, it’s pretty easy
for us to switch from one composite to another, try a different post system or a different
bur. But when it comes time for somebody who’s been in practice for 10 years
to try a Gow-Gates on a paying patient without somebody there, that’s a big leap.
And most of the dentists I talk to say, “Wow, it sounds like it’s a great injection, but
I’m terrified of telling someone to open wide and then aiming for their ear.” I’m not
surprised you find it makes a big difference to expose students to a technique like
Gow-Gates when they’re in dental school.
JD: It makes a big difference. Of course, having two different techniques to
use helps if they miss the mandibular block using the standard inferior alveolar
technique; instead, they can try the Gow-Gates. It’s a real benefit to the
students, and they love the injection. In fact, at the end of their week in local
anesthesia I talk to them about it, and about two-thirds of the students prefer
the Gow-Gates injection to the inferior alveolar. So they’re already planning on
entering clinic with that as their primary mandibular block.
It’s good for readers to try something different; it’s an anatomic issue that you
can’t see that makes it a little more intimidating, but if the practitioner just
palpates the patient’s neck at the condyle — and of course we’re needing to do
that in doing temporal mandibular joint exams — if they just palpate that neck
of the condyle and do their penetration and just aim for that, that’s the Gow-
Gates. So you know it’s two things they are used to doing: the penetration
for mandibular block and palpating the temporal mandibular joint area. Just
those two things together, finding the neck of the condyle and their standard
technique, and they’ll be fine aiming for it.
MD: That does break it down into two easy steps. For dentists who didn’t learn the
Gow-Gates in dental school, it sounds more intimidating than something we’re
used to doing. I don’t know what we think is going to happen if we try it, but you
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