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locks. So this would certainly hold true for a Gow-Gates or any other block anesthesia,
I’m assuming.
JD: Yes, that’s true. Whichever of the mandibular blocks, that’s where it appears
to occur. One of the other unfortunate and interesting things that came
about with the 4 percent solutions is: I had heard the term “paresthesia,” but I
had never heard the term “dysesthesia.” As you said, we heard about this from
oral surgeons, and it was from creating physical trauma to the nerve in the
removal of an impacted tooth. In the sense that we can traumatize a nerve and
cause it to block conduction with paresthesia, what I read about with the 4
percent solutions is they have caused dysesthesia. So the other thing is we can
traumatize a nerve and cause it to continually fire. Patients who experience
dysesthesia from 4 percent local anesthesia, primarily to the lingual nerve to
the tongue, describe that it feels like their tongue has just been scalded. But
that is a chronic phenomenon. I know of patients who have a permanent dysesthesia
to their tongue, and their life is forever changed. They’re a chronic
pain patient. So that’s another aspect, not just the paresthesia but also this
dysesthesia of pain.
Because I wasn’t showing
my skill, I thought
I’d try to act intelligent. I
did the Gow-Gates and
she was ecstatic that
she was anesthetized.
And that’s how I came
to know about the Gow-
Gates and become a believer
in the Gow-Gates.
It’s a phenomenal mandibular
block injection.
MD: Wow, that is a lot to think about. Even if somebody didn’t fully believe this
study for whatever reason, it’s in the package insert inside the Septocaine. I have
to admit I hadn’t taken the time to read that insert. I did see your letter in JADA,
which is how I became aware of this. But I’m a little ashamed I didn’t read the
insert before that. You know, we think it’s like lidocaine; it’s got “caine” at the end
of it. You can see how a dentist might skip that. But the insert contains some pretty
important information. Let me ask you this: If a patient comes into your office and
you’re going to be doing multiple maxillary anterior crowns, let’s say they have
single-unit crowns from tooth #5 all the way over to tooth #12, how are you going
to approach that in terms of local anesthesia?
JD: Well, it can be done in a number of ways if the practitioner does not want
to affect the patient’s use of their lip. If they want to have natural lip use from
not anesthetizing some of the muscles of facial expression, what we’re doing
there is infiltrations and then things like what you were mentioning: periodontal
ligament injection or the injection they call the AMSA by injecting into
the palate. And really what that injection is doing, it’s really a subperiosteal
injection, in that the needle is placed at osseous contact. The solution is under
periosteum, so really it’s another indirect intraosseous injection in the palate.
We have the PSA nerve in the posterior, and the AMSA is saying there’s an
anterior superior alveolar and a middle superior alveolar, and that’s the AMSA,
the anterior and middle. By doing that approach on the palate, a subperiosteal
injection, we’re saying we’ll anesthetize that anterior middle superior alveolar
nerve going to those teeth. There was a study done that appeared in JADA, and
it was really the only study that showed how much solution you would use
and what areas it would anesthetize and at what frequency. Dr. Al Reader out
of Ohio State was, I believe, the primary author. Any dentist who wants to do
that injection into the palate to anesthetize the teeth should read that article to
get an idea of how successful it’s going to be. What will my frequency of success
be? Besides the standard approach of infiltrations, that approach of PDL
injections or doing a subperiosteal on the palate to try to achieve that would
be some of the other techniques I would use.
MD: I still do the multiple infiltrations. To me, the patient losing the ability to smile
is a little bit of a liability, but I want guaranteed profound anesthesia for a while
if I’m doing that many units. The patient’s comfort is first and foremost in my
mind. And by the time we get the temporaries on, they’ll probably have a little bit
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