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to reverse the effects more quickly. Am I missing something
here? Is this maybe something that has limited applications?
I could see that it makes a lot of sense for children.
JD: Once again I really respect your thought line because
I, too, don’t see much usefulness for this reversal anesthetic.
It works by dilating the blood vessels that we restricted
with epinephrine, causing the duration to lessen.
But like you say, hey, I’m going to give you one more
shot. And, of course, the expense of the materials, too.
And, as you say, having that period of time if we cause
some pulpal inflammation to have the patient in a period
of anesthesia where they won’t feel anything once the anesthetic
wears off is important. The other important thing,
especially for mandibular blocks and the PSA injection is,
we know when we give an injection we aspirate first to
make sure we’re not in a blood vessel. If we are, we back
up a little bit, aspirate again and inject. And, of course,
we’re using a vasoconstrictor in the local anesthetic so
it’s going to take care of that little puncture we did. But if
you did the same thing with the reverse, if you puncture
the blood vessel and back up and give your solution, now
you’ve dilated that puncture in the blood vessel. So I have
a concern as far as hemorrhage effects from using a vasoconstrictor
with the potential of penetrating a blood vessel.
I guess one of the places in their study that I felt tried
to avoid an area of issue was, as I understand it, they did
not do the PSA injection. Of course, that’s the one where
dentists worry about a hematoma. Then again, if you were
worried about a hematoma with a vasoconstrictor, what
kind of hematoma would you get with a vasodilator?
MD: It’d be a full-face hematoma! It’s funny; I remember in
dental school when I received my first PSA from the student
to my left, who was a hygienist and had already been giving
injections. I was excited that someone with experience
was going to be working on me. I remember going downstairs
after the clinic and somebody saying to me, “What
happened to your face?” and I was like, “What?” And I
actually received a hematoma on the very first PSA that I
ever got, and I had to go through all the phases of colored
bruises on the side of the face. But the student who gave it
to me also baked me cookies for about a month after that,
so it was a good tradeoff! I’ve always been very attune to
carefully aspirating since I’ve gone through that myself.
I agree that leaving hematoma out of the study seems
suspicious at worst or terribly absent-minded at best.
I was having a discussion with my dad the other day, and I
think he was being serious with me, but he said when he was
in dental school, I think from 1961 to 1964, needles were not
disposable. Is that true?
JD: It’s hard to imagine, but the needles were not disposable.
They would try to sharpen them up. It wasn’t too
much earlier from when you were a dental student that a
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