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lot of deflection. Just like you say, it’s almost as though you could feel it when
you penetrate tissue; you could almost see the needle deflecting and bending
in the outer tissue. And it is interesting because, similar to you, I know dentists
who use 30-gauge needles for mandibular blocks, and they’ll even use 30-gauge
short needles, and it blows my mind, but they say they’re successful. It’s really a
curious phenomenon that some dentists use all these different diameter needles
and different length needles and have success, and some practitioners have tried
everything and can’t get success with anything for a mandibular block.
Fifteen to 20 percent
of the time, the dentist
misses the mandibular
block and needs to give
a secondary one. And
then, well, two things.
One, with the Gow-
Gates that number is far
less — I’ll say 90 percent
of the time to 95
percent of the time, the
Gow-Gates gets it with
the first injection.
MD: Yeah, that is. The majority of what I do, and the majority of what a lot of other
general dentists that I talk to do, is one and two single-unit crowns. You know, you’re
doing a single-unit crown on a tooth that broke and nothing else in the quadrant
needs anything. So my favorite needle has become the 30-gauge extra-short with the
PDL, which I learned today was kind of an intraosseous technique at the same time.
I had tried intraosseous injections before because I liked the idea of getting so close
to a tooth and not having to give a block, but I always found it really difficult. I
remember that Stabadex system where you would pierce the mucosa and make the
hole in the bone and then hopefully when you went back to put the anesthetic in the
hole, the soft tissue still lined up with the hole in the bone. And it always felt strange
to put a hole in the bone just to put some anesthesia in there. It seems some of those
systems have fallen out of favor, but I like the idea that we can use this other, what we
would traditionally term a PDL, and get that same kind of effect.
JD: Yeah, it really works well that way. And with that direct intraosseous system,
I think one of the things practitioners like about the improved version of the
X-tip system is the little sleeve to put the needle in to help with placement. So
that is a helpful technique, but like you said, using a PDL technique to create that
same situation of anesthetic going intraosseously works well, too.
MD: I didn’t really follow up with this question when we talked about it, but I’ve heard
a lot of lecturers say for probably 10 years now that Septocaine is great for infiltrations.
They say you can actually infiltrate teeth that you couldn’t before: lower bicuspids
and lower anteriors. If you used it on a maxillary tooth, you could pack cord on
the palatal without giving additional anesthesia. I’ve largely found this to be true, so
I’ve liked Septocaine as an infiltration. We spoke specifically of what you don’t like
about Septocaine as a block anesthetic, but do you like it as an infiltration anesthetic?
JD: Well, I agree with what you’ve said, for infiltration it is more successful. I
believe both 4 percents are more successful, but articaine definitely in the infiltration
injections are where 2 and 3 percents should not be relied on. I would
probably go to prilocaine myself — it’s a 4 percent. The other thing, there are
some patients — substance abusers or former substance abusers, and it may be
20 years since they first got clean — for which our 2 percent local anesthetic
will just not anesthetize them. Four percent prilocaine is what I’d use for patients
who aren’t numbed by 2 percent anesthetic, so I really like it for that.
You mentioned earlier about not using 4 percent for the PDL injection, and I concur.
There’s a higher degree of postoperative sensitivity using a 4 percent in attached
gingival, doing an interdental injection, or doing the nasal palatine or doing
the PDL. I would say, in those places, I don’t care for the 4 percent solution.
MD: OK, interesting. Well, that was a quick hour; the time just flew by. It was fascinating.
Do you have any upcoming courses or an easy way for dentists to check on your
lecture schedule to see where you’re going to be speaking?
JD: Thank you for asking, Mike, I appreciate that. I stopped speaking outside the
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