Sean G. Boynes

Needle Phobia: Etiology, Adverse Consequences, and Patient Management

Needle phobia has profound health, dental, societal, and legal implications, and severe psychological, social, and physiologic consequences. There is genetic evidence for the physiologic response to needle puncture, and a significant familial psychological component, showing evidence of inheritance. Needle phobia is also a learned behavior. The dental practitioner must recognize patients with needle phobia before the administration of local anesthetics to identify patients who are potentially reactive and to prevent untoward sequelae. Needle phobia is highly associated with avoidance behavior, and the dentist must exhibit compassion and respect. To avoid bradycardia, hypotension, unconsciousness, convulsions, and possibly asystole, oral premedication with benzodiazepines or other antianxiety agents must be considered for patients who are needle phobic. Management of needle phobiaeinduced syncope includes perioperative monitoring, oxygen administration, positioning, atropine, and vasopressors.

Allergic Reactions to Local Anesthetic Formulations

True allergic reactions to local anesthetics are rare adverse reactions. At the most, they represent less than 1% of all adverse local anesthetic reactions. When true allergic reactions have been confirmed, the reactions are most commonly the type I anaphylactic and type IV delayed hypersensitivity responses. The type I immediate hypersensitivity reactions are the most severe and may be life-threatening. In the event a potential allergic reaction occurs in a dental office, the dentist needs to properly evaluate the events leading up to the reaction and provide a differential diagnosis. A referral should be given to any patient when an allergic reaction cannot be ruled out as an intravascular injection, toxic overdose, psychogenic reaction, or an idiosyncratic event.

Complications associated with anesthesia administration for dental treatment in a special needs clinic

The goal of this study was to identify and quantify complications occurring with the administration of anesthesia for the dental treatment of patients with special needs. Anesthesia providers completed a standardized evaluation form, delineating possible complications for 202 consecutive ambulatory patients receiving anesthesia in a special needs clinic. Statistical analysis of four types of administered anesthesia showed that the overall complication rate was 23.8%. Evaluation of the data showed complications that were considered either mild (95.8%), or moderate (4.2%), while no reports of severe complications occurred. Airway obstruction and nausea/vomiting were the most frequently encountered complications. Variables found to affect the incidence of anesthetic complications included ASA classification, anesthetic technique, Mallampati airway classification, and type of dental procedure performed. An evaluation of the results of the study showed that the majority of complications that occurred with anesthesia during care of patients with special needs were mild and did not lead to severe adverse events. Our findings show that anesthesia administered during dental treatment for patients with special needs is safe and effective.

Ocular Complications Associated with Local Anesthesia Administration in Dentistry

The most widely used method for controlling pain during dental procedures is the intraoral administration of local anesthetics in close proximity to a specific nerve or fiber to obtund nerve conduction. The most commonly anesthetized nerves in dentistry are branches or nerve trunks associated with the maxillary and mandibular divisions of the trigeminal nerve (cranial nerve V). However, other nerves may be inadvertently affected by intraoral local anesthesia injections, resulting in anesthetic complications of structures far from the oral cavity. Practitioners should be aware of potential ocular complications following intraoral injections in dentistry. These complications include oculomotor paralysis and vision loss. The knowledge of these conditions and their potential cause should alert the dentist to the importance of appropriate injection techniques and an understanding of management protocol.

Assessing the need for anesthesia and sedation services in Kuwaiti dental practice.

The objective of this study was to examine the public health relevance of the prevalence of dental fear in Kuwait and the resultant barrier that it creates regarding access to dental care. The study analysis demonstrated a high prevalence of dental fear and anxiety in the Kuwaiti population and a perceived need for anesthesia services by dental care providers. The telephone survey of the general population showed nearly 35% of respondents reported being somewhat nervous, very nervous, or terrified about going to the dentist. In addition, about 36% of the population postponed their dental treatment because of fear. Respondents showed a preference to receive sedation and anesthesia services as a means of anxiety relief, and they were willing to go to the dentist more often when such services were available. People with high fear and anxiety preferred to receive some type of medication to relieve their anxiety. In conclusion, the significance and importance of the need for anesthesia services to enhance the public health of dental patients in Kuwait has been demonstrated, and improvements are needed in anesthesia and sedation training of Kuwaiti dental care providers.

Improving health in the United States: Oral health is key to overall health

The oral health-systemic connection has been well documented for many conditions, with strong evidence in 2017 connecting oral health and rheumatoid arthritis. 9 The results of this analysis indicated a strong correlation between dental visits and overall selfrated health, and this relationship is getting stronger over time. In other words, states in which adults are more likely to visit the dentist also tend to have the lowest proportion reporting fair or poor health. Yet, the lack of detailed nationaland state-level data means understanding the role of oral health in state-level health economics remains a challenge. The authors conclude that it will require a coordinated multisystem solution, and oral health is a key to improving the overall health of the nation.

Evaluating complications during intraoral administration of local anesthetics in a rural, portable special needs dental clinic

The aim of this study was to identify and quantify complications with local anesthetic administration on consecutive patients seen for dental care in a portable dental clinic providing care to patients with special needs. This prospective study includes data on the patients seen by the portable dental team. A standardized form is used to determine complications and associated information for 172 dental visits in which local anesthetic is administered. After statistical analysis of 172 consecutive cases, the overall complication rate is 8.1%. All of the complications are considered to be mild or moderate; there are no reports of severe events. The complications encountered most frequently are associated with self-inflicted soft tissue injury or inadequate anesthesia. Comprehensive care with local anesthesia delivered by a portable dental clinic has a low risk of complication. The administration of an inferior alveolar nerve block or body-mass status appears to affect the incidence of complications.

Analysis of parental factors and parent-child communication with pediatric patients referred for nitrous oxide administration in a rural community health center setting

Objectives: The aim of this study was to identify and quantify likeness and difference in parent response to anxiety scale, dental knowledge, parent-child communication, and parental dental history. The objective is to determine if relationships exist with these parameters and the need for analgesia and/or sedation in their children. Methods: A survey-based quality analysis was performed between June 2012 and May 2013 on 126 consecutive parents/guardians of children receiving nitrous oxide administration during dental care within CareSouth Carolina’s Division of Dental Medicine Pediatric Dental Clinic (CSCDM). Results: A total of 126 questionnaires were completed by the legal guardians of pediatric patients seen for dental care during the administration of nitrous oxide. The mean Corah’s Anxiety Scale score corresponds to moderate anxiety. The mean score for the dental knowledge quiz was 2.98±1.13 out of 5 (59.6%). The majority of parents responded that they discussed a previous dental visit with their child and 41.1% described that visit to their child with negative connotations. A total of 50% of parents reported having a bad dental experience. Conclusions: The results revealed a shared anxiety with dental care. Pediatric anxiety and fear of dental care is multifactorial and the parents have a significant role in its development. Parents of patients that required referral for a deeper form of sedation may have higher anxiety scores, lower dental knowledge scores, and be more likely to describe a previous dental visit as negative. The communication process between the child-patient and parent can include negative connotations.

Local Anesthesia Administration by Dental Hygienists

Within the last 30 years, the role of dental hygienists has expanded to include the administration of local anesthesia. Several studies have been performed to assess practice characteristics and effectiveness of these changes in state licensure regulations. Findings indicate an acceptance of this expansion in dental hygiene practice; however, the delegation of this pain control procedures remains controversial. To address this controversy, the authors have reviewed of current literature to assess the practice of local anesthesia administration by dental hygienists.