Perceived Need for Local Anesthesia: RESULTS part 2

In: Dental treatment

27 Mar 2010

Avoiding Disturbing Effects of Numbness.

Although nonuse of anesthetic among Anglo-Americans was rare, American dentists most frequently said that Anglo-American patients wanted to avoid the feeling of numbness after the appointment to have full control of their tongue, lips, and cheeks. These often have social implications such as embarrassment, as a 40-yr-old male Anglo-American dentist described:

Yeah, the fatness, the heaviness, they’re afraid that they’re going to drool. They feel that it is unsightly, even though it doesn’t show. You’ll see patients covering their lip and their chin as they’re leaving the clinic, you know, it’s because it’s like they’re embarrassed because they think their lip looks like it is big and hanging down to their knees . . .
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Swedes especially avoided losing sensory control as described by this 53-yr-old male dentist:

. . . just this tingling [pins and needles feeling] and that the tongue is gone. They experience that as really troublesome. Most of them believe they can take the [drilling] pain. They think it is more unpleasant to get numbed up, especially in the lower jaw, but the upper jaw I’ll numb up more often.

A 43-yr-old Swedish woman dentist also stated:

They feel paralyzed in the face. And they’d like to think that when they leave the dentist, they are finished. They think they should not have to go to the dentist and take something home of it afterwards, [because] it is so horrible to be there.

Danish dentists made similar comments, but Chinese dentists did not. Other western dentists, such as this 54-yr-old male Anglo-American dentist, reported unwanted chemical effects: “They don’t like the chemical feeling. They say, ‘It just knocks me out.’ They want to go home and sleep [and] their response is very dulled—until it’s eliminated from the body … a general body response that’s unpleasant.”

Fear of Anesthetic Injections. Anglo-American dentists said their patients feared the pain of injections, usually pointing out that this anxiety was worse than the drilling sensations. A 59-yr-old male Danish dentist also reported: “Others are simply petrified about needles . . . [and say they] would rather die or give birth to a child.” Most Swedish dentists specifically stated that they usually could convince patients who were afraid of injections to use a local anesthetic. In contrast, the association of tong (pain) with injections as described by Chinese dentists to their patients was the second most fre quent reason among Chinese for not using anesthetic, as detailed below. canadian antibiotics

Although fear of pain from injections was most frequently noted, five American dentists also named fear of allergic reactions as a deterrent. One 50-yr-old female dentist reported. One woman doesn’t use anesthetic because of fear of allergy. There’s apparently some allergy to caines in the family. The mother is an RN, she had four kids. And one of the children died very young and there seemed to be some relation to lidocaine in the hospital. So the mother would never let any of the children have shots for their dental work. They just had to grin and bear it. One of them even had to go to the hospital to get general anesthesia, since she had quite a few lesions (cavities).

Most patients reporting allergies were described by these American dentists as having had an emotional reaction to an injection. A 53-yr-old dentist described this thusly:

… if they say they’re allergic, you know, I’ll go along with that. But generally it’s some sort of an experience where they might have passed out before, during or after, or usually it’s at the time of the injection or something like that. But it has to do, I think, with the actual giving of the anesthetic, usually and a 74-yr-old dentist stated, “[I see] a few, and they’re hyper about everything.

Barometer of Trust. A 51-yr-old Danish woman dentist described the use or nonuse of anesthetic for drilling as a “barometer of trust” in the dentist-patient relationship:

It is trust in me treating them that makes it so that they feel they don’t need anesthetic and it could be that they would want to get numbed up if they were with a new dentist just when they first start coming.

The same dentist reported that over half of her patients had fillings done without anesthetic, very near the median. A 36-yr-old male agreed, stating:

The more secure and happy they are in the situation, the more they maybe will place themselves in the clutches of the dentist and accept that there is some pain; if they get a feeling that it would never get out of control.

Two Danish dentists and one Swedish dentist also reported that they had extracted teeth without anesthetic at the patients’ request and that the patients showed no pain.
Dentist Decides No Anesthetic Needed—Patient Tolerates Pain. This was the most common category for nonuse of anesthetic among Chinese dentists. The Chinese dentists offered statements like, “Dentists don’t use local anesthetic. Patients don’t complain. Therefore, local anesthetic isn’t used” and a kind of projected belief like, “. .the pain is only suan and is bearable.” and, “There’s no pain,” or, as a 41-yr-old Chinese male dentist explained: “Patients feel that it (drilling) is something they should tolerate.” Other than these Chinese dentists, only one Scandinavian dentist named this category. Also included in the category of the dentist deciding that no anesthetic was needed, one Danish and one Chinese dentist explained that one could better diagnose a tooth pulp problem if anesthetic was not used.

Economic Incentive—Anesthetic Costs Extra.

This unique Danish category was illustrated by a 60-yr-old male dentist’s description: “I don’t press them to have anesthetic. I tell them, ‘If you feel something, just say so and we’ll get you numbed up. Otherwise, there’s no reason for using money on anesthetic’ ”

One 45-yr-old Danish male dentist rationalized taking payment by stating: “It takes skill and time to administer anesthetic, and since I have my staff to pay, why shouldn’t I take a fee?” Another 37-yr-old male stated that a policy change to cover anesthetic would be ideal, but that it might be difficult, given that there are “other [policy] traditions” in Denmark. Two Swedish dentists also described two elderly Swedish patients who were under the impression that anesthetic was an additional, separate expense.

Preinjection Suggestions by Dentists

When asked about what they say before injecting, almost all American dentists said, “You’ll feel a little . . .” “. . . pinch,” “… discomfort,” or ” . . .uncomfortable.” A few mentioned a nonspecific “You may feel it a little bit.” Many shared beliefs of a 74-yr-old male: “I mean, if you tell them it’s going to be painful, some people will make something that may not be painful, painful. Let them make their own assessment on that.” and a 33-yr-old male said, I use [the word] discomfort. I encourage patients to express everything in terms they want to [use]. But I never say “Does this hurt?” I won’t say, “I’m going to inflict hurt on you.” I may inflict some [but] I say, “You may feel a little pinch,” or “You may feel a little discomfort here,” but [never] the word hurt, or stick, or cut, anything [like] it. suhagra

Danish dentists also usually described their shots to patients as “a little prick” (stik) or “pressure” (tryfc), being careful to minimize painful associations. Swedish dentists’ descriptions were similar to other western colleagues.

Common descriptions that Chinese dentists gave to patients prior to injections were: “You may feel a little pain (tong), but I’ll try to reduce it to a minimum with my technique. Don’t think about the pain (tong).” or “You won’t feel pain (tong).” Chinese dentists also described the patients’ reactions as, “They (patients) think that local anesthetic is very ‘tong’, but the drilling is over very quickly.” Most Chinese dentists (15/31) (11 males, four females) reported describing anesthetic injections to their patients as “painful,” implying that injections were worse than drilling.

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Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.