Perceived Need for Local Anesthesia: RESULTS

In: Dental treatment

26 Mar 2010

Frequency Distributions for Nonuse of Local Anesthetic

American dentists (n = 51) reported a median of 1% of patients not using anesthetic compared with 90% among Chinese (n = 31) and 37.5% among Scandinavian dentists (n = 40). American patients (n = 112) reported 6% nonuse of anesthetic compared with 90% of 159 Chinese and 54% of 125 Scandinavians (Danes = 54/87; Swedes = 13/38). Danes were over three times less likely to use anesthetic than Swedes (OR = 3.2, confidence interval [CI] = 1.4-7.0, P < 0.01). Table 1 presents gender and age data by ethnic group for the use or nonuse of anesthetic for tooth drilling. Although not significant, Danish men were nearly three times more likely to report not using local anesthetic than were Danish women (OR = 2.7, CI = 1.1-6.7, P = 0.056). Danish patients 45 yr or older were less than half as likely to use anesthetic than Danes 44 yr or younger (OR = 2.1, CI = 0.9-5.0, P = 0.16) and Scandinavian patients generally followed the same pattern (OR = 2.2, CI = 1.1-4.5, P = 0.052). Ninety percent of American, 31% of Chinese, and 93% of Scandinavian dentists reported using anesthetic in dental treatment when having their own teeth drilled.

Reasons for Use or Nonuse of Local Anesthetic

Thematic categories for reasons for use or nonuse of anesthesia for tooth drilling and category frequencies are presented in Table 2. Themes of reasons across cultural groups are described below in narrative form. Salient examples of categories are provided by ethnicity to illustrate category and subcategory content. canadian pharmacy cialis

Table 1. Nonuse of Local Anesthetic for Tooth Drilling (N = 396 patients)—Frequencies by Age and Gender for Ethnic Groups Sampled in Seattle, WA, Columbus, OH, Taipei, Taiwan, Tianjin, People’s Republic of China, Arhus, Denmark, and Goteborg and Linkoping, Sweden

Anglo-

Americans

Chinese

Danes

Swedes

Scandinavians

Population

(N = 112)

(N = 159)

(N = 87)

(N = 38)

(N = 125)

Men

5/59

72/82

29/39

7/21

36/60

Women

2/53

69/77

25/48

6/17

31/65

Age < 45 yr

4/58

70/81

23/40

6/14

30/67

Age > 45 yr

3/54

71/78

31/44

7/24

37/58

Biomedical, Ethical Justifications—Dentist Talks Patients into Using Anesthetic. Most categories reflected descriptions of nonuse of anesthetic because of the nature of the questioning, but nine Anglo-American, one Chinese, and five Scandinavian dentists said that they would talk their patients into using anesthetic for tooth drilling. They explained that they would be able to work without being nervous about patient reactions to pain and that reactions (jerking) might affect the quality of work or cause soft-tissue injury. Two Anglo-Americans and two Swedes also offered that the use of anesthesia improved patient trust in them.

Pain Tolerated—Anesthetic Unnecessary.

A statement typical of this category reported by a 56-yr-old male American dentist was: “I think mentally they just told themselves, this will be no pain or the pain that will come is easily controlled … .” Similar to other Danish colleagues, a 37-yr-old female dentist, about the variation of pain perceptions among her patients, said
Some think that it isn’t necessary because they don’t experience it (drilling) as intense pain. But I mean that there are differences in pain [perceptions] for people. Some feel it is pain that drives you out of your mind (afsindigt ondt).
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Other Danes, like this 47-yr-old male, added that drilling did not last very long: “About 60% don’t use anesthetic and about half of these say they can cope with the pain because it (drilling pain) doesn’t last very long.”

Table 2. Reasons for Nonuse (or Use) of Local Anesthesia in Tooth Drilling by Frequency Obtained from Semistructured Interviews with 122 Dentists from Seattle, WA, Columbus, OH, Taipei, Taiwan, Arhus, Denmark, and Goteborg and Linkoping, Sweden

Anglo-
American

Chinese

Danes

Swedes

Scandinavians
Reasons by Category (N = 51)

(N = 31)

(N = 23)

(N = 17)

(N = 40)
Dentist decides, talks patient into using 9

1

2

3

5
Pain tolerated, unnecessary/doesn’t hurt 38

6

21

16

37
Avoid disturbing effects of numbness 39

1

14

15

29
Fear of injections 35

11

16

15

31
Barometer of trust (nonuse) 0

0

6

2

8
Dentist decides, patient tolerates pain 0

30

1

0

1
Economics—anesthesia costs extra 0

0

20

2

22

Swedish dentists agreed, but not necessarily because drilling was thought of as short term. Many dentists described patients who didn’t think tooth drilling was especially unpleasant and who seemed completely relaxed and unworried. Most of these patients were described as older and were unused to using anesthetic. A 38-yr-old male said: “They have never had shots before and prefer not to. They’ve never been indoctrinated . . . .”

Some Chinese patients were also described as “not used to receiving anesthetic.” One dentist said, “In general, patients don’t yet have the concept of getting anesthetic for anything other than tooth extraction.” Other older Swedish patients were described as having receding dental-pulp nerves, which reduces pain perception. Still, a 35-yr-old female dentist exemplified her Swedish colleagues stating: “Many of these patients force themselves to work without anesthetic. To sit and work on someone that is forcing themselves to [have drilling] without anesthetic is stressing. I don’t like it and find it appalling.”


About this blog

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.

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