MANDIBULAR LOCAL ANESTHETIC FAILURES: ARE WE TAKING THE CHALLENGE SERIOUSLY?

• Published in: Pakistan oral & dental journal 2017-12, Vol.37 (4), p.551
• Main Authors: Basit, Ayesha, Mahmood, Sadia, MAHAM NAEEM, Khan, Shaz
• Format: Article
• Language: English
• Subjects: Anesthesia; Cooperation; Curricula; Dentistry; Dentists; Education; Failure; Handbooks; Knowledge; Local anesthetics; Mandible; Pain; Practice; Questionnaires; Reference books; Students; Success; Surgery
• ISSN: 1012-8700; 1996-4439

With surveys undertaken to calculate the success/ failure rate of IANB and the understanding of reasons of failure to achieve adequate anesthesia at different levels of dental career, literature on regional anesthesia in faciomaxillary and oral surgery has emphasized on the importance of knowledge and clinical expertise under guidance to reduce discomfort and pain.7,8 The authors having a considerable experience in dentistry and being engaged in teaching at undergraduate level and supervising the house officers in the department of Oral and Maxillofacial Surgery, realized that despite all the anatomical causes documented in the literature for inferior alveolar nerve block failure, the main deficiency lies in recognizing the landmarks for administering the injection as well as knowing how to check the effectiveness of the local anesthesia administered. TABLE 1: PROFESSIONAL STATUS OF PARTICIPANTS Frequency Percent Valid Percent Cumulative Percent General practioners 98 40.5 40.5 40.5 Part-time general practice 136 56.2 56.2 96.7 Only teaching 8 3.3 3.3 100.0 Total 242 100.0 100.0 TABLE 2: PROFESSIONAL STATUS VERSUS FREQUENCY OF FAILURE OF INFERIOR ALVEOLAR NERVE BLOCK Often Al- Total num- % of participants who often ways ber of parti and always experience failure cipants of IANB Professional General practice 25 4 98 29.5 status only Teaching and 29 5 136 25 part-time gener- al practice Only teaching 0 0 8 0 Total 54 9 242 TABLE 3: PARTICIPANTS VIEW OF THE MOST PROBABLE CAUSE OF FAILURE OF INFERIOR ALVEOLAR NERVE BLOCK IN THEIR CASES Frequency Percent Valid Cumulative Percent Percent 0 1 .4 .4 .4 Could not recognize the landmarks 64 26.4 26.6 27.0 Not good at IANB technique 28 11.6 11.6 38.6 Patients perceive pressure as pain 85 35.1 35.3 73.9 Not sure about the cause 58 24.0 24.1 97.9 Did not answer 4 1.7 1.7 99.6 More than one causes 1 .4 .4 100.0 Total 241 99.6 100.0 Missing System 1 .4 Total 242 100.0 TABLE 4: REVISION OF ANATOMY Frequency Percent Valid Percent Cumulative Percent Do not consider it necessary 20 8.3 8.3 8.3 Do not have time to revise 44 18.2 18.2 26.4 Sometimes 137 56.6 56.6 83.1 Often 40 16.5 16.5 99.6 Did not answer 1 .4 .4 100.0 Total 242 100.0 100.0 TABLE 5: RESPONSE OF PARTICIPANTS TO COMPONENT 2 OF THE QUESTIONNAIRE Questions Wrong Correct Did not Total answer (%) answer (%) answer (%) Areas anesthetized by blocking IAN 69 29.8 1.2 100 Areas Anesthetized by blocking Lingual nerve 23.6 74.8 1.7 100 Areas anesthetized by blocking LBN