OK, enough will all of these sad, wrenching tales. How about one with a happy ending?
I recently learned how to give dental blocks by spending a day and a half with one of our maxilofacial surgeons. I wanted to be sure I practiced the skill as often as possible so that I wouldn’t forget how to do it…dental pain releif can be one of the most satisfying or frustrating encounters in the ED. One sunday morning, when all dentists’ offices are closed, a woman came to the ED with horrific tooth pain. Her daughter was with her and was quite giggly, the entire time. In fact, when I was examining her mother’s mouth and bumped the infected tooth, her daughter laughed at her mother’s discomfort. She was certainly no help to the situation. I told the patient that she had two options. I could give her some pills that would help the pain, but would take several hours to take maximum effect. Or…I could give her an injection which would stop the pain immediately. She opted for the former…most people are scared to death at the thought of a needle in their mouth. The daughter wanted me to give her the injection. I asked her to reconsider her decision…”If you let me give you an injection, your pain will be gone within a minute…completely gone! Are you sure you wouldn’t like me to try it?” She reconsidered. I was thrilled to get to practice the technique again!
I grabbled the dental box and fumbled with it’s contents. I couldn’t get any of the needle and syringe parts to cooperate with each other. The patient and here daughter watched me try to mix and match sharp pointed objects together without success. “Are you sure you know what you’re doing?” the patient asked. Her daughter giggled. I gave up on the dental box and left the room to mix my own syringe of anesthetics. Returning to the room, I approached the dental chair. I didn’t realize it was a “new” chair that we were demoing. I had no idea how to use it. I stepped on various buttons and watched the chair go up and down, back and forth. the patient jumped out of the chair. “Are you SURE you know what you’re doing???” “Trust me.” I said. Her daughter told me what pedals to press to get the chair where I wanted it.
Finally, with my patient back in her chair, her mouth open, I began the procedure. I moved her tongue aside with a wooden tongue blade, inserted the smallest diameter needle we have, and proceded to slowly inject the anesthetic around the nerve. My patient’s eyes darted back and forth, unable to speak with a wooden stick and a needle in her mouth at the same time. About 3/4 of the way through the injection…45 seconds or so, I saw her face light up. Her eyebrows started to dance, the wrinkles and furrowed brow were gone. I finshed the injection and pulled the needle out. “How do you feel?” I asked? “Great!” she exclaimed. She put her hand to her face, incredulous that the pain was gone. “I didn’t even feel the needle,” she said. I glowed with pride on the inside at my obvious success with yet another dental block.
The patient stood up, thrust her hand towards me to shake it, and said, “If you do nothing else today, you’ve done a great job!”. Her praise carried me through the rest of my day!
So…if you ever end up in the ED with a painful tooth, just ask for me, and the 27 gauge needle. I’ll leave the dental box behind.