10 May 2011

Q. The practice owner has told me not to use local anaesthetic routinely for fillings and has asked me to economise by using it only in those cases where the patient will be in extreme pain. How can I decide what I should do?

Most patients will have an expectation that their dentistry will either be pain free or that any pain will be managed effectively. Therefore, the provision of a local anaesthetic for a given procedure will initially involve a discussion with the patient about the nature of the procedure being contemplated and what they may expect.

Bearing in mind that individuals vary considerably - some are stoic by nature and express a wish to have no local anaesthetic for nearly all dental procedures, with the exception probably of extractions, and others have a very low pain threshold or are particularly anxious and these individuals may request local anaesthetic for nearly every dental procedure, including scaling.

This is an issue of consent and as a clinician, you should not impose your views and provide treatment without local anaesthetic simply because you have considered the matter (as requested by the practice owner) and concluded that the procedure will not be painful and does not require local anaesthetic.

As clinicians, it is incumbent upon us to respect patient autonomy and an individual’s right to make decisions about their treatment and this would extend to a decision about local anaesthetic.

Of course, the patient’s medical history initially needs to be checked and updated before considering the type of local anaesthetic drug to be administered.

In summary, the use of a local anaesthetic is a matter of consent and not one of financial expediency.

DPL’s advice booklet on consent is available here

Dental Protection Limited is registered in England (No. 2374160) and is a wholly owned subsidiary of The Medical Protection Society Limited (MPS) which is registered in England (No.36142). Both companies use Dental Protection as a trading name and have their registered office at 33 Cavendish Square, London W1G 0PS.

Dental Protection Limited serves and supports the dental members of MPS with access to the full range of benefits of membership, which are all discretionary, and set out in MPS’s Memorandum and Articles of Association. MPS is not an insurance company. Dental Protection® is a registered trademark of MPS.

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