31 August 2010

Q. Is an aspirating technique essential for administering local anaesthetic as an inferior dental block? I would prefer to use the technique but there are no aspirating syringes where I work.

Dental Protection is not the arbiter of clinical opinion but in general terms*, it is good practice to use an aspirating technique, especially for inferior dental block analgesia, if not for all local anaesthetics.

However, the legal principle in this country is governed by two particular cases and the first of these was a case called Bolam. In the case of Bolam, the courts decided that they would not interfere or make a decision between two sorts of treatment or two techniques or two theories, if each of them had a substantial body of peers who used or accepted that technique. There are still a substantial number of dentists who do not use aspirating syringes, as well as a growing number of dentists who do. The Bolam principle would suggest that either method is acceptable. A later case of Bolitho went a step further however, and the courts determined that when choosing between two clinical techniques then both views and techniques must be reasonable and this of course is a difficult decision to make. Is it still reasonable to use a non-aspirating syringe?

If you believe that aspirating is a part of the acceptable technique for ID blocks, then you should ensure that you use an aspirating syringe.

If you working somebody else's practice you should ask whoever supplies your equipment, if they would make aspirating syringes and suitable cartridges of local anaesthetic available. If you are not provided with these tools, then you yourself would have to make a decision as to whether you could continue to work in a setting where it is not possible to treat patients in a manner that you consider to be correct.

*Documented research in the subject began in 1991 - visit www.gopubmed.com for more information.

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