A funny thing about mandibular blocks

You know a funny thing about blocks is putting a cotton tip applicator with topical and letting it sit for awhile with half the patients turning cross eyed and gagging and spitting and then you stick a needle in them about a half an inch deep which is so far beyond the capability of topical to have any effect on it''s ridiculous.

The phobic patient is sucking in a deep breath and/or hyperventilating while you apologize and inject with them white knuckling your arm rest, beads of sweat visible on their upper lip and brow furrowed like a disc harrow ran over it.(sorry, it must be the farmer coming out of me)

Then half the time they don''t take and when they do it takes forever and even if their lip is numb a percentage of the time you drive the bur into their tooth and they recoil in pain and you apologize again and start explaining how it''s not your fault because if their lip is numb their tooth should be numb but not always because of auxiliary (or collateral) innervation and it''s not really your fault but you feel guilty anyway.

The patient is in some sort of misery trance and is probably not hearing a word you say and if they do they can''t respond to you anyway because of their complex phobic/accusation mental make-up that puts you in the category of one who might be met in hell some day.

It doesn't matter that you are effusive in your remorse for putting them in torment, they have no capacity to even respond to you.

So you pull out your ligajector and shoot them with Lidocaine (pre-articaine), and give them another block or two (the dense pack technique) we used to jokingly call it in dental school. We shoot high, we shoot low, the patients cheek is full of holes.

The patient senses our inneffectuality and we are perfectly aware of it ourselves. "I must be the worst dentist there ever was. The most incompetent. I must have been sick and absent the day they taught mandiblular blocks." You think to yourself.

You try the Akinosi technique, you try the Gow Gates. Nothing works. You are sitting on needles as you attempt to drill again, just waiting for the patient to abruptly scream sending you gasping for breath.

Sometimes, long after you’ve finished the treatment the patient declares, "I think I''m numb now!"

Mandibular Block Gone South Syndrome sets in. (No offense to my venerable Southern brothers).

Why, after 18 years of practice do I continue to be surprised by a patient who starts to hyperventilate and groan and whine and carry on like I’ve tortured them immeasurably before I’ve actually touched them?

The real clincher is the patient who makes you sweat through the entire process leaving you wrung out like a squeezed rag and feeling at your absolute lowest. You would apologize only to hear the patient say, “Oh no doc, that was great, I didn’t feel a thing!” “Then why on earth did you subject me to such misery!!” You want to shout. But you don’t shout, you just look back at them with disbelief that they could have carried on that way making you completely miserable while they evidently received the most gentle injection of their life.

And you imagine to yourself that all your colleagues must be perfectly adept at giving mandibular blocks and you are just deficient and incompetent and probably shouldn’t even have been allowed to graduate from dental school. In fact the state board of dental examiners could come busting in at any minute to strip you of your license and drum you out of the profession.

We sweat as much as they do. We really do. And we use nitrous oxide, in which case we have a “high” phobic or perhaps Valium in which case we have a “drousy” phobic or we use “conscious”sedation or even total general anesthesia in an attempt to deal with the trauma of a mandibular block. (actually zapping them with a little Halcyon is the best fix we’ve ever come up with.)

The patient holds up their hands like they are telling a “Big Fish” tale and say, “The last dentist came at me with a syringe this long!” (the gesture is about a foot or so long) and in their mind they are telling the truth.

Now maybe you’ve never experienced what I’m describing, and your mandibular blocks take every time and you’ve never had a single solitary case of trismus or paresthesia after giving a mandiblur block and you are in a state of shock to hear me go on about mandibular blocks like I’ve been doing for so long now…………………………..but somehow I doubt it.

Can you imagine the guy who got the guts to try the world’s first mandibular block? This dude must have had some cahonas. “If you don’t mind Mr. Smith, I’ve got this theory that if I can stab deep enough and strike solid bone,( I’ll know that when my needle flexes like a recurved bow you know), and then inject a good dose of Novacaine in the area that I just might hit the mandibular nerve just before it goes diving into the mandibular foramen and then you’ll be a lot more comfortable while I’m drilling into your dentinal tubules. And by the way, while I’m at it, excuse me while I stick you again and give you a good old “long buccal” just in case I wind up wrapping your cheek around a 557 bur later on during the drilling process. If you’re really good and sit very still, we’ll probably be able to avoid this. Maybe.

Rats! I’ve done it again. Rambled on obsessively about mandibular blocks and my personal frustrations. Oh well.

To make a long story longer. Shooting a buccal furca in the PDL is quick, predictable and painless if you do it right. The tooth goes down, the patient doesn’t suffer and you can get through your procedure without a hassle and no wait, no suspense. If I want suspense I’ll watch an Alfred Hitchcock movie.