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Patients that only want topical for SRPs…

I am a recent grad and noticing that some of the patients in the office I work in only want topical for when I notice they require an SRP. This is starting to annoy me for several reasons:
1. I feel confident when I give anesthesia but feel like I am going to forget how to give it if the patients keep saying that the topical is fine
2. I feel like I am hurting the pt when going subgingival and know that they did not receive local anesthesia so I don’t go as deep or with as much lateral pressure as I should be…
3. Blood is everywhere bc they didn’t let me give them the Lido w/ epi
4. They claim they are comfortable with just topical!…

I don’t know what to do, do you think the patients think bc I’m young and newer that I wouldn’t know how to give anesthesia properly or bc they just don’t want an injection. Am I being paranoid? Any tips for me on this subject are greatly appreciated!!



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2 Answers

I don’t think that patients aren’t wanting injections because they think you are young and “less experienced.” I think that most people don’t like shots especially in their mouth. Regardless of whether topical or local is used, you need to scale as you need to in order to be effective, without hesitation. If the patient requested topical, however they aren’t tolerating treatment, then its time to do injections. It may help if your doctor comes in and justifies the need for local anesthesia to the patient until you are comfortable being firm with patients. This also applies if the bleeding is severe. You must do what is needed to treat the patient thoroughly.
 
Backing up a bit here, when I explain the need for SRPs to a patient I tell them that the treatment requires me to get them numb. I say that if they are comfortable, I can do a better job. I explain that if I leave a piece of calculus and their tissue heals around it, they can get an abscess – so I must get everything out from under their gums. I set them up expecting injections. Now some hygienists have great success with using only Oraqix or Cetacaine, but like you, I find patients are still tender and the bleeding is out of control, so I prefer local anesthesia. Point here, is if you need to do injections, you need to get the patients on board and be a bit firm.
 
Regarding forgetting how to give injections, I totally get your concern here. Just remember that there are ways to keep your skills sharp like youtube videos and other videos and articles online. You can even watch your doctor give injections once in a while to keep a visual in your head.

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I find oraquix works well if I am doing a few teeth in the quadrant. Some of my patients only want topical as well because they don’t want to be numb for hours. Give the oraquix a try and watch on you tube the exact application process. Good luck

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