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Short Needles Used During Mand. Block

The dentist I work with only uses short needles. As a new graduate, I am finding difficulty really getting the patient numb when administered blocks. I’ve asked him to purchase long needles for me, but he said I will learn…

Also, he uses mepivicaine, then lidocaine, then finally articaine. I don’t feel comfortable mixing all these anesthetics together at once. Advice?



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3 Answers

On most adult patients, you would have to sink the sharp to the hub to reach the desired spot for an IA, I would be worried about the sharp breaking off…that would result in an immediate trip to the OS for surgical removal. I would find some literature to show your boss to substantiate your desire to use a long needle.
As far as using varying anesthetics, what is his reading behind that? Mepivacaine can burn going in and lowers the maximum safe dose, plus Articaine is a 4% and also lowers the msd.
As a trained professional, you should be able to choose how you administer anesthetic. Maybe a frank sit down with your boss is in order.

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Order your own box of needles. Shouldn’t be that expensive.

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When I first graduated a few years ago, the doctor I worked for was the same way-she did NOT want to see long needles being used for IA injections unless it was a “big man”. (I still used long needles because that’s what we learned in school) I actually attended a local anesthesia CE presented by Dr. Malamed (literally wrote the book on local) and he specifically warned everyone NOT to use anything but long needles for IA injections because the short ones will break easier and they do not reach the correct area. He also said that if you use a short needle and it breaks, the patient will likely sue you for malpractice and every case he has been in on, the patient won. That may be incentive enough for your doctor to read up on techniques. 4% Articaine also has a higher chance of causing paresthesia/damage when doing IA injections. It is also our job to keep the patient safe-they are trusting in us to do the right thing.

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