Giving local anaesthetic: managing anxiety

Hello. And in this talk, we’re going to focus on giving local anaesthetic. And the punch line really is getting it right first time. So why is the punch line getting it right first time? That’s because we know that if you give somebody a painful experience you will make them more anxious. We know somebody who is more anxious is much more likely to report that they’re feeling pain. OK? So it’s really important that we have, we provide pain free dentistry. Because if we don’t, then we have this vicious cycle of anxiety, meaning more pain reporting or pain meaning more anxiety.

And as wrote Stewart Song, and a line that I often use in this talk is the first cut is the deepest. Yeah, so it’s really important if we’re going to do something that might cause pain, we do not cause pain and we provide pain free dentistry. And that’s what this talk is about. It’s about the importance and how to give local anaesthetic in an effective way. Because often we find that dentists are more scared about giving the local that the children are about receiving a local. So there are two key skills here. One is managing the specific anxiety of the child around having local anaesthetic. OK? That’s not their overall anxiety but specifically around managing the local anaesthetic.

And the second way, and second thing, the second skill is giving that local anaesthetic in a way that is pain free. All right. So how do we manage anxiety. And the first thing to think about is, do we even tell them that we’re giving them a local anaesthetic at all. Or should we lie and cover up what we’re doing? And I know some people believe that we should always tell children what we’re doing. And I don’t think I’m going to necessarily disagree with that. But I’m going to tell you what I do. And what I do is I lie shamelessly for younger children.

Because I think for a broadly under tense, I think, it’s really easy to give local in a way that they won’t see what you’re doing. And I think often if you can give it in a pain free way, they’ll have no idea they’ve had local anaesthetic. And for me, for that group of children, that’s the best approach. I think once to get a little bit older, over 10 about a bit tenure they will realise that. They’re more likely to catch you out or understand what’s about to happen. And those children you don’t rely because if they catch you out in your life, then that’s going to make everything much worse. You’re going to lose the trust with that child.

So older children I will tell them what I’m doing, but certainly for younger children I will definitely tell a complete fibs and I will not let them know what’s happening. Now for that to work, you need to have a good team with your nurse, you have to conceal local anaesthetic pass upon the child’s head. But for me for small children it’s a really effective way of managing the anxiety of the local anaesthetic. Don’t tell them I’m doing it at all.

The next part emerging anxiety is where possible preparing them for what’s going to happen. So even if you aren’t going to tell them you’re going to give local, you need to let them understand what’s going to happen to them. That’s really important to understand the feeling of the local, how it might feel, the face is swelling, it might feel warm but not to the touch. It’s really important that if you get topic as I’ve said in previous talk on behaviour management, they’ll be given the topic the week before. So they have that. They know what that feels like. But explain to them what’s going to happen so they know what to expect. It’s a really good way of managing anxiety.

And finally, the most important part of managing the anxiety of the injection is distraction. And in general, teamwork is also really important as well. Because if your nurse doesn’t understand what you are trying to do and actually if the parents don’t understand what you’re trying to do, if you’re not all working as a team to deliver this local maybe conceal what you’re doing or talk about in certain ways, then it’s not going to work as well as you want it to work. But distraction is possibly the most important thing you’re going to do. OK. So what do I mean by distraction. By distraction, I mean, distraction is by taking their mind off what you’re doing.

And when I am supervising my trainees and my students and nothing worse than seeing somebody give local anaesthetic and they’re quiet, and the nurse is quiet, and there’s nothing happening in the room, and the parents are quiet, and all the child can focus on is what is being done to them, what is this thing that’s happening in my mouth. So distraction is really key. And there are some different types of distraction, probably the most evident-base one, and there’s more and more evidence coming through using things like video glasses. So on the slide of a random picture, I have a set from Amazon, but there are loads of different types that you can buy now.

And they essentially wear these glasses, they’ve got small video screens in them, and they can watch a film, or a cartoon, or whatever you choose to put through the glasses. And it takes the mind of what’s happening. So video glasses are probably the best investment you can make in terms of some kind of distraction when you’re giving the local anaesthetic. Other things you can think about, well, certainly we use a ceiling projector. And we have a series of scenes on the ceiling that it’s very simple. It’s an acetate with a light shining through it and it just rotates. And it’s something they can look at and you can say, well can you see how many stars, can you count?

In another place I work, we have a very detailed picture and you can get in get in to look at the picture and try and pick out particular features. There’s even some evidence to show that magic tricks might work, though I’m not suggesting you learn magic, but anything for them to look at. They can look at passively they don’t have to touch it. And that will take their mind off what’s going on. If you can’t get access to these things or you have got resources, verbal distraction is important. So keep talking. Ask them questions that they can reply to in non-verbal way, talk to them about what you did, have a repartee with the nurse.

Anything again so that they’re involved in listening to what you’re saying. It’s really important that you keep that verbal pattern going. And the focal distraction is a physical distraction. And so some of my students can pinch the child on their lap and not in a painful way, but in a way that they can feel something else happening. One of my students used to get the nurse that really aspirate in a corner away from the injection walls so they’d feel the aspirator rattling around and that would take their mind off it. Or maybe you could tap with a finger. Again, any other sensation to take their mind off what’s going on in their mouth.

Good.