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NERVE BLOCK: Author’s response
COMMENTARY
LETTERS
LETTERS ADA welcomes letters from readers on articles that have appeared in The Journal. The Journal reserves the right to edit all communications and requires that all letters be signed. Letters must be no more than 550 words and must cite no more than five references. No illustrations will be accepted. A letter concerning a recent JADA article will have the best chance of acceptance if it is received within two months of the article’s publication. For instance, a letter about an article that appeared in April JADA usually will be considered for acceptance only until the end of June. You may submit your letter via e-mail to “[email protected]”; by fax to 1312-440-3538; or by mail to 211 E. Chicago Ave., Chicago, Ill. 606112678. By sending a letter to the editor, the author acknowledges and agrees that the letter and all rights of the author in the letter sent become the property of The Journal. Letter writers are asked to disclose any personal or professional affiliations or conflicts of interest that readers may wish to take into consideration in assessing their stated opinions. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated.
J
around in a small foramen that carries a nerve, vein and artery is like asking for a major complication of lacerating any or all of the three components with serious consequences. It seems to me those risks far outweigh the potential relief of inconvenience to a patient for a couple of hours posttreatment. The significant finding of the study, it seems to me, is that the two studied nerve blocks were ineffective in achieving local anesthesia in some aspects, anyway. Given the ease, reliability and safety of routine infiltration, why try to poke around to find a foramen? Steven C. Legel, D.D.S. Lincoln Park, Mich.
I’m writing with regard to Dr. Ian Corbett and colleagues’ December JADA article, “A Comparison of the Anterior Middle Superior Alveolar Nerve Block and Infraorbital Nerve Block for Anesthesia of Maxillary Anterior Teeth” (JADA 2010;141[12]:1442-1448). I am a solo general practitioner of nearly 30 years. I appreciate the work of researchers. The listed drawbacks of infiltration anesthetic for maxillary anterior teeth seem minor to me. It seems to me that probing
Author’s response: We would like to point out that neither technique described involves needle penetration of a bony foramen. The infraorbital nerve block relies upon deposition of solution adjacent to the foramen,1 and a literature search suggests the iatrogenic damage to the nerve is a rare phenomenon.2 The anterior middle superior alveolar nerve block deposits anesthetic solution in the palatal soft tissues, which is thought to reach the nerve via numerous small pores or foraminae in the maxillary bone. Although the techniques are described as “nerve blocks,” it is discussed that the action of each may equate to a “field” infiltration. Although the drawbacks of infiltration anesthesia, primarily unwanted soft tissue anesthesia, may seem minor, they can be quite disconcerting for the patient. The objective of this study was to explore the efficacy of alternative techniques, and it is up to the practitioner to decide when such alternatives, with their respective advantages and disadvan-
244 JADA 142(3)
March 2011
NERVE BLOCK
http://jada.ada.org
tages, may be appropriate in their practice. Ian P. Corbett, PhD, BDS, BSc Lecturer School of Dental Sciences Newcastle University Newcastle upon Tyne England 1. Malamed SF. Handbook of Local Anesthesia. 5th ed. St. Louis: Mosby; 2004: 198-202. 2. Berberich G, Reader A, Drum M, Nusstein J, Beck M. A prospective, randomized, double-blind comparison of the anesthetic efficacy of two percent lidocaine with 1:100,000 and 1:50,000 epinephrine and three percent mepivacaine in the intraoral, infraorbital nerve block (published online ahead of print Sept. 20, 2009). J Endod 2009; 35(11):1498-1504.
CONE-BEAM TECHNOLOGY
The October JADA special supplement, “Cone-Beam 3-D: Update on Dental Imaging Technology” (JADA 2010 [3 suppl]:1S-24S), is well-timed and meaningful, to an extent. While the articles that were published definitely addressed important issues, they also seemed to miss some of the most important areas of dentistry that have benefited from this technology, while favoring others. This technology has been a tremendous boon to the discipline of endodontics and its scope of practice, and several significant publications have supported this benefit in the past two to three years.1-5 Since management of apical periodontitis, tooth/root resorption, treatment planning for tooth retention and traumatic tooth injuries are just as important as orthodontics, orthognathic surgery and implants, it seems as though there is a bias in the ADA’s perspective relative to what should receive an impacttype of publication. I do understand the issues of cost factors and page limitations for a supplement, along with a plan that the ADA may have for timely issues. But
Copyright © 2011 American Dental Association. All rights reserved.
LETTERS
LETTERS ADA welcomes letters from readers on articles that have appeared in The Journal. The Journal reserves the right to edit all communications and requires that all letters be signed. Letters must be no more than 550 words and must cite no more than five references. No illustrations will be accepted. A letter concerning a recent JADA article will have the best chance of acceptance if it is received within two months of the article’s publication. For instance, a letter about an article that appeared in April JADA usually will be considered for acceptance only until the end of June. You may submit your letter via e-mail to “[email protected]”; by fax to 1312-440-3538; or by mail to 211 E. Chicago Ave., Chicago, Ill. 606112678. By sending a letter to the editor, the author acknowledges and agrees that the letter and all rights of the author in the letter sent become the property of The Journal. Letter writers are asked to disclose any personal or professional affiliations or conflicts of interest that readers may wish to take into consideration in assessing their stated opinions. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated.
J
around in a small foramen that carries a nerve, vein and artery is like asking for a major complication of lacerating any or all of the three components with serious consequences. It seems to me those risks far outweigh the potential relief of inconvenience to a patient for a couple of hours posttreatment. The significant finding of the study, it seems to me, is that the two studied nerve blocks were ineffective in achieving local anesthesia in some aspects, anyway. Given the ease, reliability and safety of routine infiltration, why try to poke around to find a foramen? Steven C. Legel, D.D.S. Lincoln Park, Mich.
I’m writing with regard to Dr. Ian Corbett and colleagues’ December JADA article, “A Comparison of the Anterior Middle Superior Alveolar Nerve Block and Infraorbital Nerve Block for Anesthesia of Maxillary Anterior Teeth” (JADA 2010;141[12]:1442-1448). I am a solo general practitioner of nearly 30 years. I appreciate the work of researchers. The listed drawbacks of infiltration anesthetic for maxillary anterior teeth seem minor to me. It seems to me that probing
Author’s response: We would like to point out that neither technique described involves needle penetration of a bony foramen. The infraorbital nerve block relies upon deposition of solution adjacent to the foramen,1 and a literature search suggests the iatrogenic damage to the nerve is a rare phenomenon.2 The anterior middle superior alveolar nerve block deposits anesthetic solution in the palatal soft tissues, which is thought to reach the nerve via numerous small pores or foraminae in the maxillary bone. Although the techniques are described as “nerve blocks,” it is discussed that the action of each may equate to a “field” infiltration. Although the drawbacks of infiltration anesthesia, primarily unwanted soft tissue anesthesia, may seem minor, they can be quite disconcerting for the patient. The objective of this study was to explore the efficacy of alternative techniques, and it is up to the practitioner to decide when such alternatives, with their respective advantages and disadvan-
244 JADA 142(3)
March 2011
NERVE BLOCK
http://jada.ada.org
tages, may be appropriate in their practice. Ian P. Corbett, PhD, BDS, BSc Lecturer School of Dental Sciences Newcastle University Newcastle upon Tyne England 1. Malamed SF. Handbook of Local Anesthesia. 5th ed. St. Louis: Mosby; 2004: 198-202. 2. Berberich G, Reader A, Drum M, Nusstein J, Beck M. A prospective, randomized, double-blind comparison of the anesthetic efficacy of two percent lidocaine with 1:100,000 and 1:50,000 epinephrine and three percent mepivacaine in the intraoral, infraorbital nerve block (published online ahead of print Sept. 20, 2009). J Endod 2009; 35(11):1498-1504.
CONE-BEAM TECHNOLOGY
The October JADA special supplement, “Cone-Beam 3-D: Update on Dental Imaging Technology” (JADA 2010 [3 suppl]:1S-24S), is well-timed and meaningful, to an extent. While the articles that were published definitely addressed important issues, they also seemed to miss some of the most important areas of dentistry that have benefited from this technology, while favoring others. This technology has been a tremendous boon to the discipline of endodontics and its scope of practice, and several significant publications have supported this benefit in the past two to three years.1-5 Since management of apical periodontitis, tooth/root resorption, treatment planning for tooth retention and traumatic tooth injuries are just as important as orthodontics, orthognathic surgery and implants, it seems as though there is a bias in the ADA’s perspective relative to what should receive an impacttype of publication. I do understand the issues of cost factors and page limitations for a supplement, along with a plan that the ADA may have for timely issues. But
Copyright © 2011 American Dental Association. All rights reserved.