Across the spectrum of any discipline there will be divergences; never is there universal agreement. I guess the origin of numerous jokes within our professionals such as engineers and lawyers is a classic example. No where is there aphorism more true than in the field of medicine and dentistry. However what makes this more surprising is that much of the practice is empirical and should be governed by results.

Furthermore, over wide areas, both the philosophies held and the treatments employed are truly universal. There would be no disagreement, for example, about the need for amputation in severe loss of blood circulation were gangrene had set in. Likewise, nor of the value of meticulous plaque control in the prevention of gum disease (periodontal disease). The differences seem to more at a divergence in the philosophy to technique in the more specialized fields of practice.

Dental anesthesiology is very a case in point since it falls in an important part of more specialized field of dental practice. This is simply based on historical phenomenon where people fear dentists because, to put it bluntly, most people do not regard an appointment to their dentist in the same way as they do a visit for a manicure or a therapeutic massage. Hence the need to create an accredited post graduate program appropriately called dental anesthesia. There is hardly any visit, out side of a six month cleaning which does not involve the administration of local anesthetics. Double standard? There is never a situation for a medical procedure which involves anesthesia, be it conscious sedation or general anesthesia where an anesthetist is not in attendance throughout the procedure. It therefore makes good sense to consider visiting dental anesthesiologist when conscious sedation is required. Oral sedation for dental patients does not necessarily require the presence of a dental anesthesiologist.

The International Federation of Dental Anesthesiologist Society are established in many country and it would be safe to say that no two of those countries is the practice of that specialty the same, whatever similarities there my be. In some countries only career anesthetists may administer either anesthesia or sedation; in others, dentists may do both; in yet others, dentists may offer sedation without restriction; whereas in more than one country, inhalational sedation with nitrous oxide is the most of which dentists are allowed to offer.

It is even more informative to see what divergences have occurred from what was originally a common beginning. Dental practice was revolutionized in the 1960s by the explosion of interest in IV anesthesia and sedation. The latter was confined entirely to ?The Loma Linda Technique? of Niles Jorgensen in which titrated doses of Nembutal an effective sedative was used.

As a student pharmacist, I can remember when these drugs were synthesized an prescribed exclusively by medics for the elderly who suffered from insomnia. Unfortunately that was the long journey for Michael Jackson (who was just an infant in the sixties) to the powerful drug Popofol (Diprivan) which is never administered without the presence of an anesthetist. Even during oral surgery this drug is never required for wisdom teeth extraction.

The use of barbiturate drugs in minimal incremental dosage to produce anesthesia was the work of a Dr. Drummond-Jackson. It was back in in those days that the [SAAD] Society for the Advancement of Anesthesia in dentistry was formed. It originated down under in Australia where the Advancement of Anesthesia and Sedation in Dentistry from Sidney University was the first in he world.

With the advances in synthetic compounds both the medical and dental disciplines advanced tremendously. Times were when to have non erupted third molars extracted required general anesthesia in hospital. Now with the advances of synthetic opiods and monitoring equipment, such procedures are done routinely in dental offices. The downside is the over usage in situation where local anesthetics administered correctly are equally efficacious in such procedures. Synthetic opiods offer a comfort level for patients, the like we have never seen before. Dentists are caught between a rock and a hard place. The downside for medical and dental clinicians is the unlawful access to these drugs by lay people.

Comments to localanesthetics@yahoo.ca M.Sc. PharmD. CCPE Please visit WWW.AnestheticNews.com