incidence of intravascular needle entrance during inferior alveolar nerve block injection

Dentists administer thousands of local anesthetic injections every day. Injection to a highly vascular area such as pterygomandibular space during an inferior alveolar nerve block has a high risk of intravascular needle entrance. Accidental intravascular injection of local anesthetic agent with vasoconstrictor may result in cardiovascular and central nervous system toxicity, as well as tachycardia and hypertension. There are reports that indicate aspiration is not performed in every injection. The aim of the present study was to assess the incidence of intravascular needle entrance in inferior alveolar nerve block injections. Three experienced oral and maxillofacial surgeons performed 359 inferior alveolar nerve block injections using direct or indirect techniques, and reported the results of aspiration. Aspirable syringes and 27 gauge long needles were used, and the method of aspiration was similar in all cases. Data were analyzed using t-test. 15.3% of inferior alveolar nerve block injections were aspiration positive. Intravascular needle entrance was seen in 14.2% of cases using direct and 23.3% of cases using indirect block injection techniques. Of all injections, 15.8% were intravascular on the right side and 14.8% were intravascular on the left. There were no statistically significant differences between direct or indirect block injection techniques [P = 0.127] and between right and left injection sites [P = 0.778]. According to our findings, the incidence of intravascular needle entrance during inferior alveolar nerve block injection was relatively high. It seems that technique and maneuver of injection have no considerable effect in incidence of intravascular needle entrance

Evaluation of glove damage during dental procedures among dental specialists in Tabriz

Dental practitioners are prone to occupational risk of infection. This can be prevented in part by wearing gloves. However, for this to be effective, gloves should be intact during the entire course of dental procedure. Leaky surgical latex gloves have been seen in 0.9% of cases before use. As much as 1.9% of latex gloves have been reported to be damaged during dental procedures. In this study, we decided to assess glove damage during dental procedures among dental specialists in Tabriz. Thirty-six dental specialists were selected for this study. Each practitioner received 40 pairs of intact powdered latex gloves. Upon the completion of dental procedures, the gloves were retrieved and any tears were evaluated separately for right and left hands. Data was analyzed using chi-square test. 159 punctures were detected in 144 gloves [5%] out of 2880 unpaired gloves used by practitioners. They noticed the tear[s] in 60 cases [2%], however, 99 cases [3%] of tear[s] were not noted during the procedure. The highest rate of glove damage was observed in the prosthodontists' group [12.3%], which was statistically significant comparing to other groups [p=0.048]. The lowest rate of the damage was observed in the oral surgeons' group [2%] which showed no significant difference [p=0.134]. The highest rate of punctures in the gloves was observed in the first and second fingers of the non-dominant hand. The damage to 5% of the gloves is highly significant, with a potential role in occupational hazards. The higher rate of leaks in the prosthodontists' group compared to other groups demands for greater prudence in this field. The high rate of leaks in the first and second fingers of the non-dominant hand requires more attention to this area during daily practice