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OPERATOR PREFERENCE OF RETRACTION METHOD DURING ANESTHESIA DELIVERY

The participants were then asked about their preference of the retraction method; 22 responded they prefered the mirror to be used for the delivery of the anesthesia, 29 preferred the device, and 3 preferred their finger as retraction( Table 3). Due to the small number in the last group, it was not possible to conduct a formal statistical analysis.

Table 3. Preference of retraction method

However, when asked to choose the method that was easier, 30 chose the mirror, 18 the device, and 10 said using their finger for retraction was easier( Table 4). This resulted in a p-value of 0.005, which indicates that there is a significant difference in the proportions of participants choosing the three different methods.

Table 4. Retraction Method that was easier

4. Discussion

The results from this study relate with the conclusion from Haskell et. al, that novice practicioners can become comfortable with a learned technique using mirror retraction to deliver anesthesia 19. From the results, the porportion of participants who felt comfortable and confident, was significantly greater than that of the other porportion feeling uncomfortable and anxious( p-value < 0.001). In some cases, as with learning how to use a new device, 27 % of the DCP’ s expressed anxiousness and discomfort. Limited evidence exists assessing anxiousness and discomfort of the DCP when“ trying out” novel devices. 20 Our results coincide with studies stating possible nervousness or fear may exist in some people as there is an introduction

19, 21-23 of a new stiumuli. The results indicate 94 % of the DCPs prefer to use a method of retraction other than their finger for delivery of dental anesthesia. The use of a finger for retraction during anesthesia guides the operator with palpating necessary landmarks prior to the injection, 24 in addition to the retraction of the mucosa. As mentioned earlier, leaving the finger intraorally during anesthesia delivery puts the retracting hand of the DCP at risk for an NSI. 8, 9 Regarding which retraction was easier for the DCP, 83 % of the DCPs stated that the alternative retraction( mirror or device) was easier than using the finger lending to a p value less than 0.005 among the three methods. With the many advances and innovations created for the delivery of dental anesthesia, there is a necessity to consider alternative methods of retraction while providing dental anesthesia. 9 There are reports discouraging DCPs from using their finger for retraction and encouraging DCPs to

13, 25, 26

use a safer method to deliver local anesthesia. When changing technique, or working with a new device, DCPs need to review the clinical evaluations to gauge safety 27 and appropriateness of the innovative devices. Our hypothesis and clinical implication were confirmed. Comfort and confidence with use of an alternative retraction method( mirror and device) was found to be a constructive perception. The results reassure the profession, not just within a university clinical setting, but also in practice, that there are techniques and armamentarium available to the DCP to assist in retraction during dental anesthesia. Practitioners should consider the value of additional training to get comfortable with an easier and safer technique of delivering anesthesia, 28, 29 especially if their learned technique was the use of a finger retraction. Clinicians may find other devices or armamentarium( tongue depressor, or alternative retractor) that may provide the same retraction method similar to the methods used in this study. This study provides preliminary data to showcase benefits of using alternative retraction methods. The DCPs participating in this study are considered novice and show preferences and opinions different from DCPs practicing for over 10 years. More studies need to be conducted to further investigate the benefits of using a fingerless retraction method, its relation to NSIs, and its effectiveness in dental anesthesia.

5. Conclusion

As with providing any dental care, the dental practitioner should be comfortable and confident with the delivery of dental anesthesia. This study explored other techniques for retraction when delivering local anesthesia; an area that needs further exploration. Our results show that noninvasive techniques and armamentarium can be useful when delivering local anesthesia. Retraction techniques help in reducing the risk of NSIs, which is a benefit to the dental providers.

Conflict of interest and financial disclosure The authors declare that they have no conflict of interest and there was no external source of funding for the present study. We would like to acknowledge Bing Innovations, LLC for their support in providing supplies for use with device.