From the Editor: No More Tears

On October 8, Dr. Esther Wilkins sent me an email announcing great news— the governor of Massachusetts signed a bill into law adding local anesthesia administration to the dental hygienist’s scope of practice. The Massachusetts Dental Hygienists’ Association (MDHA) lobbied thoroughly for this advancement. MDHA is the 36th of 50 state dental hygiene associations plus the District of Columbia that have obtained the legal right to administer local anesthesia. This map from the American Dental Hygienists’ Association Government Relations Department shows the states where local anesthesia is allowed and the year of implementation. Beginning with Washington in 1971 to Tennessee and Massachusetts in 2004, association leaders have worked tirelessly to change their state practice acts to include local anesthesia. Dental hygienists are the most important providers of nonsurgical periodontal therapy in this country. The 1999 American Dental Association Survey of Dental Services in the United States revealed that 90% of periodontal scaling and root planing is done by the dental hygienist in the general practice. To be charged with this responsibility without the ability to administer anesthesia places the dental hygienist in a frustrating position. Dental hygienists are forced to compromise the quality of their work when they are unable to scale deeply to the base of the pocket without causing pain and discomfort.

During my first summer as a hygienist in 1968, I was a substitute in various offices throughout Los Angeles. At least once a day I would go into the laboratory and burst into tears. The cause of my tears was the utter frustration and sadness at having scaled yet another periodontal patient without local anesthesia. Countless times I had to use a topical anesthetic and struggle along while waiting for the dentist to give the injections. Often the dentist was busy and by the time the anesthetic was given, I had 10 minutes left to scale. After the California law changed in 1976, I was able to anesthetize my patients, scale more thoroughly than ever before, and finish each day of practice with a clean conscience and a smile on my face. No more tears.

Local anesthesia allows us to reach our fullest potential as providers of nonsurgical periodontal therapy. Some very conservative dentists are fearful that allowing local anesthesia will result in dental hygienists wanting to pursue independent practice. History should convince them that these are very separate issues. Thousands of dental hygienists have been giving block injections successfully and safely since 1971. After 33 years, the ability to provide local anesthesia has not led to wide scale independent practice. On the contrary, it has brought the dentist, dental hygienist, and periodontist closer together as a team. Thousands of patients have avoided progressive periodontal disease and benefited because their dental hygienist was able to administer local anesthesia and scale more effectively.

For the remaining 15 states, we wish you well in your continuing struggle. Until you are able to provide local anesthesia, don’t hesitate to ask your dentist to give the injections needed for you to provide optimal treatment. Also, our cover story on topical anesthesia reveals a new alternative option to help you deliver better patient care.

—Anna M. Pattison, RDH, MS
apattison@belmontpublications.com