Modest spills of local anesthetic in the mouth, which have a variety of causes, create a lingering, bitter aftertaste—an unpleasant experience that patients remember vividly. The taste seems to remain on the mucosa and in the mind longer than it should, even after a rinsing with water. The disadvantage of water-spray rinsing is that the pressure and volume of the spray, the heavy mist in the mouth and pharynx, and the noise and suction of the high-speed vacuum may add to the patient’s anxiety about when it is safe to swallow and breathe.
I have devised a solution to this problem. I load a curved-tip, plastic, 12–cubic centimeter syringe (Monoject, Kendall, Mansfield, Mass.) with purple grape juice, which is available in grocery stores. The syringe is stored on a counter or tray near the patient. When the patient gives verbal or non-verbal signs of experiencing a noxious taste, I first ascertain whether he or she is allergic to grapes, raisins or grape juice. I then explain that, barring allergy, I will administer grape juice to neutralize the taste of the anesthetic, and that the mixture will be safe and comfortable to swallow.
Patients readily accept the familiar and safe taste of purple grape juice to counteract the taste of spilled anesthetic.
The questioning about allergy is important for three reasons. First, although such cases are rare, the patient may be sensitive to the fruit.1–6 Bronchospasm in an asthmatic child or adult patient allergic to grapes or sulfites7 could compromise the airway. Second, there have been hints of a connection between natural rubber latex allergy and grape allergy.5,6 Finally, some patients may have a sensitivity to sulfites,8,9 which still are used as a preservative and color stabilizer for some fruit juices, such as white grape juice (hence the specification of purple grape juice).7 Examination of the product labels will reveal the sulfite-free alternatives.
If the patient is not sensitive to grape juice, then I direct a measured dose of juice over the area where the anesthetic is likely to spread, and I assure the patient that it is safe to swallow. Multiple small doses of the grape juice can be given. Swallowing is comfortable because the volume is small. The sweet juice removes the anesthetic aftertaste. Water irrigation and aspiration are not necessary.
The patient’s relief is visible immediately. The muscles of the forehead, eyes and cheeks relax; thrusting of the tongue and jaw stops; labored swallowing ceases; and the shoulders and chest sink.
Rarely, infiltration anesthesia just beyond the apexes in the premaxillary region may express anesthetic into the nasal cavity and, subsequently, into the pharynx. Juice syringed along the back of the tongue is palliative in such a case.
This antidote works well not only with local anesthetic, but also with sodium hypochlorite irrigating solution used in endodontic treatment. The irrigating solution may leak past the rubber dam seal or under a restoration during treatment. Again, after asking the proper questions, giving explanations and determining the patient’s lack of grape allergy, I lift the rubber dam by the frame—without removing it—for vision and access. I direct grape juice under the dam to cover the area of hypochlorite spread. The small volume of malic acid and tartaric acid neutralizes the hypochlorite’s base and taste, facilitating comfortable swallowing and clearing the oily aftertaste. Only two hands are needed to carry out this procedure, rather than the three needed to control water spray, aspiration and the rubber dam.
Patients readily accept the familiar and safe taste of purple grape juice to counteract the taste of spilled anesthetic. For the dentist, the economy and efficiency of the juice make it an appropriate means of relief.
DO YOU HAVE A TIP TO SHARE
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