I am writing in reference to November JADA’s "Obtaining Written Informed Consent for the Administration of Local Anesthetic in Dentistry" (
Orr DL II, Curtis WJ. JADA 2005;136:1568–71
). There has to be a limit. We need to inform patients of potential risks where there is a reasonable chance of a "serious" adverse outcome. I do written informed consents for endodontic treatments and surgery. These take 10 to 15 minutes to do properly.
If I were to do the same with local anesthesia, I would lose two to three hours out of every day in this unproductive process. Informed consent is necessary when there is a significant chance of problems or where potential problems are devastating. General anesthesia in oral surgery offices resulted in one death in 740,213 cases of anesthesia from 1988 through 2003 (OMS National Insurance Company claims data, February 2004). Two other studies reported one death in 671,428 cases of anesthesia1 and no deaths.2
If I were a patient going under general anesthesia, I would want to know this, so I could make an informed decision as to whether I would want general anesthestic.
The risk associated with local anesthesia is probably lower than the risk of experiencing an auto accident on the way to the dental appointment. It is slightly greater than being struck by a meteor. Should we not include the risk of driving and meteors in our informed consent?
We must balance risk versus costs. In the case of local anesthesia, the risks are so low you cannot seriously suggest it is necessary.
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