use of anatomical models for learning local anaesthetic techniques in ...

Anitha Roy*et al. /International Journal of Pharmacy & Technology

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ISSN: 0975-766X CODEN: IJPTFI Research Article

USE OF ANATOMICAL MODELS FOR LEARNING LOCAL ANAESTHETIC TECHNIQUES IN DENTISTRY- A QUESTIONNAIRE STUDY Keerthika.S1, Madhulakshimi2, Yuvaraj Babu3, 4Anitha Roy* 1 Bachelor of Dental Surgery 2 Faculty of Oral Surgery, 3 Faculty of Anatomy, 4 *Faculty of Pharmacology, Saveetha Dental College and Hospitals, Saveetha University, Tamil Nadu, India. Email: anitharoy2015 @gmail.com Received on: 25-02-2017 Accepted on: 28-03-2017 Abstract: Aim: to evaluate the use of anatomical models for administration of anaesthesia techniques compared traditional lecture among dental students. Materials and Methods:

Group A comprising of twenty five students were made to listen to videos on

administration of local anaesthesia and group B consisting of another twenty five students received only lectures on administration of local anaesthesia . Both the groups were assessed by a questionnaire at the end of the section. Statistical analysis was done by using cronbach’salpha, which assesss the reliability between two groups. Results: Group A students were more confident in locating the anaesthetic sites than Group B students. Pass rate and mean value of Group A students was high when compared with Group B .Moreover there was significant variation in anxiety levels between the two groups. Conclusion: This method helps the students to recognise the importance anatomy for learning anaesthetic techniques and also increased patient's safety during first injection. Keywords: local anaesthesia, anatomic models, anxiety. Introduction: Successful local anesthesia is the bed rock of pain control in dentistry1.The administration of local anesthesia, sedation, and general anesthesia are integral part of dental practice.Local anaesthetic are the agents that bock nerve conduction in a specific , temporary and reversible manner without affecting patient's consciousness2.Local anaesthesia is frequently used in dentistry to facilitate painless treatment . Painless treatment also improves doctor patient relationship.Moreover it enables the dentist to work with calm and precision3.Understanding the anatomical

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Anitha Roy*et al. /International Journal of Pharmacy & Technology structure of maxilla and mandible and the ability to deliver local anaesthesia at appropriate site is a critical aspect of dental curriculum. Administration of first anaesthetic injection on patients remains difficult for most of the dental students when they first enter into their clinical practice.Insufficient preparation also tend to increase student’s anxiety level 4. Most of the dental students consider preclinical training procedure , useful preparation before their first injection on a patient. This feeling may still be present after graduation as a dentist. Most of the dentist find it difficult in anesthetizing inferior alveolar nerve for performing restorations and surgical procedures in the mandible. This is due to incorrect location of nerve in the mandibular region .Mandibular nerve block presents a lower success rate when compared to anaesthesia in the maxillary structuresbecause of the greater density of the mandibular alveolar bone, limited access to the inferior alveolar nerve, marked anatomical variations, in addition to the need for deeper needle penetration into the soft tissue5. Didactic teaching courses may decrease the anxiety of dental students in relation to the administration of a local anaesthetic injection6. Patients also reported a decrease in the level of pain between insertion of the needle and the feeling of a tingling. Thus preclinical training may have small but positive effects on the administration of local anesthetics by dental students and may help to prepare them for the demands of general practice7. Materials and Methods: 3D models of skull with neuro anatomy of trigeminal nerve was reproduced. Maxillary nerve was traced from its its origin in the foramen rotendum in the cranial cavity.Inferior alveolar nerve and mental nerve were also traced using yellow nylon thread.we then prepared three videos explaining about maxillary infiltration , mandibular nerve block and mandibular infiltration along with the anatomic course of the nerve , needle direction and operated direction for administration of anaesthesia .Students were divided into Group A and GroupB , both the groups comprising of fifty student each.. Group A listened to demonstration videos. Group B students were delivered only traditional lecture in power point format. At the end of the class both the groups were evaluated by a questionnaire.

Statistical Analysis: Cronbach's alpha was used to test the reliability between the two groups.


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Anitha Roy*et al. /International Journal of Pharmacy & Technology Results:

Graph1: explaining pass rate and mean rank between two groups. Groups

Pass rate

Mean rank

GroupA

87%

12.1

GroupB

60%

8.9

Cronbach's alpha = 0.72 which indicates that , there is good reliability between groups. Graph 1: shows that pass rate and mean rank of group A was higher when compared with group B students .Also there was significant reliability between the two groups(alpha=0.72). Discussion: Dhanraj et al found that in dental practice, patients can experience pain due to pulpalpathology, periodontal pathogenic infections, malignancies, trauma and caries. The management of all the conditions invariably utilizes definitive forms of anaesthesia for treatment 8.Henie et al found that use of a preclinical training model did not affect the self-reported confidence level of dental students about their injection in patients. However, the recipients of the injections rated that students who had exercised on the training model more con dent and calm. The major limitation of the preclinical training model is the poor representation of the oral mucosa in the area of the ascending ramus of the mandible. The pterygomandibularplica, which runs from the palate to the retromolar pad, is missing. This is an important landmark for the correct insertion of the needle in mandibular block anesthesia. To avoid anatomical limitations, preclinical use of hu man cadavers has been suggested as a teaching aid for localanesthesia injection technique9. The anatomical models described in this article facilitate teaching in many ways. With the use of these models it was possible to conduct a comprehensive review of anatomy, especially the neuroanatomy of the cranial nerves. We could show in detail the course and anatomical relations of the trigeminal nerve with other structures. Canelleset al noted that the students perceived the importance of anatomy during the execution of anaesthetic techniques in the dental clinic. This method of teaching showed good results regarding the safety of students during


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Anitha Roy*et al. /International Journal of Pharmacy & Technology the first injection10.Brown J et alstudents who learned in the simulation laboratory through an active approach scored significantly higher in the theoretical knowledge component than students who were taught through the conventional lecture format. Another explanation for this finding could be based on situated learning theory that suggests that there should be a balance between the explicit teaching of a subject and the activities in which the knowledge learnt is used in an authentic context 11. Swanwicket al suggested that Conventional lecture could swamp the memory with too much information delivered too fast or exceed reasonable concentration limits. Overload of information will lead to a lack of capacity for retention. The capacity of the memory relies on a fully engaged concentration generated by motivation for the learning task in hand12.Buchanan et al suggested that

students in traditional lecture had lower scores in the

theoretical knowledge component as these students were overloaded by information that exceeded their concentration limits, while students in simulation laboratory had more memory capacity because they were motivated by applying their knowledge during practice in the simulation laboratory13. Conclusion: These anatomical models enhances the acquisition of theoretical knowledge of students.These models also helps students in their clinical practice and to provide better patient care. Reference: 1.

James D RajSindhu Ramesh Evaluation of the anesthetic efficacy of inferior alveolar nerve blocks in dental patients, Saveetha Dental College,Saveetha University, India.

2.

M. James Antony Bhagat, Vinod Narayan, M. R. Muthusekhar, Ashish R. Jain1 Comparative Study of the Anesthetic Ef cacy of 4% Articaine Versus 2% Lignocaine in the Inferior Alveolar Nerve Block During the Surgical Extraction of Impacted Mandibular Third Molars .Universal Research Journal of Dentistry· May-August 2014 · Vol 4 · Issue 2.

3.

Henk S. Brand, Jacques A. BaartN. Eline Maas, Irmke Bachet, Effect of a Training Model in Local , Anesthesia Teaching .Journal of Dental Education Volume 74, Number 8.

4.

M. Poyade, A. Lysakowski, and P. Anderson, Development of a Haptic Training Simulation for the Administration of Dental Anaesthesia based upon Accurate Anatomical Data. The Eurographics Association2014.

5.

Malamed SF. Handbook of local anesthesia. 4th ed. St. Louis: Mosby; 2001. p.193-219.


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6.

Anitha Roy*et al. /International Journal of Pharmacy & Technology H. S. Brand, D. Kuin and J. A. Baart, A survey of local anaesthesia education in European dental schools, European Journal of Dental Education ISSN 1396-5883.

7.

Brand HS, Tall LL, van derSpek SJ, Baart JA. European dental students opinions on their local anaesthesia education. Eur J Dent Educ 2011;15:47‐52.

8.

Henk S. Brand, Jacques A. Baart, N. Eline Maas, IrmkeBachet, Effect of a Training Model in Local Anesthesia Teaching ,Journal of Dental Education Volume 74, Number 8.

9.

Dhanraj Ganapathy*1, Preethi Sekaran, Prathap Sekhar, Anaesthetic Efficacy of Infiltration and Conventional Nerve Block Techniques in Restorat I've DENTAL treatment. Int. J. Pharm. Sci. Rev. Res., 33(1), July – August 2015.

10. Canellas JVS, Araujo MM, Arce JPA The use of anatomical models for learning anesthesia techniques in oral surgery, Indian Journal of Dental Research, 24(3), 2013. 11. Brown J, Collins A, Duguid P. Situated cognition and the culture of learning. Educ Res 1989: 18: 12. Swanwick T, ed. Understanding medical education: evidence, theory and practice, 1st edn. Chichester: A John Wiley & Sons, Ltd., Publication, 2010: 139–150. 13. Buchanan JA. Experience with virtual reality-based technology in teaching restorative dental procedures. J Dent Educ 2004: 68: 1258– 1265.

 


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