Sir, I read with interest the hypothesised case by W. G. Brands (BDJ 2006; 201: 207–210) for a dentist planning for periodontal treatment in the mandible. Dr Brands appears to infer that adequate anaesthesia would be obtained by giving LA directly into the periodontal ligament area to achieve adequate pain control during the treatment. What he fails to understand is that the primary cause of chronic periodontitis is subgingival bacteria attached to the root surface of the affected teeth. The obvious sequelae is subgingival calculus deposition. Should not the teeth need to be adequately anaesthetised to reduce the pain of removing subgingival deposits from the ROOT surfaces as opposed to the stated periodontal tissues? Therefore, is not an inferior nerve dental block the method of choice to achieve this?

Dr Brands responds: I would like to thank Dr Taggart for his/her reply to my article. Of course this case was just an example of a test, used to read the mind of a reasonable patient. In this test Dr Taggart gives the perfect argument for the defence, stating there is no adequate alternative for a inferior nerve block in order to achieve pain control during periodontal treatment in the mandible. In our test this implies that a reasonable patient would have accepted the small risk of nerve damage.

If I was the lawyer for the patient I would argue that there is a new topical anaesthesia which is applied into the pocket and which claims to give adequate pain control during periodontal treatment even without an injection in the ligament. 1 Moreover I would point to the study of Loomer and Perry. 2 In this study the adequacy of anaesthesia for performing scaling and root planing on patients with moderate periodontal disease was evaluated. To conclude I would ask the defence whether they think every removal of calculus, even supra gingival in patients with exposed root surfaces, should be anaesthetised using an inferior nerve dental block.

As a judge I am not allowed to base my verdict on my own experience in dental practice that there is a good alternative for an inferior nerve block during periodontal treatment, so I would ask an expert witness.