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Sir, I would like to thank Hopman and colleagues for a thoroughly illuminating review on the potential neurotoxicity of dental local anaesthetics (2017; 223: 501–505). They highlighted a worrying legal precedent in the Netherlands in which a dentist's administration of articaine LA was linked to a plethora of medical complaints, for which no organic cause could be found after investigation by medical colleagues. It seems that in this legal case association was somehow proved and taken to be causation; however, I respectfully disagree with the author's assertion that written consent should be obtained before administration of a local anaesthetic. The authors themselves state that complications from dental LA administration are 'very rare' and cite estimations for persistent paraesthesia in the range of 1:160,5711 to 1:4,156,848.2 Thankfully, we have only just been relieved of the useless and scientifically unsound burden of having to record LA batch numbers within individual dental records.3 I would urge my colleagues in the dental community to ensure that we fight for a sense of balance and proportionality in these matters, otherwise a clear path to madness lies. Where exactly will we allow the line to be drawn for us? Will there be an expectation for written consent before a scale and polish? Or perhaps written consent before we expose an intra-oral radiograph, after all there may be a 1:1,000,000 risk4 of a radiation-induced stochastic genetic mutation, from every bitewing/periapical, causing a fatal malignancy? If we are to start producing half a dozen written consent forms before every examination and treatment session, this will lead to unnecessary anxiety, alienating patients and the likelihood that important dental procedures are refused – leading to more serious dental and medical problems. This cannot be in anyone's interest and especially not the patients'.
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Mehdizadeh, A. Anaesthesia: A sense of balance. Br Dent J 223, 746 (2017). https://doi.org/10.1038/sj.bdj.2017.1010
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DOI: https://doi.org/10.1038/sj.bdj.2017.1010
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