A. Reader, J. Nusstein, M. Drum. UK: Quintessence price £52.00; pp 174 ISBN

9780867155136

Many patients fear the dentist due to past experiences of pain during treatment; therefore a book which focuses on achieving successful local anaesthesia is a useful point of reference for any dentist. The authors have focused specifically on pulpal anaesthesia as required for restorative and endodontic treatment, therefore reference is not made to oral surgery or paediatric dentistry.

The book is split into seven chapters dealing first with the clinical factors relating to local anaesthetics, such as how to test for pulpal anaesthesia, reasons for failure and a summary of the different local anaesthetic agents available. The following chapters focus specifically on mandibular and maxillary anaesthesia. Basic techniques for administering local anaesthetic and the relevant anatomy involved are not described; however, different anaesthetic agents, vasoconstrictors and injection techniques are evaluated. The average time of onset and duration of pulpal anaesthesia for each tooth is illustrated for each local anaesthetic agent, which provides a useful reference for consideration when using plain anaesthetic solutions, for example. Detailed description of supplementary local anaesthetic techniques, such as intra-osseous and intraligamentary anaesthesia, are given in chapter four. The equipment available for application of these techniques is evaluated, such as computer-aided delivery systems. The information in these chapters is presented in short sections with reference made to published literature and a summary at the end of each section. This makes the book useful as a quick reference for specific situations, however, it can seem repetitive and does not flow particularly well when reading a chapter from start to finish. Extensive reference sections are included at the end of each chapter for further reading if required.

The most useful chapters are five and seven, which give clinical tips for the management of routine restorative and endodontic procedures. They include clear and well-illustrated algorithms for anaesthetising each tooth, based on the best available evidence in the literature, including how to proceed when local anaesthetic failure occurs and the best supplementary techniques for each situation. New local anaesthetic agents and equipment are described, however, sufficient evidence does not yet exist to support their use.

In conclusion, a lot of research has gone into the writing of this book. It would be useful as a reference for any dentist having trouble with failed local anaesthesia in restorative and endodontic procedures and also for those with a special interest in local anaesthesia and pain management.