Episode #341: Is My Patient Comfortably Numb?, with Dr. Tom Viola

the best practices show podcast Oct 01, 2021

Hello? Is there anybody in there? When it comes to ensuring that your patients are comfortably numb, there’s a lot to consider—it’s much more than just a little pinprick. Tom Viola joins Kirk Behrendt today to discuss the different types of anesthetic agents and how to improve the implementation of anesthesia in your practice. To find out how to ease your patients’ pain and get them on their feet again, listen to Episode 341 of The Best Practices Show!


Main Takeaways: 

  • When patients wait to seek dental care, it results in more pain.
  • Novocain is typically considered the most common anesthetic, but almost no one uses it anymore.
  • Different anesthetic agents are metabolized by the body in different ways.
  • There’s no one size fits all solution when it comes to anesthetic agents—the patient’s medical history and condition can rule out the use of certain agents.
  • Perfecting anesthesia isn’t something that happens in the classroom—it takes time and practice.


  • “It’s tough for dental professionals to take pharmacology and make it applicable and practical to their everyday practice.” (04:36—04:44)
  • “My job is to make this whole world of pharmacology fit into bite-sized pieces that you can use to get better outcomes for your patients.” (05:37—05:47)
  • “The reason is all about one thing—pain. Pain is a demotivator and a motivator for our patients.” (07:17—07:26)
  • “If we can get that pain to be not a bad memory, but an ‘Ehh’ memory, then they won’t be so fearful next time, and they’ll come back sooner, and we won’t have this vicious cycle of pain being a demotivator and actually making the situation worse over time.” (09:43—09:59)
  • “I can never teach anyone technique and accuracy because those are the skills you hone in years of clinical practice.” (10:36—10:44)
  • “Am I using the right anesthetic agent for this patient based on their particular medical history and what medical complications they may have?” (12:20—12:31)
  • “It’s all about the type of anesthetic agent and making sure the patient understands that the anesthetic agents we’re using, for the most part, are honed to perfection based on their specific needs.” (16:07—16:20)
  • “If my expectation is I should be numb in a minute, and I’m not numb after five, I’m not blaming the anesthetic agent—I’m blaming you.” (20:47—20:55)
  • “Just make sure of the selected agents you chose to be your favorites, you’ve got enough to cover every patient with every specific or individual type of medical complication.” (34:52—35:02)
  • “While Prilocaine may be an amazing agent, this methemoglobinemia thing stands in the way of a lot of clinicians warming up to it.” (37:22—37:30)
  • “I guess my greatest advice is don’t be stuck with one [topical] because again, based on the procedure and the patient, you may want to decide to use a different topical versus one size fits all for all your patients.” (41:30—41:43)
  • “When in doubt, always, always take what you’ve learned in podcasts like this and courses like mine you can take, and realize that you’re the clinician.” (42:04—42:16)
  • “Do your own research and come up with what you think—based on what I’ve said—is the right strategy for you, because not every anesthetic fits every patient.” (42:32—42:42)


  • Who is Tom Viola? (03:12—05:57)
  • Why is this important? (07:16—09:59)
  • Challenges of anesthesia. (10:19—13:12)
  • A variety of anesthetic agents. (13:26—16:23)
  • Advantages and disadvantages of agents. (16:35—24:48)
  • Lidocaine vs. Mepivacaine. (24:58—35:02)
  • Prilocaine and Bupivacaine. (35:28—38:53)
  • Topicals. (38:54—41:43)
  • Final thoughts. (42:02—45:52)

Reach out to Tom Viola:

Phone Number: 609-504-9252

Email: [email protected]

Website: https://www.tomviola.com

Instagram: @pharmacologydeclassified https://www.instagram.com/pharmacologydeclassified/

Facebook: https://www.facebook.com/tomviolarph


With over 30 years’ experience as a pharmacist, educator, speaker and author, Tom Viola, R.Ph., C.C.P. has earned his reputation as the go-to specialist for delivering quality continuing education content through his informative engaging presentations. Tom’s sellout programs provide an overview of the most prevalent oral and systemic diseases and the most frequently prescribed drugs used in their treatment. Special emphasis is given to dental considerations and strategies for effective patient care planning. As a clinical educator, Tom is a member of the faculty of twelve dental professional degree programs and has received several awards for outstanding teacher of the year. Tom instructs dental hygiene students and practice dental hygienists in pharmacology and local anesthesia in preparation for national board exams. As a published writer, Tom is well known internationally for his contributions to several professional journals in the areas of pharmacology, pain management and local anesthesia. In addition, Tom has served as a contributor, chapter author and peer reviewer for several pharmacology textbooks. As a professional speaker, Tom has presented continuing education courses to dental professionals internationally since 2001. Meeting planners agree that Tom is their choice to educate audiences within this specialty

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