Gow-gates?

[armorshell]

So who uses this/are taught this in dental school. I was under the impression this was a pretty common block, but a few lectures I sat today made it seem this isn't really something that's commonly used over a IA + lingual.

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[desert rat]

I use it over an Inferior alveolar any day. Between that and Saptacain it will make your life alot easier.

 

[armorshell]

I ask because they highly favor it at Pacific and mentioned it's not used/taught so heavily elsewhere, and I wanted to determine how true that is. I've tried both and like the Gow-gates much better but I suppose I'm being biased. 😀

 

[desert rat]

We were taught it at Iowa.

 

[li1p0ptart]

We are taught it at USC. I'm not sure why its not commonly used in private practice over an IA/Buccal. I don't think its been taught much in the past.

 

[jaiceman]

Easier to miss than IAN block, longer time to set in. Are the usual draw backs.

However, great for infected teeth that wont get numb or some anatomic variance from normal, eg a high entry of the IAN nerve into the mandible; so the nerve isn't where it should be.


AND it makes you look cooler.

 

[armorshell]

Easier to miss than IAN block, longer time to set in. Are the usual draw backs.

However, great for infected teeth that wont get numb or some anatomic variance from normal, eg a high entry of the IAN nerve into the mandible; so the nerve isn't where it should be.


AND it makes you look cooler.

Numbers I got today were 90-100% reported hits for Gow-Gates vs. 75-85% for IAN for 3ml injected solution over several studies.

 

[UKdent]

At UK it is taught. Most use an Inferioraveolar because of lack of practice. However I went to OMFS and asked to do it, got 5 under my belt and now that is all I use. Faculty actually encourage you to try it and if you like it use it.

 

[jaiceman]

True enough in the hands of someone that has the experience,

However for the context of student in everyday school supervised practice, the learning curve is less for IANB (point, shoot) for a less experience person it is easier to miss, and faculty don't want to deal with this consistently while you 'get it'. That's the reason why you probably got the impression that its not heavily in rotation. I've used it a couple times, but damed if they don't make you try a couple more time with IANB before...... check Malamed's

 

[aphistis]

Numbers I got today were 90-100% reported hits for Gow-Gates vs. 75-85% for IAN for 3ml injected solution over several studies.

This is accurate.

I use GG all the time, particularly for oral surgery. The only difference I've noticed is higher rate of positive aspiration (15%?) in my hands compared to the conventional IANB.

 

[tinker bell]

I use it all the time for oral surgery & sometimes when I do molar endo. Yeah, most dental schools use the same text book, teach the same stuff. I practiced my first GG at SFGH, still remember it

 

[NileBDS]

One word: Trismus. You have a higher risk piercing one of the muscles of mastication with a gow gates.

I still use it though. It has it's place in clinical practice.

 

[aphistis]

One word: Trismus. You have a higher risk piercing one of the muscles of mastication with a gow gates.

I still use it though. It has it's place in clinical practice.

Three more words: reliable profound anesthesia. 😉

I've never had a patient complain of post-op trismus or increased soreness after a Gow-Gates. If going through the medial pterygoid is what it takes to predictably block all of V3, then that's what it takes. For my money, it's a worthwhile trade.

 

[NileBDS]

Three more words: reliable profound anesthesia. 😉

I've never had a patient complain of post-op trismus or increased soreness after a Gow-Gates. If going through the medial pterygoid is what it takes to predictably block all of V3, then that's what it takes. For my money, it's a worthwhile trade.

If you have "never had a patient complain of post-op trismus or increased soreness after a Gow-Gates", that can only mean one of two things:

1. You're doing it wrong
2. You have not done enough of them ... oh wait, you just graduated last year. 😉

 

[HuyetKiem]

I've used GG few dozen times. I had one patient complained of post-op trismus. Couple weeks ago, one patient said that, in addition to the numbness in her jaw, she also felt the numbness in and around her ear also. I'm not sure it was true or she just made it up. I called her later at night for followup and everything was ok.

 

[thedudeabides6]

I have received a GG twice, and gotten trismis both times (from 2 different operators). Couldn't open my mouth fully for 3 days. I will say I did get profound anethesia. I guess this injection does have its place in dentistry, but I won't give it on a routine basis because of my personal experience.

 

[aphistis]

If you have "never had a patient complain of post-op trismus or increased soreness after a Gow-Gates", that can only mean one of two things:

1. You're doing it wrong
2. You have not done enough of them ... oh wait, you just graduated last year. 😉

3. I properly counsel my patients on what to expect following treatment.

Nice try, though.

 

[OceanDMD]

I've used GG few dozen times. I had one patient complained of post-op trismus. Couple weeks ago, one patient said that, in addition to the numbness in her jaw, she also felt the numbness in and around her ear also. I'm not sure it was true or she just made it up. I called her later at night for followup and everything was ok.

As a fourth year dental student, why would you "used GG few dozen times"? Few dozen meaning I assume approximately 48 times? The GG is generally used if you have a problem achieving anesthesia with a normal IA injection. The injection is more difficult to give. I have been practicing for 3 years, and giving dental injections now for 6. Sometimes you miss a IA, but I have needed to give a GG maybe 5 times total. Usually you just adjust you needle position on an IA, and/or inflitrate with some Septo and your fine.

This "GG a few dozen times" sounds like your IA technique is a little off. Unless for some odd reason you prefer to give a GG over an standard IA block. Why would you put the patient through increased incidence of trismus, and any other potential complications of sticking a needle towards the condyle(like hematoma)?

 

[aphistis]

As a fourth year dental student, why would you "used GG few dozen times"? Few dozen meaning I assume approximately 48 times? The GG is generally used if you have a problem achieving anesthesia with a normal IA injection. The injection is more difficult to give. I have been practicing for 3 years, and giving dental injections now for 6. Sometimes you miss a IA, but I have needed to give a GG maybe 5 times total. Usually you just adjust you needle position on an IA, and/or inflitrate with some Septo and your fine.

This "GG a few dozen times" sounds like your IA technique is a little off. Unless for some odd reason you prefer to give a GG over an standard IA block. Why would you put the patient through increased incidence of trismus, and any other potential complications of sticking a needle towards the condyle(like hematoma)?

DT isn't exactly a powerhouse of evidence-based practice, but there are quite a few dentists over there that use GG as their primary mandibular block. For that matter, it's where I got the idea to try it in the first place. To each his own.

 

[armorshell]

As I said above, there are also a fair amount of Pacific faculty who promote using GG as a primary mandibular block.

 

[OceanDMD]

As I said above, there are also a fair amount of Pacific faculty who promote using GG as a primary mandibular block.

why?

 

[armorshell]

why?

Their reasoning is that there's a more profound anesthesia, single block for a full quadrant of hard and soft tissue, fewer missed blocks, and they seem to think there's a lower incidence of complications.

 

[OceanDMD]

Their reasoning is that there's a more profound anesthesia, single block for a full quadrant of hard and soft tissue, fewer missed blocks, and they seem to think there's a lower incidence of complications.

I would think there would be higher incidence of complications, and I dont think the anesthesia is proven to be more profound. In fact, possibly the contrary:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2148538

http://iadr.confex.com/iadr/2006Orld/techprogram/abstract_76182.htm


My recollection in school was the gow gates is just another technique to use if you have trouble with a patients anatomy giving the conventional ia block. There is a greater chance of positive aspiration and problems related to the ear giving this injection (along with trismus). Just my opinion, but wouldn't you agree the technique is more difficult? I guess I just don't see the reasoning for using this technique as your primary way to block the IA nerve.

 

[YL4life]

If you have "never had a patient complain of post-op trismus or increased soreness after a Gow-Gates", that can only mean one of two things:

1. You're doing it wrong
2. You have not done enough of them ... oh wait, you just graduated last year. 😉

Where are you guys learning your anesthesia? Malamed's handbook clearly states that the GG has a lower incidence of trismus, + aspiration, and hematoma than IANB. See pages 237-242, fifth edition. I guess three years maybe isn't enough....

 

[HuyetKiem]

As a fourth year dental student, why would you "used GG few dozen times"? Few dozen meaning I assume approximately 48 times? The GG is generally used if you have a problem achieving anesthesia with a normal IA injection. The injection is more difficult to give. I have been practicing for 3 years, and giving dental injections now for 6. Sometimes you miss a IA, but I have needed to give a GG maybe 5 times total. Usually you just adjust you needle position on an IA, and/or inflitrate with some Septo and your fine.

This "GG a few dozen times" sounds like your IA technique is a little off. Unless for some odd reason you prefer to give a GG over an standard IA block. Why would you put the patient through increased incidence of trismus, and any other potential complications of sticking a needle towards the condyle(like hematoma)?

yup! GG comes in very handy if you do surgical extraction, impacted 3rd, full mouth with alveolaplasty 2-4 evenings every week for 3 years. 😉😉

 

[HuyetKiem]

If anyone wanna learn the GG, there is a CD from Densply Pharmaceutical company called "Mandibular Anesthesia" . It has videos demontrating different injection techniques .

 

[ProstHoney]

Isn't this just another circumstance of doing whatever works for you? For myself, I prefer the faster onset of the IA as I really want to ensure profound anesthesia before I wrestle on a rubber dam.

Plus, it is my understanding that to get the best results with GG the patient should keep their mouth wide open for a few minutes to allow the LA to diffuse before they close and completely change the anatomy of the injection site. Maybe its all these years of clenching from dental school, but my jaw wouldn't be able to take that.

 

[aphistis]

Isn't this just another circumstance of doing whatever works for you? For myself, I prefer the faster onset of the IA as I really want to ensure profound anesthesia before I wrestle on a rubber dam.

Plus, it is my understanding that to get the best results with GG the patient should keep their mouth wide open for a few minutes to allow the LA to diffuse before they close and completely change the anatomy of the injection site. Maybe its all these years of clenching from dental school, but my jaw wouldn't be able to take that.

Bingo.

 

[armorshell]

Where are you guys learning your anesthesia? Malamed's handbook clearly states that the GG has a lower incidence of trismus, + aspiration, and hematoma than IANB. See pages 237-242, fifth edition. I guess three years maybe isn't enough....

Their reasoning is that there's a more profound anesthesia, single block for a full quadrant of hard and soft tissue, fewer missed blocks, and they seem to think there's a lower incidence of complications.

I'm at UoP too, we DO use Malamed, and what I posted was exactly what we learned.

 

[thedudeabides6]

As I said above, there are also a fair amount of Pacific faculty who promote using GG as a primary mandibular block.

Yes there are, but also realize in clinic there are tons of faculty that promote the IA at Pacific. I personally use the IA, and no faculty have mentioned anything to me. I really think it is all personal preference. Whatever you feel comfortable with.

 

[jaiceman]

Wow I thought I answered this guy a minute ago.....you guys like to waste your breaths...lol...go read Malameds..he clearly states there is a steeper learning curve to the technique than IAN w/long buccal. Hence to ANSWER the OP question, read my original post....sure its (GG) 95% on point when you get the motion, and tactile feedback needed to perform this adequately. Otherwise, you are wasting chair time by doing this routinely, over IAN. And the guys that state "they use it all the time" ....why??? The other posters stating trismus is a consequence is absolutely correct..especially when learning the technique and with onset being considerably longer..unless the caveat is "all the time for oral surgery, or all the time for infections" but you know what ...to each is own.😴

 

[OceanDMD]

Wow I thought I answered this guy a minute ago.....you guys like to waste your breaths...lol...go read Malameds..he clearly states there is a steeper learning curve to the technique than IAN w/long buccal. Hence to ANSWER the OP question, read my original post....sure its (GG) 95% on point when you get the motion, and tactile feedback needed to perform this adequately. Otherwise, you are wasting chair time by doing this routinely, over IAN. And the guys that state "they use it all the time" ....why??? The other posters stating trismus is a consequence is absolutely correct..especially when learning the technique and with onset being considerably longer..unless the caveat is "all the time for oral surgery, or all the time for infections" but you know what ...to each is own.😴

I think you are on point with my issue. Why use it when the conventional IA works(based on most studies) just as well. The conventional IA onset is proven to be quicker by 10 minutes or so. The GG doesn't get the same long buccal anesthesia, and there are issues with more inta-oral bleeding with the gg--since there isnt that localized vasoconstriction with the epi. I spend more time waiting for someone to get numb in practice then I do prepping a tooth, or doing an extraction for that matter. That extra 5 - 10 minutes for onset of anesthesia is not logical, even when performing extractions and straightforward surgery. Even if you are doing flaps and alveoloplasty, dont you want some localized vasoconstriction with the epi? It just doesnt make sense to me. I guess its cool to give the gow gates. I think maybe I'll start a "gow gates tuesday" tomorrow.

 

[OceanDMD]

yup! GG comes in very handy if you do surgical extraction, impacted 3rd, full mouth with alveolaplasty 2-4 evenings every week for 3 years. 😉😉

Wow. Surgical extractions and alveoloplasty 4 days a week during your second year. You are way ahead of the curve. My second year I was having residents help me with those broken root tips. You are such a stud.

 

[HuyetKiem]

Wow. Surgical extractions and alveoloplasty 4 days a week during your second year. You are way ahead of the curve. My second year I was having residents help me with those broken root tips. You are such a stud.

yup! only in Cleveland that a dental student can gain such experience.

http://www.thefreeclinic.org/