Faculty profile
Neils Bjorn Jorgensen, DDS: the man, a legend

Dr. Niels Bjorn Jorgensen, a pioneer in dental anesthesia and pain control and one of the original faculty members at the School of Dentistry.

From the time of Horace Wells, many individuals and institutions contributed to the development of today's modalities for the control of apprehension, fear, and pain in dentistry. Neils Bjorn Jorgensen, DDS, a general practitioner of dentistry, also made such a contribution.

Early life and education
Dr. Jorgensen was born in 1894 on the island of Fyn, in Denmark. He would later reminisce of having a physician extract his aching first permanent molars without local anesthesia. This experience profoundly affected his empathic treatment of individuals as expressed in his motto, "For the comfort of the patient."

On the basis of high scores on the entrance examination to University of Copenhagen, he was accepted at age 25 by University of California School of Dentistry. There were 160 hopefuls in the class, of which 50 would graduate. Students received lectures on local anesthesia, but without a textbook. They prepared their own 2% solution Novocaine with epinephrine, or a concentration of 1:20,000; local afterpain and fainting were not uncommon.

Graduating in 1923, he completed a three-year oral surgery residency in hospitals of the Southern California Edison Company in the High Sierra. His studies in sedation continued as he observed hardrock miners and husky pick-and-shovel men fainting at the sight of a needle and a dental chair.

In 1969, at a banquet in his honor, Dr. Jorgensen summarized his credo: "When I was young I tried many types of dental care after three years of surgery training. But I had a dream...I was up against the patients' apprehension of pain and discomfort associated with dental work. So I concentrated on learning how to control pain through the study of anatomy, physiology, and pharmacology, and learned to give a truly painless injection for all the nerve blocks. Then there was still the fear and nervousness, so I concentrated on overcoming that with intravenous premedication and nitrous oxide and oxygen. When you graduate you can go out and perform competent dental operations and make money. But it is not enough... Your patient is a human being who has entrusted himself into your care; you are responsible for his well being. The feeling of full responsibility makes you a good dentist...a Christian dentist must be a good dentist."1

Thus when he started his practice in 1926 he understood the fundamentals of local anesthesia and was investigating premedication by the draught or an orally administered barbiturate. For perspective, it was 1927 before the use of local anesthesia in dentistry was widespread in the United States.

In 1926, age 32 and his residency completed, he settled in Los Angeles. The era was one in which the dental patient was often asked to choose between general anesthesia or to suffer. Patients receiving N2O-O2 were commonly anoxic and of black or blue hue, and the published standard or average dose of a p.o. barbiturate could induce hypnosis rather than sedation.

For the latter he advocated a "divided doses" oral administration. Meanwhile he sought alternatives because the method was too time consuming for an ambulatory practice.

The White Memorial years
His studies were encouraged in 1942 when he was invited by Dr. Herbert Childs of White Memorial Hospital (now White Memorial Medical Center) department of stomatology, to attend and lecture in local anesthesia and sedation. This led to an "incalculably fruitful collaboration" with Forrest Leffingwell, MD, chief of the section of anesthesiology.

To eliminate emotional barriers to dentistry, Dr. Leffingwell advocated the intravenous administration of barbiturate, the substitution of scopolamine for atropine, and the addition of the narcotic analgesic meperidine at a time when meperidine was not recommended for intravenous administration.

Dr. Leffingwell's credentials and reputation among medical anesthesiologists aided in the acceptance of the Loma Linda Technique (Dr. Jorgensen's preference), but better known as "The Jorgensen Technique." In his studies he gleaned from Frank McCarthy MD, DDS, that the time for a 10 mg bolus of pentobarbital to travel from the Cubital Fossa to the brain is less than 20 seconds. Since 10 mg of pentobarbital (Nembutal) rarely had much sedative effect, by slowly and sequentially injecting increments of that amount while both observing and engaging the patient in "small talk," the injections could safely be carried to the first signs of sedation, designated as a baseline, and stopped. Varying widely among individuals, it is constant and reproducible for any one individual. Meperidine mixed with scopolamine was next administered intravenously. Publication in 1971 of research of Gerald Allen, MD, and Gaither Everett, DDS, then at the University of Washington, attest to the method's safety.²

The way most alumni from Dr. Jorgensen's time at the School of Dentistry will remember him: teaching at the chair the practical aspects of keeping patients comfortable.

In the early 1940s he studied 3-dimensional head and neck anatomy at LLU and the White Memorial where Drs. Samuel A. Crooks and H.J. Hara were head of anatomy and otolaryngology, respectively; aided by a collection of 1,400 skulls assembled in Pasadena by the renowned orthodontist, Spencer Atkinson, DDS. Each skull had a full complement of teeth and the skulls were arranged according to Angle's classification. The resulting measurements of the maxillae and mandibular and their relation to the injection of local anesthesia solution were published in the Journal of Oral Surgery in 1948 & 1952, respectively.

At LLU the cooperation of faculty, including Drs. Lloyd Baum and Melvin Lund, encouraged the students to judge indications for augmenting painlessly placed profound local anesthetic blocks with inhalation or intravenous sedation (with no reported incidents of morbidity or mortality among thousands of treatments) while imparting the art and science of restorative dentistry.³ Less well known is that Dr. Jorgensen patented what may have been the first aspirating local anesthetic cartridge.

His further studies led to determining for each patient the unique reproducible amount of inhalation or intravenous drug for sedation.

In the late 1940s Mr. Edward Hamilton, head of the LLU audiovisual department, began production of a film presenting the advantages of combining oral sedation with local anesthesia, especially nerve blocks, in children, and actress Margaret O'Brien granted necessary funds. The film gained widespread recognition and was shown at the 1950 ADA annual meeting in Atlantic City.

Educational film series receives international acclaim During the 1950 ADA annual meeting in Atlantic City James Lee, DDS, of Cooke-Waite Laboratories visited the exhibit, and the company began a collaboration with LLU, underwriting from 1950–70 the production and distribution of a series of films related to sedation and local anesthesia in dentistry. During the establishment of the department of oral surgery section on dental anesthesia he soldiered on with making nine educational films. He started at age 56 and was 76 when the last revision was made. The first film review ended with the discouraging comment: "It may be too elementary for dental society programs." The Association submitted revised editions of the first and second films in 1965 and 1970, respectively, to the International Dental Film Competition in Paris where in competition with 70 others, the first two films won Ier Grand Prix. So, 12 and 17 years after initial production they won honors, when few films circulated more than three or four years. At the time of the inauguration of the Jorgensen Memorial Library (1978) the films, first circulated by Cooke-Waite, additionally were circulated by the audio visual service of the American Dental Association and that of Loma Linda University. Over 20 years, Cooke-Waite Laboratories provided the sole source of extramural funding, and there existed a cordial relationship based on mutual interest and a high level of ethics, promoting no one single product. The films are archived in the National Library of Medicine. Films were distributed overseas to the dentistry departments of the three branches of the U.S. armed forces, including medical officers assigned to submarine duty. The films were classics, regularly used by most schools of dentistry. The Japanese government bought two prints for their schools of dentistry, and Spanish editions were made of two.

At the meeting Dr. Jorgensen and John Hughes, MD, head of the department of anatomy, College of Medical Evangelists, presented an extensive table clinic demonstrating with wet dissections the anatomical approach to nerve blocks.

Dr. M. Webster Prince, dean-elect of the LLU School of Dentistry, visited the exhibit and invited Dr. Jorgensen to the annual NASDAD meeting. In progress was a vigorous discussion of where the School should be located. Subsequent to the meeting Dr. Prince extended an invitation to Dr. Jorgensen to join the faculty.

The Loma Linda years
Emerging from the empiricism of pre-World War II, the teaching and practice of dentistry underwent revolutionary changes in the period from the late 1940s to the '70s.

j In an era when many dental colleges were or bordered on proprietary or for profit, Drs. Prince and Jorgensen were graduates of first rank university schools of dentistry,⁴ and were experienced practitioners.

Their unique professional experiences were complementary; they agreed that the painless administration of profound local anesthesia was the basis of control of pain in dentistry. They also agreed that when necessary the addition of sedation would be vital in managing medical problems and/or the apprehension and fear often associated with treatment.

Under their direction, three-dimensional studies of anatomy with respect to local anesthesia, and the physiologic-pharmacologic approach to sedation, were built into the final three years of the dental curriculum.

Later years
At the age of 60, Dr. Jorgensen arose at 5:00 a.m., drove to Loma Linda, taught all day, staying overnight in the spartan guest accommodations in Prince Hall.

He had no dedicated divisional office staff at the School. His secretarial support came largely from Heidi (Harriet), his beloved, devoted wife who typed and filed all his correspondence and early drafts of most of his manuscripts.

In later years, as he weakened due to chronic illness, Mrs. Judy Sakurai or Mrs. Cathey would chauffeur him to Loma Linda. Still, he was planning another teaching film.

Altruism is a cause personified by Dr. Jorgensen and occasioned his rueful, retrospective remark that he wished he had settled solely for a secretary and an office at the School, rather than pay.

At the 1960 annual banquet of the American Dental Society of Anesthesiology (ADSA) when presented with the Society's highest honor, The Heidbrink Award, he was characterized as: "...A mild-mannered gentleman who is widely respected for his intellectual approach to his scientific responsibilities."⁵

Norman Trieger, DMD, MD, editor of Anesthesia Progress, the Society's official publication and established authority, wrote "...One of the giants in anesthesiology in dentistry, and in particular in the education of the undergraduate student for...sedation, he has no peer."

Posthumously the School of Dentistry further recognized the contributions of Dr. Niels Bjorn Jorgensen with the establishment of the Jorgensen Memorial Library and later, the Jorgensen Learning Center. The American Dental Society of Anesthesiology (ADSA) designated the Memorial Library as its Archival Resource, with an accompanying contribution which in 2003 tender would amount to approximately $25,000. The JML was "...Essentially to provide for the profession of Dentistry and equivalent of the Wood Memorial Library in Anesthesiology for Medicine."⁶

Jess Hayden, Jr., DDS, was one of the School's original faculty members. Dr. Hayden received his DMD degree from University of Oregon in 1947; a MS degree from University of Michgan in 1955; and a PhD degree from LLU in 1962.

1 Jorgensen, N.B. In appreciation to NASDAD. J. NASDAD. Spring 1961 p. 19 2 Everett, G.B., Allen, G.D. Simultaneous evaluation of cardiorespiratory and analgesic effects of intravenous analgesia using pentobarbital, meperidine, and scopolamine with local anesthesia. J Am Dent Assoc. 1971 Jul;83(1):155-8. 3 Klooster, Judson. professor and dean emeritus, School of Dentistry, Loma Linda University. Personal Communication, June 5, 2003 4 Tabular statement of graduates from all dental schools or colleges in the US & Canada from 1841-1908. From History of Dental Surgery, vol. 1, Charles Koch, ed. (Chicago National Art Publishing Co, 1909, insert at pp. 402-3; Dental Colleges of the US & Canada, Polk's Dental Register & Director, 1925, pp. 3-33 5 The Jorgensen Memorial Library-American Dental Society of Anesthesiology; An Important Relationship Reviewed. Anesth Prog. 33:262-4, Sept.-Oct. 1986 6 1960 Heidbrink Award to Neils Jorgensen. J. NASDAD. Mar. 1961, p.15 Additional resource: Dental Pain Control. In: Schaefer, Richard A. LLUMC. Legacy—Daring to Care. Loma Linda, CA. Legacy Publishing Association. 271 p. (p.192) Mr. Schaefer is historian for the 100th anniversary of Loma Linda University.