Numbing, freezing, pinching, burning, pricking, and tingling—no matter what you call it, the thing many of our patients dislike most about visiting us are the injections associated with local anesthesia. Obviously, a high level of patient comfort while delivering dentistry is something we as conscientious practitioners try hard to maximize. Despite using topical, shaking, vibrating, wiggling, pressure, and numerous other things, the local anesthetic delivery system certainly could be improved.
The Need for Change
Dental materials have changed dramatically during the past few decades, but anesthetic delivery systems have changed little. We all think we are good at our numbing, and “newer” anesthetics like articaine have certainly helped, but we have all maximized our potential efficiency with these traditional systems. Buffered local anesthetic can build a practice while decreasing office tension at the same time. The Anutra buffered anesthetic system will provide more profound anesthetic and faster onset, and it will provide more comfort than your traditional dental anesthetic systems while making your patients more likely to brag about how good you are.
|Figure 1. The Anutra System comes complete with syringe, needle, and an ergonomic dispenser.||Figure 2. The dispenser houses the lidocaine and sodium bicarbonate cassette for accurate mixing.|
|Figure 3.The syringe is attached, and the amount of anesthetic needed for the case is drawn into the syringe.||Figure 4.The syringe is no longer the stainless steel dental type but a disposable plastic one. The solution is mixed by agitating.|
|Figure 5. The soft tissue is dried with a gauze.||Figure 6. A few drops of buffered lidocaine is dripped onto the tissue, which provides a much more profound topical than traditional benzocaine.|
Figure 7. The benefits of intense topical—a minimal-discomfort injection and almost instant results—are a game changer in dentistry.
Benefits of Buffering
Buffering of anesthesia has been attempted for years, but the predictability and delivery systems were not that efficient. Anutra now makes this procedure easier, simpler, and faster (Figure 1). Two percent lidocaine and 8.4% sodium bicarbonate are mixed in a very stylish and ergonomic dispenser in a system that includes everything from the buffering materials to the syringe and needles (Figure 2). The syringe is placed, and anesthetic is drawn into the hospital-type syringe (Figure 3). Generally, we use about half of the amount of anesthetic that we typically used with a mandibular block before. The syringe is then rotated back and forth to ensure mixing (Figure 4).
Traditional local anesthetics are acidic, which makes them soft-tissue irritants. The sodium bicarbonate buffered solution gives anesthetic more of a neutral pH, which makes it less irritating to the tissue without the burning while giving faster results. Our mandibular blocks typically take from 10 to 15 minutes for the numb lip sign of anesthesia. With buffered lidocaine, we normally have profound signs in 2 to 5 minutes. It is a great efficiency booster for me to give a block and be ready to work without degloving and leaving the room. Inject, describe the procedure, and begin treatment—a fantastic time saver that can result in thousands of dollars in time savings annually. The return on investment is exponentially great with this system.
An important question to ask is this: How often do you miss a block, and how much time is wasted doing so? We all miss them, wait 10 to 15 minutes, re-inject, and then wait another 10 to 15 minutes, hoping to get it the second time. With buffered solutions, we see signs of numbness beginning almost immediately, so in a very short time, the feedback tells me whether I “got the block” or need to re-inject. Now, instead of multiplying the time wasted on a missed block, we quickly have the information we need and can re-administer after only one to 2 minutes of waiting. This time saved cannot be underestimated from a dollar standpoint and from the stress level associated with running late.
When we inject, the buffered anesthetic is a terrific topical anesthetic, more potent than benzocaine topical gels. We first dry the soft tissue with a 2x2 for a few seconds (Figure 5). We then let a few drops fall on this dried tissue and wait 15 to 20 seconds before injecting (Figure 6). The time and interview studies we have done in our office tell us the patient experience is much better than typical topical and anesthetic delivery systems, and the penetration of the soft tissue is more comfortable and often not felt. We inject slowly as we penetrate tissue, and because of the ultrafast manner in which the tissue is numbing as we insert the needle, this decreases any sensation.
We also must remember that the more time in our chair, the more time a patient has to think about the procedure. More time also means increased chance for apprehension to build in the patient’s mind. The time a patient sits in the chair and waits for us to inject is a stress builder; the time the patient sits, waiting for numbness, adds to that stress. Greeting a patient, injecting, and treating within minutes of anesthesia delivery decreases this stress and promotes patient satisfaction.
Wasted time in a busy office is a great source of money loss. If I add up all the time spent waiting for anesthesia to work and the time I spent renumbing patients, buffered anesthetic can save me thousands of dollars annually. (Not to mention the fact that more profound numbing results in happier patients, who refer more people to me.) It is certainly time to challenge our traditional anesthetic procedures. The busier practice you have—or the busier you want to be—buffered anesthetic is all that.