Comfortably Numb

12 Jan 2016 Paul Feuerstein, DMD
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Figure 1. The Wand (Aseptico).
Figure 2. VibraJect (Golden Dental Solutions).
Figure 3. The Anutra System (Anutra Medical).

There are several anesthesia products and techniques available today, but our number one objective must be to remove our patients’ fears.

Dentist: “Why are you afraid of me?”
Patient: “I hate the shots.”

This all-too-common answer needs a lot of TLC and comforting responses from a practitioner. Of course, empathy goes a long way, but it is also reassuring to respond to an “I am afraid” statement with this: “Well, that was the old days; things have changed.”

So, what has changed to help these fearful souls? First and foremost is technique. Slow insertion and injection are always key. And do I mean SLOW. Infiltration does not mean blasting a bolus of liquid into a small tissue area of the mouth, unlike what you would do in the gluteus maximus. Topical in my hands works, although many experts state that it is more psychological for the patient. So what? You are doing something to combat the patient’s previously poor experience. Also, technology and chemistry have now entered into this discussion. The word slow has led us to the Wand (aseptico.com [Figure 1]), a product that has gone through a few transformations throughout the years, including name changes. It was once called STA (Single Tooth Anesthesia), emphasizing its strong point, but its manufacturer went back to the Wand since it is a substitute for all injections and supplies the anesthetic slowly and evenly. The Wand also provides practitioner feedback, letting you know visually and/or with sound cues if you have the correct placement and when the correct amount of anesthetic is delivered. Once you are familiar with the Wand technique, your patients will marvel at their very small amount of soft-tissue numbness, and you will easily be able to work bilaterally on the lower arch.

There are also times when there is a small lesion at the gingival margin, and giving a full block for less than 2 minutes of drilling seems to be overkill. In this situation, the Wand is great. Of course, there are patients who don’t believe they are numb without that feeling, so it is not imprudent to give a few drops of anesthetic in the buccal fold prior to the Wand, and of course you can get supplemental anesthesia from that. The numbness with a periodontal ligament injection lasts 30 to 40 minutes, so choose your cases selectively.

When using lip wiggling, pressure, cotton roll biting, and others, you are creating a distraction. The Gate Theory of Pain states that loading the sensory input with one stimulus can reduce (“close the gate”) the pain impulses going to the central nervous system. Some studies have shown that vibration applied to the area being injected is a great (albeit annoying) stimulus and can distract the patient from feeling the injection. One of the first devices to use vibration as a distraction was VibraJect (goldendentalsolutions.com [Figure 2]), a battery-operated device that clips onto a syringe. Not only does the syringe vibrate, but the operator’s fingers do also as the patient’s lips or cheeks are stimulated. Even the syringe tip is vibrating, causing a great distraction.

This concept is carried further by the DentalVibe (dentalvibe.com), which is actually a lighted retractor that vibrates the injection area with a distracting on/off tempo. The device’s disposable tips are also strong enough to deliver pressure on the palate in a combination with the vibration to additionally ease that injection.

Finally, part of injection discomfort is from the actual “burn” of the injection, since the anesthetic is acidic. By buffering it with sodium bicarbonate, its pH can be neutralized, thus further reducing the injection sensation. As a “side effect” of this buffering, anesthesia occurs more rapidly for the patient, usually in less than 2 minutes. This could be very effective in reducing chair time for a patient and doctor since there is no long wait for the anesthetic to take effect. And in the case of a mandibular block, which I am sure all practitioners have “missed” in their careers, you will know in 2 minutes if the block is effective. Two anesthesia buffering systems are Onset (onpharma.com) and Anutra (anutramedical.com [Figure 3]). Onset features a device that loads a standard carpule along with a cartridge of bicarbonate, then practitioners utilize its dial system to add the precise amount into the carpule. Anutra uses a bicarbonate with a longer active life and an interesting mixing unit. It lets you to fill a larger proprietary syringe (5 mL), allowing you to give multiple injections without changing carpules after each one. This, added to the rapid anesthesia, can cut treatment time.

There are several anesthesia products and techniques available today, but our number one objective must be to remove our patients’ fears.

Last modified on Monday, 18 January 2016 14:23
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