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10/08/2012 at 2:19 pm #10810
Fear of going to the dentist is extremely common – according to the American Dental Association, more than 20 percent of Americans are too afraid even make an appointment.
But a new medical device called Dental Vibe is helping to lessen patients’ pain and anxiety during dental procedures.
New York City-based root canal specialist Dr. Aleksander Iofin said the device only looks simple.
“It looks like an electric toothbrush, but what it does is it creates, oscillations or vibrations and when applied to the patient’s mouth, that basically takes away the sensation of pain where the injection is delivered,” Iofin said. “You feel the vibration, you don’t feel the pain.”
Dental Vibe is applied to the gums during Novocaine shots, and the vibrations travel to the brain faster than pain signals.
Before, dentists only had topical pain relievers to help with the discomfort of Novocaine needles.
“The problem is the actual injection. The fear of needles, nobody likes injections,” Iofin said. “So what this device does is it eliminates the pain, thus eliminating the fear. Therefore, more patients will come in and get preventive care because they’re not afraid of the needle.”
Now, Iofin uses the device on every procedure and said patients are usually shocked at how little pain they feel from injections.
“The patients are fascinated about it,” he said. “Many times they comment, ‘I didn’t feel anything, I didn’t know you already gave me a shot. So it is absolutely revolutionary.”
31/08/2012 at 5:23 pm #15873
The VibraJect dental needle accessory blocks pain from dental injections. Attached to an aspirating or intraligamental syringe, high-frequency needle vibrations block injection pain based on the Gate Control Theory. It provides a cost-effective way to simplify injections and improves the patient’s dental experience. It is available with 1.5-V batteries or rechargeable batteries and a recharging unit
29/09/2012 at 2:59 pm #15964
One of the biggest challenges a dentist may face on a day-to-day basis is helping to calm a fearful patient. Usually these patients have had some visit in the past in which they remember an episode of discomfort, pain, or otherwise. In our own office, we pride ourselves in helping a patient get through the procedure with zero pain with good administration of a local anesthetic, and simple TLC. The idea is that eventually we can get them comfortable with each new visit to reverse the negative association with getting work done on their teeth.
Many times, TLC just isn’t enough for a patient to make it through a procedure, and there is nothing like a little nitrous oxide to make it easier for everyone. It’s not just the patient who feels less stress. As a dental operator, you will be able to relax as well instead of being on edge the entire appointment. It can truly be a win-win for your office.
Nitrous oxide works by creating an anesthetic and euphoric effect on the central nervous system. As it is inhaled, the anxiolytic effect can be increased simply by adding more nitrous oxide to the mix. The nice thing about it is that it has a minimum alveolar concentration of 105% before it causes general anesthesia. In other words, you could never breathe enough of the stuff to actually lose consciousness. Coupled with a constant flow of oxygen, it becomes a safe adjunct to the procedure to get someone comfortable.
As popular as local anesthetics are these days, use of nitrous oxide in the dental setting predates the 1960’s popularity of Novocaine (Procaine) by more than 100 years. Horace Wells, dental entrepreneur of the 1840’s, built a 12-practice empire equipped with nitrous oxide. Even by today’s standards, that is a significant accomplishment. But what the innovation gained for his business, it lacked in safety. These machines had no scavenging system, allowing the gas to seep into the operating room. Also missing was the addition of oxygen to the mix. The dentists had no idea how much nitrous the patient was getting, or whether or not it was too much.
While the systems are much safer now, the irony is that the look of these stainless steel appliances has created their own brand of anxiety. Patients today expect the dental office setting to have nice décor, to be non-threatening, and to even smell very little like a dental office.
It’s nice to see a dental company recognize these types of changes, and create products that address the changing needs of our patients. Accutron is a company that manufacturers nitrous oxide flowmeters and equipment. They have shown that they have a very basic understanding of how to make a patient more comfortable, and make life easier for the dentist. Instead of the typical black or silver units of the past, their systems are white, complementing whatever cabinetry you have in a very clean way. And, the units are designed to have mounting flexibility.
Digital Ultra flowmeter with a digital touchpad can be mounted almost anywhere, including in a cabinet or on a swing arm attachment. It even has an automatic calibration feature that allows you to simply set what percentage of nitrous oxide you want without having to calculate it yourself based on liter per minute flow.
To complement these systems, Accutron also has a complete line-up of single use nasal hoods. The Personal Inhaler Plus comes in three different sizes depending on your patient population. These also come in a variety of different scents, from mint to strawberry, to bubblegum. Unscented is available too if the patient prefers it that way.
Keeping with that theme of patient comfort and doctor convenience, Accutron recently added the ClearView Single-Use Nasal Hood to the line-up. The design of the device is more like having two nasal hoods in one. The outer hood is transparent, reducing the area that is normally blocked from your field of view as the operator. The clear outer hood also allows you to watch for condensation from breathing, allowing you to visually monitor whether the patient is breathing properly. Because of this design, the secondary hood helps to capture more of the exhaled nitrous oxide through the scavenger system.
Dr. Jeff Rohde DDS, MS
10/10/2012 at 6:03 pm #16013
Written by Jason H. Goodchild, DMD, Anthony S. Feck, DMD, and Michael D. Silverman, DMD
pain control and sedation have become important aspects of dental care. It is now becoming more common for general practitioners to provide in-office sedation for routine dental procedures. A segment of the population that would otherwise not seek care because of fear or anxiety is now receiving treatment. The use of sedation for dental care has become a topic of intense interest, and many states are re-writing their regulations to require a special permit to provide this service. The intent of this article is to introduce definitions and concepts pertaining to oral sedation that may be helpful to the general dental practitioner.
There has been much debate concerning different levels of sedation, and what is appropriate for the dental office. Anxiolysis and conscious sedation are well suited for oral medications, and depending on state regulations, may be safely and effectively administered in the dental office.
The definition of anxiolysis is simply, “a reduction in anxiety.”1 More precisely stated, “…a drug-induced state in which patients respond appropriately to verbal commands. Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are unaffected.”2 In the spectrum of sedation, anxiolysis is the lightest level of sedation (Figure 1). For the purpose of many state regulatory agencies, anxiolysis involves the use of a single anxiolytic drug (per day, not including nitrous oxide), in a single dose, prescribed before a patient’s appointment, and administered prior to the beginning of the dental appointment.
The anxiolysis technique must be distinguished from conscious sedation for the following reasons:
1. Fearful patients
2. Anxious patients
3. May be a helpful adjunct to the achieving profound local anesthesia
4. Can be useful for longer appointments
5. Can be helpful during invasive procedures (eg, endodontic therapy, third molar extraction)
6. Patients with pronounced gag reflex
1. Patient who is medically unstable (eg, angina, diabetes)
2. Patient who is medically complex (eg, ASA III to IV).
3. Patient who has had an adverse reaction to medications
4. Pregnant patients
5. Can be helpful during invasive procedures (eg, endodontic therapy, third molar extraction) 5. Elderly patients
(1) Anxiolysis is a technique that all dentists could implement. Many states (and provinces in Canada) have now developed restrictions on the use of conscious sedation by dentists, thereby limiting the ability to perform needed sedation for certain procedures. These restrictions mostly prevent dentists from administering conscious sedation without a special permit, usually one that requires training in intravenous drug administration. However, as defined above, anxiolysis is permitted in all 50 states and in Canada. (Those dentists who are interested in conscious sedation should consider continuing their sedation training and satisfy their state requirements for a conscious sedation permit).
(2) Anxiolysis provides a light level of sedation. A situation may arise in which the dentist and/or patient desires a lighter level of sedation than conscious sedation provides. An example may be the slightly anxious patient who states that they need the “edge taken off” in order to receive treatment. Anxiolysis could be appropriate for this situation. Many patients in general practice presently benefit from a medication given preoperatively, ultimately helping them relax for a perceived invasive procedure.
(3) Anxiolysis is ideal for shorter sedation appointments. Typical anxiolysis protocol consists of an oral medication given pre-operatively. Some newer sedation medications have short durations, and when given orally, can be effective for a short appointment. If, for instance, the expected length of the procedure is 90 minutes or less, anxiolysis may be indicated. It should be noted, however, that anxiolysis may also be appropriate for longer appointments, up to and sometimes exceeding 4 hours
01/11/2012 at 5:42 pm #16117
Dental anesthesiology came close to becoming the 10th ADA recognized specialty but fell short last week when a majority of the House of Delegates (HOD) voted against approving Resolution 16 during the 2012 ADA Annual Session in San Francisco.
"We couldn’t overcome the political nature of what the ADA HOD is," said Steven Ganzberg, DMD, a clinical professor and the chair of dental anesthesiology at the University of California, Los Angeles and the president of the American Dental Board of Anesthesiology. "This action by the ADA confirms that the ADA process of specialty approval is fatally flawed."
Leading up to the HOD vote, the application submitted by Dr. Ganzberg and a group of fellow anesthesiologists had been supported by the Council on Dental Education and Licensure (CDEL), its Committee on Recognition of Specialties and Interest Areas in General Dentistry, and the ADA Board of Trustees.
The American Association of Oral and Maxillofacial Surgeons (AAOMS) disputed that there was a need for dental anesthesiology to become an ADA specialty and felt that the application did not pass muster.
"When we saw the application for specialty recognition, we felt that overall it did not meet the requirements of the ADA for recognition," explained Miro Pavelka, DDS, MSD, president of AAOMS, in an interview with DrBicuspid.com. "Right now, even though this specialty was not approved, this has absolutely no effect on the ability of the dentist anesthesiologists to continue practicing exactly as they do."
Dr. Ganzberg disagreed. "This was clearly an effort by the ADA, through AAOMS, to restrict professional activities that specialty recognition would have provided," he told DrBicuspid.com.
In a previous article, he and other supporters expressed optimism that passage would lead to increased training and emergency preparedness at dental schools, increased treatment options, and insurance reimbursement.
Requirements for recognition
The ADA CDEL’s Committee on Recognition of Specialties and Interest Areas in General Dentistry studied the application for a year after it was submitted in June 2011. Six requirements are outlined by the ADA that must be met in order for it to pass. While the application passed the review process up until the HOD, the AAMOS remained unconvinced.
"The first one that really caught our eye was requirement 3A, which requires that the specialty be separate and distinct from any recognized dental specialty or combination of recognized dental specialties," Dr. Pavelka explained. "It’s been the contention of AAMOS that anesthesia is a core competency of dentistry, and for 160 or more years many recognized specialty providers and general dentists have incorporated advanced forms of anesthesia, including general anesthesia, into their practices."
The application was also centered around increased training for the dental anesthesiology resident, he added. "And I would submit to you that increased training in a special interest area of dentistry does not equal separate and distinct," he said.
AAOMS also disputed the application’s satisfaction of requirement 5, that "a proposed specialty must directly benefit some aspect of clinical patient care."
"The application stated that ‘the mobile dentist anesthesiologist can quickly transform the operating dentist’s office into a mini operating room for patients who are medically complex, as well as those with special needs,’ " Dr. Pavelka stated. "That’s really troublesome to me personally. Even though [a dentist anesthesiologist] brings monitors and some other safety equipment with him, he’s coming into an environment that is probably a general dentist who does not have his level of training and a staff that is not up to speed on an anesthesia emergency situations."
"Based on those two, we felt like this application didn’t meet the requirements the ADA put in place," he said.
Dr. Ganzberg contended that there was nothing wrong with their application. "All the criteria were met, according to the Committee on Specialty Recognition and overwhelming approval from the Council on Dental Education and Licensure, the ADA Trustees, and the Dental Education Reference Committee," he said.
Politics or patient safety?
In Dr. Ganzberg’s view, politics and influence sank the application. He characterized AAOMS’ concerns about patient safety as "misinformation" and took umbrage at the suggestion that dentist anesthesiologists were unsafe.
"We need to work together to improve safety," Dr. Ganzberg said. "Unfortunately, oral surgery’s tactics have undermined their relationship with dental anesthesiology. This is unfortunate for oral surgery, as the data are not desirable for them."
The AAOMS also had concerns about the future of anesthesiology in dentistry if the application passed.
"Once you get a specialty in medicine or dentistry established, then they become the authority," Dr. Pavelka said. "And I’m not sure where it would go. If it got to the point where this medical model is established, then hypothetically we could get to the point where the only person that could provide the anesthesia is a trained dentist anesthesiologist, and the rest of us would be left out of the loop. I hope that that doesn’t happen."
Dr. Ganzberg agreed. "I’d personally fight that," he said. "It’s not good for patients if oral surgeons cannot do deep sedation. They’re worried that we won’t support them in the future, but I don’t know what else to say to that other than, ‘Look at our track record.’ "
However, he noted that oral surgeons’ ability to continue doing deep sedation will not be jeopardized by fellow practitioners in dentistry.
"The threat is going to come from medicine, which will at some point stop training oral surgeons as they are clearly opposed to what oral surgeons do: operator anesthesia," Dr. Ganzberg stated. "They’ll stop training them and then they’ll have their own problems."
In light of the results during the HOD, dentist anesthesiologists have moved on from the ADA specialty approval process, which Dr. Ganzberg views as flawed.
"Staying with this format will be destructive to the ADA," he said. "We will no longer be applying for specialty status through ADA. We’ll pursue other state and federal remedies outside of them."
According to the ADA, changes to the specialty approval process may occur, and the ADA is not taking any additional applications for the time being.
"In San Francisco, the House adopted Resolution 185H-2012 calling for the Council on Dental Education and Licensure to review the process and criteria for recognizing dental specialties and report to the 2013 House of Delegates with appropriate recommendations on how to improve the process and evaluation criteria," the ADA wrote in an email to DrBicuspid.com. "Further, Resolution 185H-2012 directs that the ADA take no action on any application for recognition of a specialty in dentistry until CDEL has completed a review of the requirements for specialty recognition and reported such recommendations to the House of Delegates for adoption."
23/11/2012 at 5:55 pm #16205
Acupuncture can calm highly anxious dental patients and ensure that they can be given the treatment they need, suggests a small study published in Acupuncture in Medicine.
A visit to the dentist provokes extreme fear and anxiety in an estimated one in 20 people, and can put them off going altogether, a condition termed odontophobia. And up to a third of patients report moderate anxiety at the prospect of dental treatment, studies show.
The authors base their findings on 16 women and four men from eight dental practice lists.
Each of the patients was moderately or extremely anxious about going to the dentist for treatment, as assessed by a validated questionnaire — the Back Anxiety Inventory (BAI).
All were in their 40s and had been trying to deal with this problem for between two and 30 years.
The BAI score was assessed before and after five minutes of acupuncture treatment, targeting two specific acupuncture points (GV20 and EX6) on the top of the head.
The acupuncture was carried out by the dentists themselves, all of whom are members of the British Dental Acupuncture Society.
The average BAI score of 26.5 fell to 11.5, and all 20 patients were able to undergo their planned treatment, whereas before this had only been possible in six — and then only partially and after a great deal of effort on the part of both dentist and patient.
The authors point out that several attempts have been made to conquer this type of anxiety, including sedatives, relaxation techniques, behavioural therapies, biofeedback and hypnosis. The research indicates that these do help, but they are time consuming and require considerable levels of psychotherapeutic skills, if applied properly, say the authors.
They caution that further larger studies are needed to confirm the value of acupuncture in these sorts of cases, but suggest that acupuncture “may offer a simple and inexpensive method of treatment
18/06/2013 at 10:22 am #16695
A computerized video tool designed to reduce fear of dental injections has the potential to help patients stop avoiding dental care due to fear, according to a new study in a supplement of the Journal of Dental Research (May 20, 2013).
A quarter of adults report a clinically significant fear of dental injections, and 1 in 20 say they avoid dental treatment due to such fears, according to the study authors, from the University of Washington School of Dentistry.
"While systematic desensitization is the most common therapeutic method for treating specific phobias such as fear of dental injections, lack of access to trained therapists, as well as dentists’ lack of training and time in providing such a therapy, means that most fearful individuals are not able to receive the therapy needed to be able to receive necessary dental treatment," the researchers wrote.
To address this issue, they turned to a computerized treatment approach: computer-assisted relaxation learning (CARL), which uses systematic desensitization to reduce dental injection fear. Through a series of two- to four-minute video segments, CARL introduces cognitive and physical coping strategies. The patient is then shown a model successfully managing anxiety while being presented with increasingly invasive aspects of a dental injection.
This dentist-blind, parallel-group study, conducted in eight U.S. sites, compared CARL with an informational pamphlet in reducing fear of dental injections. It is the first randomized control trial of a computerized treatment for dental injection fear, according to the authors. Previous research has shown that CARL effectively reduced dental injection fear after program completion and at one-year follow-up.
The researchers used newspaper ads to recruit people who reported fear and avoidance of dental injections. The ads ran in the communities of eight participating dental practices from February 2008 through June 2010. After arriving at the assigned dental office, participants received study information from a dental staff member, then completed three surveys about anxiety and fears regarding dentists and needles on a computer.
A total of 68 participants completed the study. Half viewed the CARL videos and half were given pamphlets with information about patient comfort, topical and local anesthetics, and postoperative pain management. Of the 34 CARL participants, 12 (35.3%) subsequently got injections, while 6 (17.6%) of those who read the pamphlets received injections.
Only 26% of participants who completed the study returned for an optional dental injection. Due to the small overall proportion of participants who got injections, the study was not able to fully assess the primary outcome of self-reported anxiety during injection and so did not achieve statistical significance, the researchers noted.
However, participants who viewed CARL reported significantly greater reduction in self-reported general and injection-specific dental anxiety measures compared with control patients (p < 0.001). While twice as many people who saw the video subsequently opted to get a dental injection, it was not statistically significant.
"CARL … was successful in reducing self-reported dental fear related to dental injections compared with an informational standard of care," the researchers concluded. "Since CARL does not require involvement by trained therapists or special training for dentists, it may increase access to this therapeutic approach to a wider proportion of the population, improving access to dental care and better oral health."
30/06/2013 at 10:26 am #16719
Patient fear of the needle is a regular obstacle for dental professionals. Now St. Renatus, a Colorado start-up, is navigating the U.S. Food and Drug Administration (FDA) approval process to bring an anesthetic in the form of a nasal mist to the market.
The nasal spray, called Kovacaine Mist, is designed to anesthetize the maxillary arch. While the absence of a needle is an important aspect of the technology, it could provide other advantages to a dental practice as well, according to the company.
"A dental assistant can apply this topical drug, allowing for the dentist or dental professional to work more on actual procedures and billable treatments," Jill Shoemaker, vice president of investor relations at St. Renatus, explained.
In addition, because nasal mist anesthetic does not circulate in the bloodstream for as long as injected anesthetics, it is less harmful to the kidneys, liver, and lungs, according to an article in Innovation News. And since its effect would wear off more quickly, it could mean less drooling after a completed procedure. Also, a pediatric formulation could make treating children with an anesthetic much less stressful for everyone involved.
Inspired by a bloody nose
Founded to commercialize the new needle-free dental anesthetic, St. Renatus entered phase III clinical trials in July of 2012 after it secured up to $3.5 million from an angel investment group in January 2012.
Mark Kollar, DDS, was inspired to create the product after a basketball smashed into his nose during a pickup game of hoops, according to the Innovation News article. He noticed that the nasal spray drug that he received, commonly used by used by ear, nose, and throat physicians when they operate on the nose, numbed his upper teeth as well. The novel drug was successfully patented in 2002; it took only seven years to complete phase I and II safety studies.
After Dr. Kollar partnered with St. Renatus, the company hired Steve Merrick as its first full-time CEO, luring him away from his position as vice president of global marketing for Septodont’s pain control division in the fall of 2009.
There is no shortage of optimism that the product, if approved, could be successful — and a valuable tool for dentists.
"Market research has revealed more than 70% of patients are willing to switch to a dentist that offers the needle-free mist if their current provider doesn’t offer the nasal mist anesthetic," Shoemaker said. "Research has also revealed more people who are needle-phobic would visit the dentist."
Positive patient feedback
The results of the company’s successful phase II clinical trials were published last month in the Journal of Dental Research (May 20, 2013). Researchers from the department of periodontics and endodontics at the University at Buffalo and other schools compared the effects of Kovacaine Mist (3% tetracaine hydrochloride and 0.05% oxymetazoline hydrochloride) plus a sham infiltration injection to a buffered saline nasal spray plus an active-control intraoral injection (lidocaine hydrochloride 2% and epinephrine injection 1:100,000 in a dental cartridge).
Forty-five adult participants needing restorations participated in the single-center, randomized, double-blind, active-control, parallel-group study. Of the 45 patients, 30 were selected at random to receive the nasal spray, and the remaining 15 received the lidocaine injection.
After the patients received the experimental spray, the researchers monitored vital signs and used a probe to test sensitivity in four sites at regular intervals until one hour after full sensation had returned.
"The occlusal, distal, and mesial surfaces were most often involved for both groups, accounting for 77% of the spray cases and 93% of the lidocaine cases," the researchers noted.
The results were quite positive. During the intent-to-treat analysis, the researchers determined that 83% of nasal spray group required no rescue anesthesia; for one of the five that required it, the rescue anesthetic proved ineffective as well.
"Also, 90% of test individuals had anesthesia success from maxillary premolar to premolar," the researchers noted. The side effects, which included stuffiness, runny nose, numbness of the roof of the mouth, and sneezing, were minor, and the 11 patients who experienced them recovered without assistance.
"The St. Renatus team is very pleased to have the successful phase II data," Shoemaker stated. "They are also very encouraged by the positive patient feedback for the needle-free mist to provide proper anesthesia with significantly less anxiety."
While phase III clinical trials are already underway, some of the testing that is included was revealed in the phase II study. A wide age range of patients will be asked about preferences and facial numbness. In addition, a separate study in children is nearing completion, the researchers noted. "Children have better circulation and a smaller area for delivery of a larger volume of drug, which could be an advantage," they wrote.
So far, phase III appears to be progressing as well as phase II did.
"St. Renatus has seen similar success in the first part of their adult phase III trials," Shoemaker noted. "They anticipate being done with all FDA trials by the end of summer 2013."
smileatsan20/11/2018 at 7:47 am #17955
Thanks really helpfull.
29/11/2018 at 6:19 am #17957
Thanks for the information!!
05/12/2018 at 7:29 am #17958
26/07/2020 at 8:40 am #17969
Advancements in painless dentistry is really interesting . It will help in increasing more and more confidence among patients for undergoing dental procedures
26/07/2020 at 8:42 am #17970
Advancements in painless dentistry is really interesting . It will help in increasing more and more confidence among patients for undergoing dental procedures
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