Comfortably numb: how dental anesthesia can differentiate your endodontic practice

In today’s economic climate, dentists are looking for ways to differentiate themselves within the community. Here, Dr. Diwakar Kinra, editorial director for DE’s ENDO File, shows you how Onset from Onpharma can be used to provide comfortable and profound anesthesia for your endodontic patients as he presents three clinical case studies.

Mar 17th, 2014
Diwakarkinra

In today’s economic climate, dentists are looking for ways to differentiate themselves within the community. With the vast amount of dentists practicing in concentrated areas, it is critical to provide a service better than anyone else, elevating you to the elite in the field. Providing comfortable and profound anesthesia can allow you to accomplish this differentiation. If done correctly, it will provide better word-of-mouth marketing than anything else done in your office. As a specialist, this will allow feedback to your referring dentist to then confidently retain and grow quality referrals.

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Providing confortable anesthesia involves several factors, in which some can be controlled and others are not. Previously, the dentist would control the temperature of the anesthetic, injection speed, and physiological factors in delivering a proper injection. But the practitioner could not alter the patient’s physiologic pH, which does contribute to the level of pain upon injection and the latency of inception. Now there is an opportunity for the dentist to influence this factor through an additive within our normal anesthetics. The company Onpharma has addressed this concept with its product, Onset. The product works by replacing a small amount of the acidic anesthetic (pH 3.5) with sodium bicarbonate (pH 8.4) via a mixing pen in a standard lidocaine cartridge. Now the acidic pH of the anesthetic is closer to the physiological pH of the patient, which allows for a more comfortable injection and shorter latency period for onset of the anesthetic.

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Being an astute dentist intrigues me to be on the “leading edge of technology,” not the “bleeding edge of technology.” Therefore, I wanted to try this technology in the office to ascertain if it was a good fit for an endodontic practice. Many of our patients arrive in discomfort and are fearful of the entire procedure. Providing profound anesthesia is at its most critical states in this situation. If done well, it will reduce patients’ anxiety and help them regain confidence, which is already difficult to do in short-term dental relationships. When successful anesthetic is accomplished and a pain-free root canal completed, I ask the patient to report this information back to the referring dentist. This form of internal marketing has helped me build a successful practice, and now has become easier with Onset.

Upon arrival of the starter kit to my office, there was an instructional DVD, buffer carpules, and mixing pen. After my staff and I reviewed the DVD, we felt confident in our abilities to deliver the “upgraded anesthetic” safely and efficiently.

Case 1

A female patient presented to our office for root canal therapy on No. 30 at 9 a.m. She had a pulpal diagnosis of irreversible pulpitis and apical diagnosis of acute apical periodontitis. She also stated that her general dentist tried to perform the root canal two days prior, but was not able to anesthetize her properly. She claimed to have lip and tongue signs but was still very sensitive to cold water. She went on to detail how she has always been difficult to numb on the lower. The patient discussed that her pain has increased exponentially since her last visit with her general dentist. This was our best scenario to put Onset to the test. After combining the anesthetic and buffer with the mixing pen, we administered via mandibular block one carpule of buffered 2% Lidocaine with 1:100k epinephrine. A timer was set in the room and the patient felt tongue and lip signs in less than two minutes. At that time EndoIce was sprayed onto a cotton tip applicator and placed on the occlusal and buccal surfaces of the tooth. Patient had no response to the thermal sensation. Root canal therapy was initiated without any complications and the patient remained in comfort throughout the procedure.

Case 2

The same day a male patient presented as the first patient after lunch with a “toothache” on No. 29. Upon exam and radiograph No. 29 had gross caries into the pulp chamber. The patient accepted a treatment plan of root canal therapy and permanent restoration with the referring dentist. The anesthetic was buffered for 30 minutes before the patient was seated. An inferior alveolar nerve block was injected with one carpule of buffered 2% Lidocaine with 1:100k epinephrine and long buccal infiltration. A timer was set in the room and the patient felt numbness in approximately five minutes. At that time, EndoIce was sprayed onto a cotton tip applicator and placed on the occlusal and buccal surfaces of the tooth. The patient had response to the thermal sensation. Another carpule of nonmixed 2% Lidocaine with 1:100k epinephrine was administered. Root canal therapy was initiated without any complications, and the patient remained in comfort throughout the procedure.

Case 3

The next day, a female patient presented for a root canal therapy on No. 19 at 9 a.m. The patient had a sedative filling and direct pulp cap placed two weeks prior due gross caries. The patient was in severe pain and very nervous. The anesthetic was buffered for 15 minutes before the patient was seated from the cartridge that was opened the previous day. A mandibular block for No. 19 was injected with one carpule of buffered 2% Lidocaine with 1:100k epinephrine along with a long buccal infiltration. A timer was set in the room and the patient felt slight numbness in approximately seven minutes. At that time, EndoIce was sprayed onto a cotton tip applicator and placed on the occlusal and buccal surfaces of the tooth. The patient had response to the thermal sensation. Another carpule of mixed 2% Lidocaine with 1:100k epinephrine was administered. After an additional five minutes, EndoIce was sprayed onto a cotton tip applicator and placed on the occlusal and buccal surfaces of the tooth. The patient had no response to the thermal sensation. Root canal therapy was initiated without any complications, and the patient remained in comfort throughout the procedure.

After the third patient, I was deflated about the results of Onset. Having confidence in my anesthetic abilities, I was concerned that some part of the process was not working correctly. I placed a call Onpharma for an explanation, and within an hour I was given the keys to success with Onset.

I was told that the difficulties that were occurring in the office were common and twofold. First, Onpharma explained that mixing the anesthetic must be done as close to the time of injection as possible.

Second, once the buffered anesthetic is put into use, it is like “opening a can of soda.” As time goes on, it loses its buffering capacity. Therefore, the buffering agent can be used within 12 hours without diminished effects. For Case 3, on the second day of usage there was virtually no buffered effect.

After adjusting the technique to proper form, the remaining group of approximately 30 patients used with the initial starter kit reacted like the patient in Case 1. The buffered anesthetic allows one to dispense less anesthetic with more profound numbness. The procedures will commence quicker and more comfortably, permitting greater profits due to less patient chairtime. A great experience is reproducible among the practice population. This internal marketing technique is a simple skill that can be implemented easily into any dental practice.

Diwakar Kinra, DDS, MS, is the editor of DE’s ENDO File. He received his dental degree in 1999 from the University of Michigan and his master’s degree in endodontics at the University of Detroit-Mercy in 2004. Afterwards, he began his solo private practice limited to endodontics in Flint, Mich. He has lectured domestically and internationally on practice management and endodontics since 2007. For further information, please contact Dr. Kinra at dkinra@gmail.com.

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