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Minimizing injection pain and stress

Feb. 8, 2010
One major association people have with pain in the dental office is the fear of injections. The use of an instrument like VibraJect allows the dentist to consistently give more comfortable injections.
Statistics tell us that only 50% of the U.S. population visits a dentist on a regular basis. The other 50% need dental care but are fearful of the dental experience. These statistics were published by the National Institute of Dental and Craniofacial Research (NIDCR).One major association people have with pain in the dental office is the fear of injections. Dentists have given injections for years, and have developed distracting techniques like shaking the cheek while dispensing the anesthetic. Many will tell you that their injections don’t hurt, but the reality is that their injections are probably not painless. The use of an instrument like VibraJect allows the dentist to consistently give more comfortable injections. There are injections that, no matter how inventive the dentist is, remain hurtful. Palatal, intraligamental, periodontal ligament injection (PDL), and blocks are examples of such injections. VibraJect is particularly effective in blocking pain when administering these injections.Howard S. Glazer, DDS, in an article about VibraJect and anesthesia in Inside Dentistry (July 2009, Vol. 5, Issue 7) states with regard to injection pain management:“A vibrational device attached to a syringe uses this same concept of tricking the mind to recognize only the sensation caused by the ‘wiggle and jiggle’ vibrations. The VibraJect® ... offers a simple and easy-to-use solution that can anesthetize patients quickly in a more comfortable manner. Use of this two-piece device is simple: Just clip the VibraJect motor unit (a small, battery-operated unit) onto the barrel of a conventional and/or intraligamentary syringe, turn it on, and use any standard technique for injecting the patient.Not only is this device ideal for ‘normal’ patients, but even more so for those patients who have a phobia of dental injections. The device also can be used with pediatric patients. In almost all cases, the need for topical anesthetic is eliminated, which saves time and money.”Dr. Glazer goes on to say the following about VibraJect in his article’s conclusion:A Benefit to Patients and the Practice“Undoubtedly, an extra benefit is the practice building that will result when patients tell family and friends about their painless injections. This technique also saves time by eliminating the time it takes for topical and block anesthesia to take effect. With this technology, dentists can treat multiple quadrants, often eliminating the need for additional appointments. This time savings also has economic benefits, creating time to treat an additional patient each day and ultimately adding to the practice’s bottom line. After becoming comfortable with this technique, dentists will be not only high-tech, but also making happy, loyal, and referring patients.”Speaking with reference to the VibraJect dental injection system, Dr. Howard Glazer states:“The system is useful with all types of routine dental injections. Typically, the most painful area for the patient to endure an injection is the palate. This, of course, is because the already taut tissue is stretched further when a bolus of anesthetic fluid is introduced, causing a great deal of pressure. The VibraJect enables a less painful palatal injection because it delivers small amounts of anesthetic solution over a period of time.To anesthetize the mandible, most dentists were taught to use a regional block technique. While this technique is viable, three adverse effects are associated with the procedure: first, the risk of ‘missing’ the site (i.e., the area surrounding the inferior-alveolar canal orifice); second, the risk of paresthesia; and third, the patient’s lip and tongue may remain numb for several hours, thus impeding the ability to speak and function in a work or school environment. This author no longer gives traditional mandibular block injections. Following is a technique for mandibular injections that helps to eliminate these adverse effects and provide a positive experience for patients. The technique can be used for maxillary injections. In both instances, the technique relies on a very slow drip deposition of anesthetic fluid and using vibration, via the VibraJect.”Another VibraJect application/adaptation is with regard to STA, single-tooth anesthesia, intraligamental injections that can be comfortably and successfully given without using a topical. No numbing of the cheek, tongue, and lips is experienced with the VibraJect Dental Needle Attachment. The vibrating device is attached to any intraligamental syringe using any of the usual STA injection techniques.The following quotes and news items represent just a few of the clinical observations various dental practitioners have expressed using VibraJect.“The big advantage is little to no pain. That’s a big practice builder all by itself. But if you’re working on a 3-year-old, you’re not going to get away with even a little stick. He’ll remember you hurt him and you’re going to have a harder time getting his cooperation the next time. This seems to do the trick. I haven’t used it that long (only a couple of weeks), but so far, zero pain. I haven’t had a kid notice the injection yet. So thanks again.”Dr. Roy L. Robbins, DMD“It’s brilliant in its simplicity, powerful in its effectiveness.”Alan W. Budenz, MS, DDS, MBA
Professor, Department of Anatomical Sciences
University of the Pacific, Arthur A. Dugoni School of Dentistry
“In my practice, we use lasers, magnification, intraoral cameras, digital X-rays — all of the high-tech goodies. However, the VibraJect provides the best bang-for-the-buck in terms of doctor and patient satisfaction.”Dr. Don McNamara
Elkhart, IN
Dr. Joe Blaes has a general practice in the St. Louis area. He is known for his expertise in the dental materials and techniques and his innovative systems designs. He writes and lectures on "How to Increase Productivity and Profitability." Dr. Blaes is a member of the American Academy of Dental Practice Administration.Dr. Blaes wrote: “If you saw this product on an exhibit floor at a meeting, you probably would walk right by and not even give it a second look. In the case of VibraJect that would be a mistake.”Joseph A. Blaes, DDS
St. Louis, MO
The VibraJect product’s fundamental operating principleVibraJect clips easily onto the barrel of aspirating and intraligamental dental syringes (and some disposable syringes) and vibrates the needle at a high frequency while injections are administered.Its effectiveness is based on the Gate Control Theory of nerve function proposed in 1965 by psychologists Ronald Melzack and Patrick Wall. In short, the theory suggests that oral nerve endings sense vibrations first and then cannot transmit feelings of pain. So the vibrations essentially block your patients' discomfort, putting them at ease during even the most dreaded injections.Two VibraJect product models are available from ITL DENTALThe two available VibraJect models are the VJ2002 with replaceable 1.5 volt batteries (Fig. 1) and the VibraJect VJR3R (Fig. 2) with rechargeable batteries. Clinicians who administer 50 shots or more per week get the best value from using the rechargeable VJR3R.
Fig. 1
Fig. 2The Model VJR3R and the Model VJ2002 operate the same way sharing identical functionality, performance, and effectiveness. The VJR3R comes with a recharging unit, spare rechargeable battery, and a power cable.A number of advantages with VibraJect useage include:
  • Reduction of the stress and pain associated with oral injections
  • Ease of use with no learning curve for the clinician and VibraJect’s operation
  • Low equipment expenditure
  • Reduction of injection time not having to wait for topical to take affect
  • Low per-injection cost
  • Practice building due to “comfortable injection” referrals
  • Appointment cancellation and complaint reduction
  • Builds revenues and patient base

Studies confirm VibraJect® effectiveness

Two independent studies have confirmed the effectiveness of the VibraJect Dental Needle Attachment to block the pain of dental injections. The purpose of these two studies was to confirm and document the effectiveness of VibraJect in blocking the pain resulting from dental injections and its effectiveness against CCLAD devices.

The first study by Fred Quarnstrom, DDS, et al. dealt with pain level comparisons resulting from usage of the Wand with those compared to usage of the VibraJect dental needle attachment.

Study #1 by Fred Quarnstrom, DDS, FASDA, FICD, FAGD (diplomate, American Board of Dental Anesthesiology, diplomate, National Board of Dental Anesthesiology), Sun Hee Bang-Pastore, DDS, Ruth Woldemicael, DMD, and David Chen, DDS, compared the VibraJect® to a computer-controlled injection device to control pain for injection of local anesthesia. Nineteen injections were done with the Wand handpiece of the CompuDent system by Milestone Scientific and 17 with the VibraJect by VibraJect LLC. Twenty-four were maxillary infiltrations and 12 were mandibular blocks. Patients reported the level of pain for the needle piercing their tissue, the injection of solution, and their overall evaluation of the injection.

This study’s conclusion stated: “This study tends to indicate there is little difference in the pain perceived by a dental patient when injected using the Vibraject as opposed to injecting with the Wand.”

Study #2 by Queens University, Belfast Ireland — The second study by Queens University statistically measured and compared the amount of pain reduction experienced by patients given block injections of local anesthesia using the VibraJect dental needle attachment, with block injections given to subjects using conventional injection methods. A Queens University study on 400 patients showed that VibraJect® statistically reduced the amount of “pain from 4.6 to 1.7 which has never been statistically achieved before VibraJect.” According to the Queen’s University study results: “Subjects receiving the conventional injection methods had a mean pain score of 4.6 (± 0.414) The VibraJect group had a mean pain score of 1.71 (±0.235)(P<0.05). Certain sites had larger decreases in the mean pain score using the VibraJect. These included the upper anterior segment infiltrations and lower right IDB injections.
P. PURRAY, K. TERRETT, E. LYNCH, and D.L. HUSSEY wrote this final conclusion to the Queens University Study: “The vibrating syringe attachment resulted in reduced pain levels on receiving intraoral injections.”

Botox/dermal filler injections

Botox and dermal filler injections have been recently introduced to the dental field and are performed by a growing number of dentists worldwide.

Botox injections can be used for dental treatments such as TMD and implantology. Dermal fillers can be used when dealing with asymmetrical lips, minimizing underlining skeletal discrepancies, and many other uses.

To administer Botox and dermal filler injections, the mouth and lip area need to be anesthetized. A common method is to give an infraorbital nerve block injection. This can be a painful injection if a device such as VibraJect is not used to block the pain.

Dr. Louis Malcmacher, a leading opinion leader for Botox and dermal filler injections for dentistry, has used VibraJect and provided this endorsement: “infraorbital and VibraJect is great for that and any regular dental injections.”

In summary

Dental clinicians are universally interested in eliminating appointment cancellations, minimizing no-shows for dental procedures, reducing patient complaints about injection pain with its associated stress, and eradicating the number of squirming, wiggling, and screaming children in their dental chairs. With the VibraJect®, dental professionals will see considerable reductions in such problems, resulting in more satisfied and relaxed patients.