Pearls For Your Practice

By Joshua Austin, DDS, FAGD

DentalVibe Injection Comfort System
from Bing Innovations LLC

Local anesthesia continues to be a barrier for many dental patients. We all understand it. We hear it every day. Any device that can help to reduce the discomfort that patients feel during injections is handy to have around. Over the years, a few tools have come around to help with this. Improved prescription topicals, the Wand, and now, the DentalVibe, are all popular because they can make our lives easier when it comes to dealing with apprehensive patients.

The DentalVibe's design is based on the gate control theory of pain. You use your mirror hand to apply the DentalVibe adjacent to the injection site, where you hold it for five seconds before the injection, during the injection, and five seconds after the injection. This allows for the vibrations to override the pain signal to the brain that occurs during injections. The single-use, latex-free tip has two fingers that allow the clinician to retract his or her hand and maintain contact between the DentalVibe and the injection site while the injection is delivered. The LED light is another nice addition, and it helps to improve visibility. The DentalVibe is rechargeable and comes with a charging station. Although the device holds its charge throughout the day, it should probably be recharged nightly.

The makers of DentalVibe strongly encourage users to watch YouTube videos with technique suggestions (it takes about 10 minutes). These were pretty helpful in learning how to use and manipulate the DentalVibe. Technique-wise, I found that the inferior alveolar block was the most difficult injection to give with the DentalVibe. Using the DentalVibe felt more awkward than it did with the other injections, especially at first. Since I am so used to using my thumb and index finger to palpate anatomy, not having my left hand in the mouth felt foreign. It got better after a couple of weeks, and I would guess that, after a few months, it will feel very natural.

The responses from my patients were all pretty positive. The DentalVibe seemed to work really well for maxillary and mandibular buccal infiltrations, and it was also surprisingly effective with palatal injections. Although it didn't make the palatal injections pain free, it absolutely helped, according to my patients. On inferior alveolar blocks, it did seem to help reduce pain some. While it didn't seem to completely take away the discomfort of an inferior alveolar block, my patients reported that it helped to reduce their discomfort and distract them.

Pros: Reasonably priced; effective; stimulates questions from the patients (who seem to appreciate that you are concerned about reducing their discomfort)

Cons: Single-use tips add disposable costs for each patient visit; can be awkward to use while learning techniques

Final thoughts: I have enjoyed using the DentalVibe over the past few weeks. It seems to reduce discomfort, and it stimulates conversations between my patients and me. With more time, I think I will become more proficient at using it, thereby further reducing patient discomfort. I will continue to use the DentalVibe, and I think it's a neat little device to keep in the office. Line-drive double to the fence!

Cosmedent's Carry & Pack

Shaping anterior resin composites is always a challenge. The nature of composite is to be sticky, so it's no surprise that, frequently, it also sticks to our instruments causing frustration and headache. Lots of instruments on the market modify the material to make it less sticky. Some of these work pretty well, and some don't.

With the Carry & Pack instrument, Cosmedent has produced another solid product. The Carry & Pack is titanium-coated to ensure that it does not stick. With a condenser on one side and a traditional plastic instrument on the other, the Carry & Pack is right in my wheelhouse because a condenser and traditional plastic instrument are my first two instruments of choice when performing resin composite procedures. The Carry & Pack instrument performed well and lived up to its billing as nonstick.

Pros: Each side is the exact instrument I want when placing composite; one of the most nonstick instruments I have encountered; simplifies tray setup by combining two instruments

Cons: Only time will tell whether the nonstick properties will hold up over hundreds of sterilization cycles.

Final thoughts: I like the Carry & Pack. As I said above, it combines two instruments I already use, so there wasn't much of a learning curve for me. As one of the most nonstick instruments I've used, it does exactly what Cosmedent says it does. Line-drive single!

Microcopy's Bite-Chek Articulation Film

Articulating paper isn't sexy. Just give me some forceps with some kind of articulating paper in them, and let me get on with my day. That's probably what you are thinking, and oftentimes, that's what I am thinking. But using the wrong articulating paper can be a problem, creating postop issues and visits that are headaches. In my opinion, general and restorative dentists need to have a few different articulating papers in their office - a thin paper (21 microns or less), a thick paper (200 microns), and a full-arch option for complex cases and dentures.

Microcopy's Bite-Chek is a really nice option for thin paper. At 19 microns, it's slightly thinner than Accu-Film II. Part of what sets Bite-Chek apart is that it has a built-in, sturdy paper handle that eliminates the need for forceps of any kind. One of my frustrations with articulating paper is that, sometimes, the paper separates from the forceps after a few cycles of tapping and grinding. While using Bite-Chek's articulation film consistently over a few weeks, I never had any issue with this. The film left easily readable marks in black on both wet and dry surfaces (although dry is probably better). At around 18 cents apiece, Bite-Chek is pricier than other articulating paper, presumably because of the built-in handle. The cost is about three times that of Accu-Film II.

Pros: No forceps-related frustration necessary; clear readable marks; double-sided; paper doesn't curl up

Cons: Pricier than other articulating papers; only comes in black

Final thoughts: I liked using Bite-Chek films. Having to adjust occlusion in my hygiene rooms frustrates me. Sometimes I need to do quick bite adjustments or equilibrations on patients during routine periodic hygiene exams. Every time I ask for articulating paper, it seems like my hygienists scramble around, looking for the forceps hidden somewhere in the depths of a drawer; then, they have to find the articulating paper hidden under 15 other things in the cabinet. I stocked my hygiene rooms with Bite-Chek films and advised my hygienists to give me one when needed. I think the hygiene room is a great place for Bite-Chek films, but I also keep a few in my restorative operatories for times when I don't have a full tray out but want to check or adjust occlusion. They are handy for situations in which articulating paper and forceps might not be readily available. Bite-Chek articulating paper is a hard single up the middle!

Joshua Austin, DDS, FAGD, graduated from the University of Texas Health Science Center Dental School in San Antonio. After associating for several years, he opened a solo general practice in a suburban area of San Antonio in October 2009. Dr. Austin is involved in all levels of organized dentistry and can be reached at [email protected].