Comfortably Numb

Dec. 1, 2012
Having happy patients who can say this is probably one of the top practice builders of all time.

By Paul Feuerstein, DMD

“My dentist gives me Novocain and I don’t even feel it.”

Having happy patients who can say this is probably one of the top practice builders of all time. With technology and pharmacology, we are now close to allaying this huge fear shared by many patients. From a personal perspective, let me share some of the findings in this arena. While not an expert in this technical area, I know enough about it in terms of taking the best care of patients.

Topical anesthetics have both advocates and naysayers. There are some wonderful new products that deliver a little better than earlier ones. If used for the recommended time and amount, they seem to have an impact — even if it’s purely psychological. Patients who are told not to touch the anesthetic with their tongue inevitably do, and at least on that level, they feel some effects.

Needles are another story. There is the perception that 30-gauge needles are less painful. This has not only been disproven time after time by clinicians such as Stan Malamed and Ken Reed, but there is also a danger in using the 30-gauge, especially with mandibular blocks.

You may have to prove it to yourself, but a 27-gauge, or better yet, a 25-gauge is the way to go, not only for safety but also for accurate aspiration. I will be glad to supply references. By the way, Malamed just released his sixth edition of “Local Anesthesia,” which is available with an instructional DVD. Information is at

During the injection, many of us shake the lip, pull the tissue taut, and use different distraction techniques. One idea is to use electronic vibration of the syringe or the tissues with the VibraJect or DentalVibe, two similar but different products.

The VibraJect attaches to the barrel of the syringe and sends a constant vibration to the barrel, the needle, and the clinician’s fingers. As the clinician’s hand and barrel touch the lip and mucosa, the patient is distracted by the vibration and slight noise. In addition, the needle is vibrating.

The DentalVibe is actually an intermittent vibrating system using a soft retractor that is placed just prior to the injection at the site, and it vibrates the whole area quite a bit while the practitioner advances the needle. This device has been quite popular with practitioners and has now been seen in the public media. The website contains clinical, as well as marketing advice.

Both of these work on the Gates theory of distraction, overloading the brain with more stimulus than it can handle, thus overshadowing the injection.

A totally different approach is Milestone’s STA system. This is an offshoot of The Wand, which had mixed reviews. Using some clever technology and feedback to the unit, one can deliver single-tooth anesthesia (STA) quite predictably.

Due to the slow, controlled delivery of local anesthetic, it can be used for all injections. This includes the PSA. The days of bilateral lower restorations without bilateral blocks are here. The rapid onset allows the treatment to be started quickly, and the patient can leave without a numb tongue, or in many cases, lip.

Speaking of rapid onset, this is the name of a relatively new product from Onpharma. By buffering carpules of lidocaine with bicarbonate, Onset raises the pH of the anesthetic to seven, and the acidic “burn” is gone.

The onset of the anesthesia is rapid, and you can start working in two to four minutes. (If you miss a block, which we all do, you know it right away. This saves a lot of time.)

Onset uses a clever, seemingly foolproof device that allows you to buffer carpules as you load them. Literature, how-to videos, and more are at

Finally, the opposite of Onset is available from Septodont with Oraverse. Although not “instant off” injecting, after treatment with Oraverse reduces the time patients are anesthetized by more than half. For more information, visit

Paul Feuerstein, DMD, installed one of dentistry’s first computers in 1978. For more than 20 years, he has taught technology courses. A general practitioner in North Billerica, Mass., since 1973, Dr. Feuerstein maintains a website (, and can be reached at [email protected].

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