Chairside Magazine Volume 2, Issue 1 - Glidewell Dental Labs

Question 1: What’s the most exciting thing to happen in local
anesthesia in the last 5-10 years?
Alan Budenz: There’s been a lot certainly with the advent
of the CompuDent Wand and the Dentsply Comfort Control
syringe. Both are computer controlled devices and more than
ten years old, but still relatively new to the field. I have both
of these devices and they don’t necessarily allow me to do
anything I couldn’t do with a traditional syringe, but what
they do is make the process less taxing, and they let me
administer the anesthetic more consistently, time
after time.
The more slowly it gives the injection
-- particularly if it’s an anes-
t h e t i c
with a vasoconstrictor, because
those are more
acidic and would tend to cause the patient a little more
burning sensation -- and with consistent control, the patient
feels virtually nothing. It’s all about making it more comfortable
for the patient, and it doesn’t hurt that it makes it more
comfortable for yourself as well.
Another exciting development recently is the VibraJect. At first
I doubted it was worth $230 for a little vibrator so I don’t have
to shake the cheek anymore to distract the patient. I thought
there had to be more to it, and I discovered that it’s actually
a very clever device. It gives you a very low level of stimulation
going down to the tip of the needle, and if the needle
is in close proximity to the nerve tissue it will stimulate that
nerve at a low level, which will open up more of the sodium
channels. And it’s the sodium channel opening that allows
the anesthetic to flow in and bind to the receptor sites in the
sodium channels.
Q2: So it’s really more than a comfort and distraction device, it
actually improves the quality of the injection?
AB: Yeah, it’s really not a distraction device at all. It’s not
vibrating where it’s going to distract the patient from the
penetration, particularly. Really, what it is all about is getting
that stimulation to open up the sodium channels. It’ll tend to
give you a more profound anesthesia and potentially less of
that problem where you start to drill on a mandibular molar
and the patient feels it even though when you check with an
explorer, everything appears to be numb. But the patient still
feels it when you root plane or drill because you don’t have
enough of those sodium channels blocked. This device will
reduce the incidence of that. I bring this up not because it’s
the greatest thing in anesthetics, but because it’s a very simple
device with a very brilliant idea behind it – and it works!
But bottom line, the best thing that’s happened in local anesthesia
in the last 5–10 years is Septocaine coming on the U.S.
market in 2000. It’s a really good anesthetic but there are
drawbacks to it. The simple fact that there’s so much controversy
about it has stimulated people to ask so many more
questions about anesthetics and how they give them, that
overall, I think it’s beneficial because people aren’t just taking
everything for granted anymore. Typically people would say “I
use lidocaine for everything except when I can’t use epi, then
I use mepivocaine plain and for long-acting, I use Marcaine.”
It’s made people think about what’s out there, what’s appropriate
to use, what’s safe to use and what technique should
be used with it.
Q3: As a 4% anesthetic, do you avoid giving blocks with it? There’s
some literature about a possible increase rate of parasthesia with
Septocaine.
AB: All of the reports I’ve seen are anecdotal. There’s no real
scientific study that shows that absolutely the 4% anesthetics
are the cause of paresthesia, but there’s enough anecdotal
material out there to make me think there is a greater risk of
parasthesia using the 4% solutions, both articaine and prilocaine.
I’m not hesitant to use Septocaine for blocks, when it’s
indicated, except for the inferior alveolar block. I’m extremely
hesitant about Septocaine for that one because we’ve seen
numerous reports that the greatest incidence of paresthesia is
with that injection technique and the 4% anesthetics.
But personally, I don’t choose to give inferior alveolar nerve
blocks the conventional way. I prefer the Gow-Gates technique,
which from all the evidence I can gather is a safer injection
with any solution. I use it on a regular basis.
Q4: Say someone’s been practicing for 15–20 years and has been
giving lower blocks and knows there’s something better but is just
a little nervous about shooting that high with the Gow-Gates versus
the typical target point, what do you think is the best way for a
GP to learn how to do the Gow-Gates technique comfortably?
AB: The ideal way is to go to a hands-on course. Mostly you’ll
find this in a dental school setting, occasionally at a larger
meeting, but that’s pretty rare. Another alterative is to find a
practitioner in your area who knows the technique. A lot of
oral surgeons are familiar with the technique. More recent
dental school grads are more likely to have been taught the
technique. Watch them do it and have them observe you
doing it to give you feedback as you do it. A “study club” setting
like that is the ideal way to do it outside of a dental school
course/CE course. Í
20 Questions with Dr. Alan Budenz