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Anesthesia buffering: Onpharma’s Onset

Trish Walraven — Fri, 16 Jul 2010 02:03:07 +0000

After all the buzz in the past two years about a new type of carpule that also starts with an “O,” you may think you’ve seen this product before. In one sense it’s similar: it must be used in conjunction with your regular anesthetic instead of as an anesthesia alternative. What’s more exciting is that this just may change the way we prepare syringes for every single patient from now on.

Onset™ is the name of a new buffering agent created by Onpharma™ Inc. that will be available as soon as the final FDA review is complete. If you can answer yes to these questions, read on:

Do you want to eliminate the sting that can be caused by the acidity of local anesthetic?

Would you like to be able to give an injection and go to work immediately?

Are you interested in a product that will help you get your patients profoundly numb, even when infection is present?

What about tissue necrosis? Would you like to prevent it if possible?

The idea behind the pH buffering isn’t novel, but the patented device is. Onpharma™ has created a simple system that can be used with all anesthetics and also solves the problems of shelf life and proper dosing. Product previews aren’t yet available on the internet so all images and details will be withheld here at DentalBuzz until further notice (it’s so hard to hold a secret, though!).

If your curiosity is now piqued, make sure to click over to the Onpharma™ website and sign up so that the company can let you know when you can purchase Onset™.

Just don’t expect it to be rapid.

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8/8/10 Update: Here’s the sneak peak of the prototype; the buzz is that the dosing indicator will have further refinements before the product comes to market.

To juice or papoose is the question

Trish Walraven — Thu, 01 Jul 2010 18:07:33 +0000

No one likes the idea of seeing a child being restrained. Especially not at the dental office. But on the same hand, if a child is admitted to a hospital, has thousands of dollars spent to knock them out with potentially risky gas, and is in need of a procedure that takes only minutes to perform, which care is the right one?

Notorious press has given the papoose board a bad name. Granted, its utilization can be abused, especially as seen in the story that was profiled on ABC’s 20/20. General anesthesia isn’t without its opponents as well, especially when a child dies.

With that somber note hanging in the air, you may want to revisit David After Dentist and pick yourself up with a little sedation dentistry humor. Even if you don’t agree that his dad should have ever posted the video on YouTube, it’s still so freakin’ funny.

Children who can’t be cooperative still need a means of getting their dentistry done, so pedodontists must make choices that sometimes include the use of papoose boards or general anesthesia. For entertainment’s sake, let’s just call this polarizing dilemma by another name: Hugs vs. Drugs.

	Hugs	Drugs
Familiar name	Papoose board restraint	“Knocked out with the mask”
Kinder-sounding euphemism	Protective stabilization	Inhalation anesthesia
Risks	Creation of dental phobias Inadequate relaxation resulting in poor pain management Difficulty in treating a lengthy, complicated case	Aspiration May affect the developing brain (autism/ADHD) Death
Benefits	Can be used quickly and inexpensively without much training	Instantaneous and complete patient control
Perception	Brute force and inhumane treatment seen in Medicare clinics	Clean, modern care paid for by inscos and private payer

There have been accusations from both sides: allegations of “nest feathering” by morally outraged dental anesthesiologists, abuses of public funds to pay for unnecessary procedures, the ultimatums given that any child restraint is considered grounds for lawsuits, equating papoose boards with third-world dental care, or offering general anesthesia for simple extractions when a combination of restraint and other sedation would be less expensive and as effective.

As a dental professional, it is your responsibility to make well-informed choices about sedation and restraint methods. For instance, individuals with autism or cerebral palsy may find that restraints are not only necessary, but even welcomed when compared to the use of drugs that can do more harm than the good that the dentistry is trying to achieve. Restraints may not be a better choice for toddlers whose biggest problem is a helicopter parent or two who are freaked out about the psychological trauma of having an irreparable tooth pulled. If a parent freaks, most likely so will the child, so it may be your choice to pander to the whiny world of children who are more in charge than their parents. After all, it’s no big deal to go under GA for a five-minute ear tube procedure with the ENT, right? That’s expected.

No matter what you decide to do, as long as you’re doing it from a level of comfort with your ability, and most importantly, from a sense of compassion, you should be able to confidently make the call for each patient, no matter where it falls on this line.

But sometimes, you just want to throw up your hands and say “AHHHHH I QUIT!” because you don’t know how to manage a patient. That’s when it’s awesome to have someone in your contact list who you trust to make this call.

And then pass the buck to them, because referring out can be very, very gratifying at times.

STA, OraVerse, or GumEase (oh my)

Trish Walraven — Mon, 07 Jul 2008 07:00:08 +0000

For a moment, imagine that this is one of the forms your patients fill out at an initial visit:

Anesthesia Options

We understand that each person has unique concerns when it comes to pain management, and would like to give our patients the opportunity to explore all of the anesthetic techniques available in our modern practice. Please read the following paragraphs and make a checkmark next to the one that best describes and addresses your needs:

1. Please do not get a needle anywhere near me. You can numb my face with a sledgehammer, but you’d better not even let me see the tip of an etchant syringe or I’ll flip. Pain is preferable to an injection in my case. I will be willing to try electroshock treatment or even a couple of frozen teething rings wedged under my lips, but definitely no shots.

With your delicate situation, we have a dental TENS unit available. Two electrodes will be placed in opposite areas of your mouth. We will then run a current of electricity that will fry your noodles allow a fair amount of pain management. Your hand signals will help us control the frequency of the current. TENS feels very similar to sticking your finger in a light socket. Our other non-sharp alternative is called the GumEase, which is a frozen saline-filled ring that numbs the teeth at the roots. If you are not cold sensitive, cryoanesthesia is better than nothing. And it’s warmer than ice cream.

2. I am okay with injections, but I don’t want to feel anything. Ever.

I will do best with relaxation, especially if nitrous oxide sedation is part of the trip, and then you can very, very gently and slowly do what you must. When Dorothy got sight of Glenda’s wand, her ride somewhere over the rainbow was…over. Please use the Wand on me, but make sure that I never see it.

We’re not supposed to call it that anymore; the official name for this single tooth anesthesia method from Milestone Scientific is the STA System ™. Other dentists may momentarily zing you good with the Henke Sass Wolf Ligmaject when they are administering intraligamentary anesthesia, but you’ll find that the STA System is careful and precise. Additionally, the passage of time will seem like nothing as you float off into the happy clouds of laughing gas.

3. I like having my cheek shaked and pulled. It takes my mind off of the needle and back to the golden days of dentistry. Oh, to be a kid again.

Because of the inherent post-injection trauma associated with slapping a cheek around like a piece of wet ham, our preference instead is to snap on the VibraJect analgesic syringe clip. You’ll enjoy five times the wiggling in only a quarter of the space.

4. The dental visits had better not interfere with my day because I am a very busy person. Needles are fine, a little pain is okay too. Most importantly, my lip should not still feel like it’s on the floor, a la Bill Cosby, for more than an hour after the appointment. I would like something to make the numb feeling go away as fast as possible.

If you can wait until October, 2008 for your dental treatment, OraVerse™, a new anesthetic reversal agent, will be available from the Novalar pharmaceutical company. This additional injection has been shown to accelerate the return to normal sensation and function. It only works if your original anesthetic shot contained the vasoconstrictor epinephrine, but it can pull out the anesthetic stops in less than 90 minutes following the administration of OraVerse.

No matter which method you prefer, the best way to administer anesthesia is always with a caring touch.

So for all you dentists who mail out postcards to potential patients, please don’t advertise that you’re gentle if you’re not. With all the options available, painful dentistry is pretty much inexcusable.