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It’s not OK for your dental practice to use free cloud-based communication

June 10, 2021 By DentalBuzz Staff 2 Comments

It was nice – the way that the HIPAA police looked the other way as we all figured out how to take care of each other during the worst of 2020 – but now that we’re over that hump, emergency usage is no longer an acceptable excuse for a security breach or a privacy violation.

Before you begin defending the use of cloud-based messaging in your office by explaining that you never share protected health information (PHI) there, or that you have other security measures in place to protect you from malware, or hope that the regulations only apply to large organizations and not small practices, know that there is one rule that is hard and fast when it comes to using communication tools in healthcare:

Only Paid Versions are HIPAA compliant.

This is because free versions do not include something called a Business Associate Agreement (BAA). A signed BAA is required in order for cloud-based systems to be HIPAA compliant. It’s not as though you’ll ever need to exercise an audit, but if one becomes necessary, this is the safeguard in place to allow you to have the ability to prove that a program such as Slack or Microsoft Teams was not the source of the privacy breach. Here’s the thing: even if you’ve never shared sensitive patient information on any platform, it doesn’t matter if you can’t prove it!

And that right there is the crux of the matter. While you may think this threat is a flaming fear spear, remember, data has value, and there are those out there who seek it out in order to further enrich themselves. We all have an obligation to follow the recommendations set for us professionally. After all, you’re a patient, too. Maybe not always where you work, but if you have a body, somewhere you’re a patient in an office’s system, and as such, you’d like to know that the practices you visit are managing all of their privacy matters correctly. If they’re no being careful with something simple like communications, it makes you wonder where else they’re making mistakes.

While this is not a comprehensive list, these are the most common communication platforms that dental practices (and healthcare practices in general!) may encounter when they’re looking for a way to collaborate with their team members, along with the current pricing that users should expect to pay in order to safely utilize the software anywhere in their business.

As you can see, it starts to get expensive, very quickly, if you’re dead set on using one of these platforms. They don’t even do a good job of getting the right person’s attention at the right time, especially if people in the office don’t just sit at one computer all day. You can get so much more for your money once you accept that healthcare businesses must have a paid subscription to use cloud-based communication. It’s just a matter of doing a simple Google search to find many other solutions more tailored to dentistry, at a lower cost per year, per user, per month, whatever. Making do with the programs above means that you end up paying for things that most team members aren’t even using, like Microsoft Word, or screen sharing, or video conferencing.

In case you’re still confused, here’s the concise answer for each of the free versions of these platforms.

Is Slack HIPAA compliant? No.
Is Microsoft Teams HIPAA compliant? No.
Is WhatsApp HIPAA compliant? Never.
Is Skype HIPAA compliant? No.
Is Google Chat HIPAA compliant? No.
Is Zoom HIPAA compliant? No.

And for final clarification, you can become HIPAA compliant in the use of five out of six of these applications, but only once you’ve paid a subscription fee per user, disengaged any non-compliant third party integrations (so many rules!) and received a signed business associate agreement.

Otherwise, it’s time to look elsewhere.

Resources:

HHS.gov Business Associate Agreements: https://www.hhs.gov/hipaa/for-professionals/covered-entities/sample-business-associate-agreement-provisions/index.html

Slack Enterprise Grid for Healthcare (otherwise NOT HIPAA compliant): https://slack.com/resources/why-use-slack/hipaa-compliant-collaboration-with-slack and https://slack.com/help/articles/360020685594-Slack-and-HIPAA

Microsoft Teams for Healthcare: https://www.microsoft.com/en-us/microsoft-365/compare-microsoft-365-enterprise-plans

Zoom for Healthcare: https://zoom.us/healthcare

Lead Aprons feel so good! Here’s why.

October 30, 2019 By DentalBuzz Staff 5 Comments

Ever since you were a kid, you’ve known this: there’s a comfort that settles through you right before getting dental x-rays. You notice when the heavy shield gets draped over your shoulders and tummy that it’s a bit easier to relax, to open your mouth and let the dental professional twist things in your mouth at weird angles.

That comfort is called Deep Touch Pressure. It’s what swaddled babies feel with a tightly-wrapped blanket, what dogs experience when they wear a Thundershirt, and what up until recently has been known as a soothing technique primarily for kids and adults who are on the autism spectrum.

When Deep Touch Pressure is applied over a wide area, it switches the body from running its sympathetic nervous system to its parasympathetic nervous system. Deep touch pressure gives a sense that it’s okay to leave the “flight or fight” mode and settle into a “rest and digest” mode instead.

The sympathetic nervous system engages when you anticipate anything that is challenging, scary, or painful, while the parasympathetic nervous system is responsible for releasing feel-good endorphins, relaxing muscles, and creating a sense of peace and calm.

To review, then, this person has their Sympathetic Nervous System fully engaged:

Person holding mouth as dentist and assistant sneak up behind.

Next, look at this little puppy enjoying its Parasympathetic Nervous System response:

No rhetorical questions here. You know you could just be the puppy forever.

There are stories like this one from Dr. Spindel’s blog that tell of patients wanting to keep the lead vest on for their entire appointment as a sort of security blanket. Only unlike her, once the x-rays are taken, most of us are nakedly shocked back into anxious uncertainty with the removal of the deep touch pressure feeling.

Um, hello?

You know exactly where this is going, right?

More than just a heavy Snuggie.

Pretty much every retail and online shop sells Deep Touch Pressure products now. This therapy is found in the form of weighted blankets which are much more comfortable and heavier than lead shields so yay!

If you’re a patient who gets a little anxious going to the dentist and you already have a weighted blanket that you shelled out $200 for when they first became available, try bringing the blanket to your next appointment to see if it helps.

And for those dental professionals reading this, you might consider getting a few weighted blankets for your office. You can find them as low as $50 each but current pricing hovers around $75 these days. Here’s an inexpensive fifteen-pounder seen in the local warehouse store this weekend:

Need something a little more rugged? These weighted blankets from DentaCalm are available in different sizes, can be wiped clean, and come in two colors:

Dental fear is real.

Even people who have been going to the dentist forever get nervous sometimes, like it wells up from some organic “gonna get you” place in our primitive perimeter warning system. Deep touch pressure helps to inhibit dental anxiety. Except for the anxiety within the dentists when slinking into a dental chair to get their teeth cleaned when there’s an opening in the schedule. Their stress comes from the fear that they’re about to be exposed as a fraud by their hygienist if the dentist’s gums bleed even one little speck during their preventive care. Sorry, the weighted blanket is simply not going to make up for not flossing.

Feeling calm is better.

Instead of shaming dentists for their questionable home care, then, let’s all get the word out that weighted blankets are more than a fad, or that they’re used as merely an excuse to stay in bed longer in the morning.

Worried about the stigma or mood-altering effects of using laughing gas (nitrous oxide)? Weighted blankets create a similar sense of well-being without masks, drugs, or that loopy feeling. Many practices have already discovered the benefits of weighted blankets, and feature this amenity on their websites as one of the ways they make dental visits easier.

Please share this link with your dental professionals, your patients, and your friends. And as always, DentalBuzz does not use affiliate links or accept ad payments, so feel free to browse the resources list and share your experiences with weighted blankets (or any good deals you discover!) in the comments below.

Resources and further reading:

Can I please wear the heavy vest: https://lspindelnycdds.blogspot.com/2019/05/can-i-please-wear-heavy-vest.html

The Allure of the Weighted Blanket: https://www.brainfacts.org/Thinking-Sensing-and-Behaving/Sleep/2018/The-Allure-of-the-Weighted-Blanket-112918

Penn Medicine: More than just a fad: https://www.pennmedicine.org/updates/blogs/health-and-wellness/2019/february/weighted-blankets

HippoHug: https://hippohug.ca/2018/12/12/anxious-at-the-dentists-office-try-a-weighted-blanket/

TruHugs Research Blog: https://blog.truhugs.com/deep-pressure-stimulation-used-during-various-dental-procedures-to-curb-anxiety-symptoms/

DentaCalm: https:/dentacalm.com

Sommerfly Wipe-Clean Relaxer: https://www.sommerfly.com/collections/wipe-clean-collection/

What is this $&!% on my toothbrush?

September 4, 2019 By Trish Walraven 2 Comments

This morning I threw my toothbrush into the toilet. That’s where it belongs, apparently, since I can’t seem to do the right thing to keep germs off of it.

See, a few years ago there was a big news story about the aerosols that are created with every toilet flush. I call this phenomenon “Fecal Fallout.” Let me explain: if a toothbrush is stored in the open air near a toilet, the debris from the bowl can be carried into the air and then sprinkled down onto anything within a six foot radius in a plume of doom. As a result, we may find ourselves brushing with the e.coli germs from feces if we’re not keeping our toothbrushes covered.

So if we’ve been keeping them covered, that’s not good either? Covering causes yet ANOTHER PROBLEM:

The growth that you see in this and the following image was accelerated by a few days, but this is really what happens! If we close in the moisture on our toothbrushes, we might as well invite a whole slimy rainforest to grow in there. It’s not just our toothbrushes that are being over-helicoptered. Mouthguards also tend to grow things on them if left unattended:

Nope. No way. I welcome the Demons Of TMJ Disturbance to visit me and make me dream about my teeth falling out all night. Sad that I’d rather grind myself down to gummy nubs than to have to clean that nightguard off and sleep in it again.

When someone tries to gross us out with a problem, there’s a reason behind it, because there must be an answer, a solution to the horrible thing that we want to prevent. What I like is that this solution happens to be quite economical and user-friendly.

No. Not that economical. You’re going back to the whole idea of “things that should be in the toilet.” But at least you’re thinking dry.

The Toothbrush Shield

As a dental hygienist, at times I’ve been merely satisfied with knowing my patients are using a toothbrush, but lately I’ve decided to acknowledge that they can be vectors for pathogens to invade our bodies if not managed properly. What’s excessive though, is how there are all these UV blue-light sanitizers on the market and other expensive gadgets you really don’t need to keep your toothbrush healthy. Along that path, I discovered the one thing that actually makes a lot of sense:

These covers both wick away moisture from your toothbrush and provide a physical barrier between your bristles and anything you don’t want them to touch, like your family’s other toothbrushes, bathroom cleaning chemicals, or stray hairs. I will never put my toothbrush in another plastic case now that I know about Toothbrush Shields.

This product is so obvious that I’m surprised I’m just now finding out about it. I want to get the word out why wicking sleeves should be as universal to our lives as something like plastic baggies. This particular wicking sleeve is designed for your toothbrush, and here are the reasons why I am endorsing the Toothbrush Shield:

Affordable. A pack of 10 Toothbrush Shields retails around $4.00 at the time of this writing, and each one is effective for up to 7 days.
Simple to use. Slip the cover on right after brushing, then your toothbrush can go anywhere! Your bathroom counter, luggage, purse, kids’ backpacks for quick sleepovers. No fumbling for a way to protect toothbrushes from questionable environments.
Hospital-grade. The lightweight but quality material feels almost identical to the larger sleeves I’ve used to keep saliva and blood off of patient headrests in the dental practice.
Made in the USA. Not only that, the company is woman-owned.

Part of that last bullet point is how I found out about this product. In the United States, 97% of dental hygienists are women. Other than kindergarten teachers (see the 2018 Labor Statistics here), the rest of the professions aren’t even close to having this extreme gender skew. So a short time ago I was at a conference exclusively for the dental hygiene profession – for all these women, essentially – where I was given a few samples of the Toothbrush Shield. Mind you, I was carrying a trade show bag heavy with familiar toothpastes, flossers, mouthwashes, and brushes from all the dental hygiene exhibitors. But this one product stood out, especially since I’d never seen anything like it before.

That’s where the “woman-owned” part comes in. While the person who invented the Toothbrush Shield is not a dental hygienist by profession, she has the insight to realize where her biggest advocates are poised, and most importantly, who they are, and what drives them.

I’d like to introduce her to you. She is Susan Klinsport, an entrepreneur with a background ripe for solving the problem of germs and wet toothbrushes that she encountered in her personal life. Her experience working with engineering companies gained her the access to materials testing, scientific consultations, and manufacturing, and has resulted not only in the Toothbrush Shield, but she has also designed the larger version as a Mouthguard Shield.

I didn’t snag any of these Mouthguard Shields at the conference, so I asked for some images from Susan herself. I know, right? She’s like totally my best friend now. That’s because after the show was over, I was like “Hey,” and she was like “What” and I emailed her to ask about her story and everything. And she was really cool about it so here we are, on DentalBuzz, getting the word out about a simple, effective product that will protect yours and your patients’ toothbrushes by keeping them covered every day, and that takes the place of plastic cases and rolled up toilet paper when traveling.

So where can you get Toothbrush Shields? Probably just down the street! You’ll find them in stock at CVS, Walmart, and Rite-Aid. Or if they’re not on your local pharmacy shelves, you can purchase online from many retailers, including the IntellidentProducts.com website that will take you to the Walgreens retail page where a box is on sale for $2.28 currently. Good deal! Even if they’re privately labeled, they are still the same product, as you can see below:

Critical Cleanliness

Patients undergoing cancer therapy are especially vulnerable to secondary infections, so oncology clinics and individuals are able to purchase Toothbrush Shields in bulk here on the website at SideEffectsSupport.com, the world’s leading resource for minimizing oral effects of cancer treatment. The shields are also included as part of the Oral Cancer Rescue Kit as pioneered by Jill Meyer-Lippert, RDH of SideEffectsSupport.com and Jennifer Brown, RDH, BS of CARTI Cancer Center in Arkansas.

Aetna has gotten the message as well. The insurance company is currently including the Toothbrush Shields in their oral hygiene care packages as part of their Rush to Brush program, thanks to the efforts of Susan Klinsport and Dian Baker, PhD RN. This program is designed to decrease patients’ risks of acquiring infections during hospital stays.

Final words

There is also a great news story featuring Susan and the Toothbrush Shield that I wanted to share here:

I’m now using the Toothbrush Shields over my manual toothbrush as well as my electric ones. Why so many brushes? It’s because I’m currently going back and forth, comparing my previously shelved Philips Sonicare with the new Braun OralB that I received for free from the same conference, but that’s a story for a future article. All have been easier to remember to re-cover, and I’m looking forward to traveling with them now instead of closed-in plastic caps that I have to keep up with.

As for the toothbrush I threw in the toilet? It’s got a new job: scrubbing the dark grime out of the washing machine.

Trish Walraven RDH, BS has been curating DentalBuzz.com since 2008 as a casual place for dental professionals and their patients to explore dentistry in ways that make their lives better. This does not include firm toothbrushes, which is probably an equal factor for tossing that one that ended up in her laundry room.

Disclosure and copyright: Other than the samples, I did not receive any other form of compensation for this article. Feel free to share this information on your dental blogs, social media pages, or any habitats where patients and colleagues tend to dwell.

Resources and further reading:

https://www.allure.com/story/toothrbush-germs-bacteria

https://www.usatoday.com/story/news/nation-now/2017/04/06/youre-probably-brushing-your-teeth-fecal-matter/99785026/

https://www.onhealth.com/content/1/toothbrush_germs_facts

https://www.guardiandirect.com/resources/articles/shocking-facts-about-your-toothbrush

Amabrush (and all other mouthpiece toothbrushes) do NOT clean your teeth in ten seconds

June 27, 2017 By DentalBuzz Staff 22 Comments

Update 10/22/2021: Don’t buy mouthpiece toothbrushes. Not only do they not work, most of them don’t even turn on. It’s an easy way to get people to send money for scammy things. Need more proof? Go to Electric Teeth at the link below – they have much more current information than you’ll find here.

Mouthpiece Toothbrushes: Think Twice Before You Buy

IMPORTANT UPDATE 6/5/19: The Amabrush is extinct. This article is useless. Scroll to the bottom to learn why.

What do you get when you start with a silicone sports mouthguard, embed it with hundreds of tiny bristles, and magnetize a rechargable toothpaste ball that vibrates and cleans all of your teeth at the same time? DentalBuzz recently sat down with the inventor of the new Amabrush to find out where this thing came from, where it’s going, and how to get one.

____

DentalBuzz: Hi Marvin. Thanks for joining us here at DentalBuzz. What’s the story? Tell us about yourself and your company, how you got into the business of toothbrushing, where the name Amabrush came from.

Marvin Musialek: Thank you for having me! Well, my name is Marvin and I’m the founder of Amabrush, a completely redefined toothbrush. I came up with this idea 6 years ago. I brush my teeth twice a day, not because I want to, but because I have to, and this is every dentist’s advice.

Six years ago I stood in front of the bathroom-mirror as usual, and asked myself, “Why are we on the edge of self-driving cars, but we all still have to stand in front of the mirror and put a stick with nylon-bristles into our mouth, in order to clean our teeth?” Since then I thought about an autonomous cleaning-robot-thingy everyday. Three years later there was still no product like this on the market, and I simply decided to “do it on my own.” I did a lot of research and put a strong team together from many disciplines: dentists, biomedical engineers, physics engineers, electronic engineers and even a psychologist. We had to clarify even the simplest questions with a scientific approach. Why are we brushing our teeth? How should we do it correctly? How much toothpaste? What angle should the bristles have? And so forth. We have been developing Amabrush for the last 3 years and have also received grants from the Austrian Government and the European Commission. With our own money and these grants we were able to finance the cost-intensive development of numerous different prototypes, test-units, pre-production-devices and expert-consultations. Our redefined toothbrush should be seen as a stable and good friend, who takes over an annoying and time-intensive task (toothbrushing) for everyone. So we decided to call it Amabrush, so people who ask “what’s that?” will get their answer: “I’m a brush.”

DB: Since it doesn’t look like a typical brush, that’s perfect! And endearing. Kind of like the name talks back to you when you say it.

Now, you’re in Austria but also have offices in San Francisco? Before everyone in the United States gets addicted to using your brush, we want to make sure that replacements will be easily available. What percentage of your sales do you see coming to the US once you’re in the retail market?

MM: Yes that’s right. We estimate that 50% of our sales will take place in Europe, especially in German-speaking Europe (Germany/Austria/Switzerland) and the other 50% will take place in North America, especially in the United States. This coincides with our research and as well with our current subscribers, who are also equally distributed between these two regions. Because of that we want to produce Amabrush in these two different regions in the long run.

DB: You have subscribers already? For a product that they can’t even get yet? Okay, so we haven’t even talked about the toothbrush. You’re estimating that its retail price is going to be around $200. While you can’t put a price on good dental health, there have been regular electric toothbrushes in this range for years that have proven not to work any better than the $60 version of the same brand (yes, we’re talking about you, Sonicare). Explain what it is about the Amabrush that puts it far ahead of its competition, and why it is a value at $200.

MM: Yes indeed. We already got 7000 subscribers within a month, which is really, really great. That proves to us that our community is as excited as we are about a toothbrush that takes over the task of toothbrushing. There are many low-priced electric toothbrushes available, but also many high-priced ones. The cost of Amabrush is more to the mid- and high-range, but the brush itself is really high-end. We had to develop everything from scratch, like the micro-pump that foams the toothpaste, the specially formulated toothpaste itself, and the mouthpiece, which was one of the most complicated parts. Not only because we use an uncommon material (anti-bacterial silicone) with a specific toughness, but also because of the integrated, carefully arranged bristles and the micro-channels that deliver the toothpaste directly to the customers’ teeth.

DB: This has the potential to change everything we think we have to do to take care of our teeth. A silicone mouthpiece instead of a handle that you hold as you move a small brush around your mouth, brushing every tooth at the same time, Bass method bristle alignment, self-contained toothpaste, sonic vibrations. If this brush is capable of consistent and thorough plaque removal, then you may have just created the holy grail of preventive dentistry. When and where will customers get the Amabrush once they’re available to the general public?

MM: We have to explain this completely new concept of toothbrushing to people a lot. Amabrush is currently “online-only.” The simplest way for people to inform themselves about Amabrush is over the internet with our online-shop and our website. But in the long run we definitely want to bring Amabrush into grocery stores and drug stores, because the majority of people still buy personal care products “offline.”

DB: Do you see an application for people whose hand dexterity is limited?

MM: Amabrush is definitely also for people with hand disabilities. We developed Amabrush on purpose as a hands-free device, not only that it is as convenient and automatically as possible, but also that there is no barrier in order to use it.

DB: What does it feel like to use?

MM: It feels like if someone else brushes your teeth with a soft bristled toothbrush paired with the feeling of a gingival massage.

DB: So it’s sort of like having your teeth cleaned by a professional? We would imagine that would be pretty effective. What kinds of plaque index scores are you getting; in other words, how well does the Amabrush actually clean compared to manual or other electric toothbrushes?

MM: That’s true, it does a pretty good job at cleaning your teeth! We’ve had plaque index scores calculated by an independent clinical institution and have been pleased with the results. What’s worth knowing is that Amabrush is not necessarily better than a regular manual or electric toothbrush, because common toothbrushes work good enough if they are used properly. The thing is, Amabrush is way more convenient. You can do so many things wrong with a regular toothbrush, as you have to be highly concentrated for at least 120 seconds each time you brush your teeth. And while brushing, you should use different methods like the Bass method paired with the red-white technique. This is not only time-consuming, but also annoying for most people. Because of this, people usually tend to do something else while brushing their teeth. Furthermore, they put too much pressure on the toothbrush which can damage their gum. What’s more, most of the people don’t brush their teeth long enough. Amabrush cleans your teeth the same every time, with the right technique, and does not depend on your concentration.

DB: What it sounds like you’re saying is that the problem with electric toothbrushes is that manual ones are just that – they have to be moved around with your hand, so even if they’re the best at what they do, they’ll still miss areas because the human being attached to the hand doesn’t apply the brush properly. The Amabrush provides hands-free brushing at a fraction of the time? Very novel.

Back to your subscribers, then. How can subscribers order the Amabrush? How can I get one as a consumer? What do I need to do?

MM: Interested customers can subscribe to our newsletter right now on our website. We created a landing-page that explains all relevant information and details about Amabrush and the upcoming Kickstarter campaign. Speaking of which, this will be the first opportunity for our customers to get Amabrush. We will start our crowdfunding-campaign on Kickstarter next week (end of June 2017). Customers have the ability to support our project, and as a return, get Amabrush at a strongly discounted price ($69 instead of $199)!

Regarding your question what the customer needs to do: simply sign up for our newsletter on our website (www.amabrush.com). We will send a reminder with the exact date of our Kickstarter-campaign to all subscribers. When the campaign is live, simply choose a package that suits best for you. All of them are strongly discounted, as this is our way to say “Thank you” to all of our supporters and the community!

DB: Dentists and dental hygienists are particularly interested in finding new ways like yours to pass on to our patients that help them keep their mouths healthy. Do you have anything more you’d like to say to us?

MM: Our pre-production units are already in the making, in order to be shipped around the globe to various dentists. We highly appreciate feedback and input from every professional expert in order to make Amabrush as perfect as it can be. We are really looking forward to the support of our community!

DB: Thanks again, Marvin for sharing your story with us, and we sincerely hope that you get all the attention that this Kickstarter campaign deserves.

MM: We hope that too. Thank you very much for the interview and the great time!

UPDATE 6/28/2017: Amabrush announced today that the launch date for their Kickstarter campaign is next week – July 5, 2017.

UPDATE 7/5/2017: The campaign is now live, with the Amabrush expected to begin shipments in December 2017. This video shows close-up vibrations of the prototype. We imagine that the production version will be even more refined.

UPDATE 8/31/2018: It’s taken quite a bit longer than expected, but today Amabrush announced that they will start to ship brushes very soon. The best part? Their testing suggests that all the hard work means that this is a true 10-second toothbrush and not a gimmick. Here’s what came in the mail:

Many patients took part in our dental studies, which took place on 3 different dates with a minimum interval of 24 hours. The tests were performed and evaluated by independent dentists. Amabrush was tested simultaneously with two different institutions and two different sets of patients.

The TQHPI (Turesky modified Quigley Hein Plaque Index) which we used as the method determines how much plaque was present on the teeth – the lower the value, the less plaque on the teeth.

Test procedure

1.) 24 hours before the test, participants were not allowed to brush their teeth. For the plaque test, the patients chewed plaque disclosing tablets so that the dentist could then determine the initial plaque values (tablet is used to make plaque visible).

2.) Patients had to brush their teeth with a regular manual toothbrush for at least two minutes. The remaining plaque values were determined afterwards.

3.) The same process was repeated for the second appointment one week later, but this time with using the Amabrush instead of the manual toothbrush. Teeth were cleaned for just 10 seconds and the dentist determined the plaque values again.

Results

The plaque index decreased statistically significant and there was no statistically significant difference between Amabrush (with 10 seconds brushing time) compared to a regular manual toothbrush (with roughly 3 minutes brushing time on average).

These results make us truly proud and show us that hard work, clever engineering and patience pays off for all of us. We hope that you also like those results, which we would have never reached without your support, help, and feedback!

Want to know when we post a detailed review of the Amabrush once it’s available and we’ve had a chance to chomp on it? Be sure to subscribe to DentalBuzz by adding your email address and you’ll automatically get notifications each time we add a new article.

FINAL UPDATE 6/5/19: Nevermind. Amabrush is officially done. No surprise there, unfortunately, because they’ve been propping up their company with delays for the last two years. Here at DentalBuzz, we never even received our super early bird Amabrush. What’s worse though, is our role in this for convincing our readers to invest in the Kickstarter campaign. At this point, we feel sort of like everyone who invested in Theranos, with their fake blood testing. Great ideas still depend on that which is physically possible, but Marvin still doesn’t seem to get this! You can read the litany of excuses here from Amabrush: https://www.amabrush.at/blogs/news/important-information-regarding-amabrush-company. Bottom line? We’re sorry, and you still have to brush your teeth for two minutes.

Best ways to get numb at the dentist

February 3, 2017 By DentalBuzz Staff 8 Comments

Why “Painless Dentistry” Doesn’t Have to Be An Oxymoron

Dentistry has got a bad reputation!

“No offense doc but I hate dentists.” …said everyone who ever came to see me.
“I was in Vietnam and I’d rather be shot at than come see you.” …said one of my veteran patients.
“My last dentist put his foot on my chest and pulled a tooth out while I wasn’t numb!” …said most people who ever had a tooth extracted.

Why so much hate? In my personal experience, most of the people who hate dentists have had really bad experiences in the past. They’ve got legitimate reasons to be fearful. As a profession, we dentists, especially in years past, haven’t done a great job with pain and anxiety management. Uncontrolled pain and anxiety creates lifelong dental phobics.

So here’s the secret… While dentistry isn’t ever something that will be fun, it doesn’t have to be the traumatic experience that many people expect. Dentists have a huge number of different tools at their disposal to make dentistry as painless and easy as possible. For the most part, all it takes is a willingness to listen to a patient’s fears and address them with whatever tool is most appropriate.

What?!? We have more options than just “Open wide”, “It’ll only pinch a bit” and “Suck it up”? Yes! I’m going to cover all your options here, from techniques that have been around forever, to the latest advances in painless dentistry.

If you’re a dentist who thinks all dental phobics are over-dramatic and that the previous statements are appropriate, this article may not be for you. You should probably go hang up your drill and find a job that doesn’t require contact with the public. I hear dental insurance companies are always looking for cranky dentists to deny claims. Everyone else, let’s get working on ways to make dentistry better for our patients!

Old School

Let’s start with some options that have been around for a long time. Just because these options are technically “old school” doesn’t mean they shouldn’t be used. It’s my opinion they should be used far more often than they currently are today.

Laughing Gas / Nitrous Oxide
Laughing gas is almost synonymous with going to the dentist but somehow many dentists don’t offer this at all. I’ve heard from many that they find it to be too much hassle. I’ve had the exact opposite experience in my practice. The benefits of laughing gas include decreased anxiety, increased pain tolerance, quick acting effects, and an almost perfect safety profile compared to any other type of sedation. The downsides… ummm…. occasionally people don’t like how it feels and we have to stop using it. So why aren’t more dentists using laughing gas? Beats me. It is the absolute easiest and quickest way to make a dental appointment easier. I often give it away free because it makes the appointment easier for me and the patient. Easier for me + Easier for the patient = A good day!

Sedation
Sedation can range from taking an oral medication before a dental appointment (with or without nitrous oxide) all the way up to IV sedation or general anesthesia. Of all the techniques we go over here, this is by far the most challenging to get trained in and implement due to safety and liability issues with sedation. It is also the most effective option for treating patients who are truly terrified of any type of dental experience. If you’re able to offer this safely and effectively, you’ll really set yourself apart. One option for sedation if you don’t want to go through training is to look for a traveling anesthesiologist who comes to your office and does sedation while you do the dental work. This is a fantastic option where you can focus exclusively on treating your patient instead of worrying about anesthesia at the same time. There are more and more anesthesiologists who offer services like this today. If you’re especially lucky, you might even find a dental anesthesiologist who understands the special challenges that come along with sedating a patient for dental work (dental work is essentially an anesthesiologists worst nightmare).

Air Abrasion
Air abrasion uses a high pressured jet of abrasive particles to conservatively remove smaller to medium sized decay in teeth. As it doesn’t generate any vibrations, pressure, or heat most people don’t need any shots of anesthetic (yay!) to have the procedure done. Many people think air abrasion is a new technique in dentistry. It actually has been around over 60 years! Early on, it wasn’t something that was typically used because the bonding materials needed to do minimally invasive dentistry weren’t invented yet. Now that we’ve got all these great bonding techniques, somehow air abrasion still isn’t routinely used. Very few dentists own an air abrasion device and even less use it routinely. It can be especially useful on children as it is far less “scary” than a dental drill and doesn’t require a shot! Kids who have good dental experiences are far less likely to become dental phobics in the future.

This article by Dr. Gordon Christensen goes into a bit more detail about air abrasion and why he thinks it should be used far more often… http://www.dentaleconomics.com/articles/print/volume-100/issue-6/columns/ask-dr-christensen.html

New-Fangled Stuff

Distractions
I spent about $400,000 several years ago to build a brand new office. You know what makes the biggest impression on our patients? It sure isn’t the $50k panoramic machine, several thousand dollar chairs, or amazingly efficient layout. It is the $300 television mounted on the ceiling that they can watch during treatment while wearing a pair of noise canceling headphones. OK, OK so televisions aren’t exactly new to the scene. CHEAP flat screen televisions sure are though. I just saw a 37 inch TV at Best Buy the other day for about $150. This is what most dentists charge for a single filling. Considering the benefits, calling it an affordable investment is an understatement. I’ve found it to be equally effective for both adults and children.

Vibraject™ / DentalVibe™
The Vibraject™ and DentalVibe™ play off our overall distraction theme. These devices vibrate a patient’s lip while the injection is being given in order to distract them from the sensation. They’ve been proven to be quite effective and many dentists say they wouldn’t want to give injections without them anymore. If you’re talented you can pull off this trick yourself without the device. Just vibrate a patient’s cheek quickly while giving the injection. Dentists have used this technique successfully for a long time. That is about the only thing I remember about the dentist from when I was a child.

For more information on these devices visit https://www.physicsforceps.com/vibraJect-comfort-solution or https://www.dentalvibe.com/.

Compounded Topical Anesthetic
Topical anesthetic has been used for a long time to reduce the pain associated with the needle stick. Unfortunately the only topical anesthetic that is widely available is 20% benzocaine. This works OK but there are a lot better options out there. The downside… you have to get them specially compounded at a pharmacy. It’s unbelievable that none of the big dental companies have come up with a better topical anesthetic (OK I do actually know why… The FDA approval process is a bureaucratic nightmare and costs a fortune for approval of a new formulation). If anyone in dental product R&D is reading this, I’D BUY A BETTER TOPICAL IN A HEARTBEAT! Get working on it!

My favorite formulation is a compounded gel with 10% lidocaine, 10% prilocaine, and 4% tetracaine. A SMALL dab of this a couple of minutes before an injection does wonders to almost entirely eliminate the pinch of the needle stick.

There are a good number of other formulations but most are some variation of these anesthetics. Some compounding pharmacies offer to add 2% phenylephrine to the gel to prevent but I do not recommend this. Any of these gels with phenylephrine seems to cause high incidence of tissue sloughing in the area where the gel was applied. I’ve only rarely seen minor tissue sloughing with the plain mixture of anesthetics. Once you use compounded topical you’ll never want to go back to plain benzocaine again!

Buffered Anesthetics
Even if the needle stick during a shot is totally painless, the shot can still hurt. Why is this? Most anesthetics used in dentistry are quite acidic. When they are injected they cause quite a burning sensation. This sensation can be minimized by injecting very slowly but people will still occasionally feel it. A couple of years ago a system known as Onset™ was introduced that buffered the anesthetic with sodium bicarbonate in order to bring it up to a more neutral pH level. Buffering solutions is commonly done in medicine but really hasn’t been used in dentistry up to this point. When anesthetic is injected with a pH close to physiologic levels, the burning sensation is almost entirely eliminated. In addition to reducing the burning it also dramatically increases the speed that the anesthetic takes effect. Mandibular blocks are fully complete within a minute and a half. You don’t even have to leave the room before getting started. There are a couple of other buffering systems that have come out since then but Onset™ remains the standard.

Stanley Malamed (You know, the guy who basically wrote the book on dental anesthesia) is a big fan. You should be too!

For more information on Onset™ visit http://www.orapharma.com/products

The Wand™
The Wand™ is a computerized anesthesia device that injects anesthetic at a controlled rate. As we discussed with buffered anesthetics, the rate at which anesthetic is delivered determines whether that uncomfortable burning sensation is felt. The Wand™ keeps this from happening by injecting at an extremely slow and controlled rate that is controlled by a computer, instead of your hand. Interestingly enough, the slow injection rate also provides higher success rates of getting people numb. One additional benefit to The Wand™ is that it looks far less scary than a typical dental syringe. Perception counts for a lot in how pain is experienced. The Wand simply looks like it will hurt less.

For more information on The Wand™ visit their website at http://www.thewand.com/.

Lasers
Lasers are very slowly making headway into dental offices. They can be used to remove tooth structure, oftentimes without any need for an injection. Due to how the laser pulses it actually induces some analgesia in the nerve of the tooth. It is truly needle free dentistry. There are some major downsides with lasers at this point. They can’t remove all types of materials from a tooth like a dental drill can, there is a huge learning curve, major magnification is required, and lastly the units still are wildly expensive (think $100kish). When the price comes down, I think they’ll start showing up in more dental offices but I don’t expect them to replace dental drills anytime soon.

For more information on dental hard tissue lasers you can visit http://www.Biolase.com, http://www.convergentdental.com/solea/, or https://www.lanap.com/laser-dentistry/periolase-mvp-7/

Kovanaze™
Kovanaze™ is the first needle free anesthetic option that I know of. Kovanaze™ was approved in the summer of 2016 by the FDA for use as a dental anesthetic and became available for purchase towards the end of the year. Kovanaze™ is a combination of the anesthetic tetracaine and oxymetazoline. This solution is sprayed up the nostril and provides anesthesia from the premolars to central incisor on the same side. Second premolars have a success rate around 64% while the first premolar through central incisor have a success rate of 96%. For major anterior work, such as veneers, this is a game changer. I know that I personally hate giving injections for the maxillary anterior teeth due to the sensitivity of the tissues in this area, especially around the centrals. Going from multiple painful injections to several painless nasal sprays makes these procedures far easier and essentially painless for patients.

The big downside at this point is cost. As of the time of this writing it costs approximately $600 for 30 sprays (or 15 doses as each dose requires two sprays). This is cost prohibitive for routine use by most dentists. Hopefully the price will start to come down and it will come into more routine use in practice. This would be a huge win for patients in general. Injections don’t bother me that much and I’d still pay extra just to have this type of anesthesia. My guess is that I’m not the only one.

As cool as needle free anesthesia is, the real story I’d like to hear is how the inventor originally came up with the idea of nasal spray anesthesia. Also, who was the unlucky person to be the original test subject?!?

For more information on Kovanaze™ you can visit their website at http://www.Kovanaze.com

There are so many different options out there for making dental care easier for patients. Not all of them have to be difficult or expensive. I’d highly recommend that you pick just one of these tools to implement well in practice and see what a difference it can make. Even better, pick several that you don’t currently offer and put them in place. I believe that comfortable patients will be happier, trust us more, and follow through with treatment which is ultimately a win-win for everyone.

About the Author:
I’m Dr. M, a regular dentist with aspirations of being a tooth saving superhero. My website, The Healthy Mouth Project is dedicated to educating and equipping patients to take control of their oral health.