Paul Feuerstein, DMD
For more on this topic, go to www.dentaleconomics.com and search using the following key words: cordless electric vibrator, injection, irrigation, fiber-optic, Dr. Paul Feuerstein.
Cordless electric vibrators. Some of these devices have rolled into dentistry as useful products. Three will help you give injections with less perceived pain. One can help you irrigate endo cases, while another helps you brush your teeth more cleanly.
Let's start with the invention of Michael D. Zweifler, DDS (called Dr. Z), in Arkansas. He developed the Accupal palatal injection system in the last few years. This vibrating unit has disposable tips that are placed on the palate prior to and during the injection. The end is a little plastic circle with a hole in the center illuminated with a fiber-optic light.
It is recommended to place topical on the wand, press it against the palate for a few seconds, then "poke and inject" a couple of times to finish the injection. In the palate, you are not going to unload an entire carpule – just enough for blanching. There is a descriptive video on the product's Web site with patient testimonials and more at www.accupal.com.
The Vibraject, another recent release, clips on to a syringe near the barrel and transmits vibration through the needle. The company reports less sensitivity to any injection with no real change in technique at www.vibraject.com.
The newest entry is the DentalVibe from Steven Goldberg, DDS. This has a v-shaped end that is placed around the point of needle entry. It is illuminated with fiber-optics and can be used for retraction anywhere in the mouth. After running it for a few seconds, you inject it at the middle of the "v." To distract young patients, there are some cute animal heads that they can keep as finger puppets. For more, go to www.dentalvibe.com.
These devices are based on a 1965 article, "Pain Mechanisms: A New Theory," (Science: 150, 171-179, 1965) by Ronald Melzack and Patrick Wall. The article states that one sensory stimulus (in this case vibration) can open a "gate" and close another (pain).
I can report that, in a few instances with the Accupal, I had to extract primary teeth. After using it for local anesthetic, I found that putting the vibrator on the buccal mucosa during the extraction distracted the child enough to make this a painless experience, almost as if I had vibrated the tooth out.
I would be remiss if I didn't mention the new version of Milestone's STA device. This computer-controlled anesthesia does not vibrate like the aforementioned, but changes the method in which you actually inject. If you tried the original "Wand" and were disappointed, this is a makeover. For me, the STA device does work as advertised.
The computer senses the back pressure and lets you know audibly, if you desire, that you are in the right spot and have placed the needle accurately. As with the original, it does deliver the local anesthetic at a remarkably slow rate. This provides a positive patient experience.
With some practice you can deliver PDL, one-tooth anesthesia (STA means single tooth anesthesia), as well as the palatal AMSA injection that numbs the central to second premolar with one injection. You also can do standard injections. Since the device does not look like a traditional syringe, this adds to patient acceptance.
The newest clinical vibration entry is the Vibringe, which is used in another area of dentistry. This interesting system from Holland is intended for endo irrigation. The vibrating handle is attached to the end of specially designed endo syringes and is depressed to deliver the irrigant.
Studies show this device provides a more thorough debridement of the canals, even removing the smear layer and biofilm. Several endodontic investigators are evaluating this product/process now and should have results soon. For more, go to www.vibringe.com.
The granddaddy of vibrating dental devices is Sonicare. Philips Corporation has put an incredible amount of research toward its elaborate tooth-cleaning devices, and has constantly improved their function and features. The body of research is substantial (more than 150 studies) and available on the company's Web site.
Sonicare is not satisfied to stand still with a certain model. Recently, the company added children's devices, as well as a slick new UV sterilization chamber in which the heads can reside between uses. If you take a good look at the research, you will realize this is more than just a high-tech patient-pleaser. Get more at www.sonicare.com/dp.
The anesthetic and irrigation devices are too new to have had long-term studies. But they seem to make sense and certainly warrant a closer look.
Dr. Paul Feuerstein installed one of dentistry's first computers in 1978. For more than 20 years, he has taught technology courses. He was named "Clinician of the Year" at the 2010 Yankee Dental Congress. A general practitioner in North Billerica, Mass., since 1973, Dr. Feuerstein maintains a Web site (www.computersindentistry.com) and can be reached by e-mail at [email protected].
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