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Needleless Local Anesthesia Approved for Commercial Use

 

One of the top fears in the world is the fear of needles. About 10% of the general population suffers from such fears. This can make going to the dentist something to be feared because typical anesthetics are administered using needles. 

 

A needleless anesthesia, called Kovanaze, might be a beneficial practice to ease the anxiety of needles and save patients from injections overall.

 

The History of Needleless Anesthesia

Since the 1940s, the use of Tetracaine (also known as amethocaine) has been used for eyes, nose and throat treatments. It is a local anesthetic, typically applied in liquid form to the desired area. It wasn’t until patients began to inform doctors that when used for nasal treatments, that their upper lip was also numb. This led researchers to look into the compound for dental applications.

 

About a decade ago, a pharmaceutical company called St. Renatus developed Kovanaze which was a combination of 3% Tetracaine and 0.05% Oxymetazoline. On June 29th, 2016 it was approved for dental use by the Food and Drug Administration. It is the first approved nasal anesthia. 

 

What is Kovanaze Anesthesia and How is it Used?

Tetracaine is a very temporary anesthetic, approximately lasting only 15 minutes. This makes it quite difficult to work on a patient in such a tight time limit, especially for intricate dental procedures. With the addition of Oxymetazoline, the duration was increased because it slows the systemic absorption of tetracaine.

 

Using it is extremely simple. Spray into the nostril that corresponds with the side in which the patient is having work on followed by another spray 4-5 minutes later. It is important to wait 10 minutes to ensure the effects are working, if not another spray may be administered for adults only.

 

The nasal spray treats the upper anterior teeth, specifically teeth 4-13 (See image). Initial tests resulted in an 84% success rate for teeth 4-13 and 96% effective for teeth 5-12. The premolars seem to have less success in having a consistent and reliable result using Kovanaze.

 

Additional testing has been conducted since with fantastic results. Out of 186 subjects, only two had any pressor response. This was likely caused by the Oxymetazoline component. A history of Hashimoto’s thyrotoxicosis, a relative contraindication to oxymetazoline, was found in one of the pressor response patients.

 

Kovanaze is unique because it does not anesthetize the lips. Dentists performing anterior restorations could find this to be invaluable. Precision is greatly improved for the placement of veneers and crowns. Additionally, due to the ability to move the lip in a natural way, patients are able to have more aesthetically pleasing results.

 

Drawbacks of Kovanaze Needleless Anesthesia

As with any medical procedure, there are of course risks associated with it.

 

Approximately 10% of patients have identified the following possible temporary side effects:

  • Rhinorrhea
  • Nasal congestion
  • Increased lacrimation
  • Nasal discomfort
  • Oropharyngeal pain

Like all other local anesthetics, there are limitations to who may be administered it. Children under 88 lbs, patients with uncontrolled hypertension, thyroid disease or taking MAOIs (Monoamine Oxidase Inhibitors) should not be given it.

 

Due to the fact that this is a very localized anesthetics, it is limited to only the maxillary and premolar anterior. For any of restorative work outside this region would require an injection to complete. 

 

Kovanaze is limited for hygiene procedures such as scaling and root planing because of unpredictable gingival conditions. Further testing will be conducted to determine if it will be able to produce the desired result.

 

This exciting new development allows for people to now have the choice to have an injection or not. Many people would jump at the chance to avoid it.

 

It is not only good for patients but also practitioners because it can put patients at ease and lowers the fear of the dentist office.

 

As this company continues to develop and improve this product, it’s our hope that new insights will be found that furthers the use for Kovanaze. Many people would prefer this option over an injection so if it can be used for more than just the maxillary and premolars of the anterior, it should be!

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Dental Office Design

 

When concentrating on efficiency and making the best use of the available space, it can be easy to forget a dental office also must provide the right atmosphere for clients. Although many dental practitioners have done their best to reduce anxiety for clients, Ondontophobia is still all too real for many people.

 

Dental Office Layout

 

While some of these individuals require therapy to manage this issue, practitioners can still do their part to reduce anxiety experienced by anyone dreading a trip to the dentist. A great way to start is by reducing a client’s apprehension before they sit in the examination chair.

 

Here are some things to keep in mind for dental office design that will help to generate an inviting, relaxed atmosphere for your patients.

 

Visual Distractions

 

In the old days, dental offices often had a tropical fish tank in the waiting room. These provided a gentle distraction for patients, particularly children. Many still do, but now many offices are also installing televisions.

 

These generally play programs and movies without the sound, but with closed captions activated so interested viewers can follow what is happening.

 

A TV can provide a relaxing diversion, but you need to be careful about what is on. Violent shows or ones that are particularly suspenseful will be counterproductive, as will news channels on days when the reporting is particularly negative.

 

Soothing Colours and Artwork

 

Personal preference always plays a big role when choosing colours for an office, but here are some suggestions to consider. When choosing your colour scheme, aim for hues that induce a sense of tranquility and do not have any hint of threat.

 

Colours able to bring about a calming energy include those people commonly enjoy in nature, such as sky blue, green/sage, and tan/brown.

 

White suggests cleanliness and reminds some of anti-septic, but can be triggering for some due to its hospital connotations.

 

Bright colours, while attractive, can actually put people on edge (red is particularly strong in this regard), so try to stay away from them.

 

Do not choose only a single colour; pick a main one as well as another that provides a notable contrast, but not too harsh (e.g. a darker and lighter version of the same hue). Solicit opinions from your staff, and ask what they would prefer for areas only they will use.

 

Artwork can also provide both decoration and visual interest. Be sure to choose art the average person can easily relate to and does not include an abundance of off-putting shades.

 

Plants and Furniture

 

Plants will help to reinforce the natural theme and suggest that your practice is a healthy and vibrant place. Be sure to regularly water and maintain them so wilted, dying leaves are never apparent. If it is apparent that everyone on staff is too busy to ensure this happens, hire an outside company to do it.

 

Choose chairs that look and feel comfortable, but can also hold up well to steady traffic and children. Side tables should be big enough to accommodate patient’s incidentals, but not take up so much space that it becomes awkward to move around.

Include magazine and brochure racks for those who would prefer to read.

 

Provide a View

 

If building design permits, and you are lucky enough to be in a picturesque area, provide a window view in the waiting and exam rooms.

This offers another healthy and natural way for patients to get their minds off their procedures, both before and during the process.

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Three Innovative Ways to Calm Your Patient

 

Some people find a trip to the dentist quite stressful. This can stem from anxiety, an unpleasant experience with another practitioner, or even a dental accident they saw in a movie or television show. Let’s face it—the thought of a stranger having access to an intimate part of the body can spook some individuals.

 

 

Many practitioners already take steps to offer the most relaxing and professional atmosphere possible to allay such fears. However, a recent study by Deva Priya Appukuttan offers additional suggestions on how to help clients struggling with dental phobia and a subsequent failure to maintain oral health through regular appointments.

 

Here are three of the main points the author discussed.

 

Get to Know Your Clients

 

When a practice first accepts clients, they answer a series of questions relating to their medical history, insurance, etc. Appukuttan suggests it is also wise to consider a semi-structured interview. This calm, informal conversation would allow the practitioner to learn more about situations causing fear and/or anxiety. The dentist or staff member could unobtrusively guide the conversation using open-ended questions, rather than direct and potentially off-putting queries.

 

In addition to learning what situations may cause issues, the dentist might also determine such fears are part of a wider psychological issue and recommend the person to seek out a therapist. This mental health professional may work directly with the dentist to design an approach to help the patient overcome their worries.

 

Anxiety Questionnaire

 

In addition to the medical questionnaire mentioned above, practitioners can also offer a second one dedicated to anxiety issues patients sometimes experience. This would act as a confidential way for nervous clients to self-report using a series of questions and a scale mirroring the person’s anxiety. For example, when asked about having a cavity filled, a “1” could mean little worry and a “5” could show great worry.

 

The dentist could use this knowledge to categorize patients and approach them accordingly. Starting a dialogue in this fashion can help avoid unexpected issues during the moments of a procedure where such an interruption could be problematic.

 

Building Trust

 

The rapport dental professionals build with their clients is very important. A busy practice often reduces the amount of time a practitioner can spend with patients, which is unfortunate, as it can lead to an increase in anxiety for some.

 

Taking the time to listen, answer questions, and map out each step in the procedure can go a long way in reducing a client’s fear. This opportunity to make inquiries and spell out any concerns will increase the person’s respect for the practitioner. It is important to acknowledge it is not unusual to experience some anxiety before a procedure. Make eye contact, avoid any negative word choices, and emphasize you are here to help. All questions are valid; provide detailed responses demonstrating your interest and desire to do a thorough and professional job.

 

Maintain this dialogue while performing the procedure. Keep the client informed of what you are doing and what the next step will be. Also, ask whether they are experiencing any discomfort and reassure them they are doing well. Be honest and straightforward.

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