Local anesthetic news

Summer was once again approaching and while unlike the anticipation and eagerness I usually enjoyed each November, as I journeyed to my
Caribbean retreat for my fix of ultra violet rays, yet there was something almost homeopathic and  calming about the aging hammock with a good book and the almost deathly silence of summer by the lake.

On my usual November trip south, the captain would put us through  the “g force” as he challenged the physics of gravity prior to lift-off. I often thought how Albert Einstein could have ever imagined what it would have been like to travel along side the speed of light when my main concern was focused on whether this de-iced 700,000 lbs monster would continue to gain altitude. However as true to form the falling leaves of red and gold faded into white fluffy cumulus which seemed to be void of density as the shining machine sliced through them as effortless as a knife through butter. There you go.  

Life above the 49^th parallel had lasting memories for me. I lived the best of both worlds. Snow shoveling was replaced by an early walk where I summonsed my younger balancing skills at playing hopscotch through the sharp edged seashells being caressed by each gentle wave. In contrast, summer was spent mostly reclining in a hammock which over the years had formed itself like a large latex glove around my girth with each increasing year.  This posture allowed me together with my book of the day to blend in with the sparsely placed pine furniture in the large and opened verandah which surrounded the cottage on three sides. open and almost oblivious to the distant hum of a power boat on the lake.

Winter, albeit relaxing and therapeutic, was in deep contrast to the silence one experienced on most lakes north of the 49^th parallel. The mere experience for most northern tourists to afford a
Caribbean vacation was seen as a right of passage to gave way to any Freudian inhibition which may have not been completely resolved. In addition, there was the cooling and refreshing rum punch mixtures added to the rhythmic sound of the “steel band” made it a powerful prescription of feeling entitled to shed not only one’s pent-up stress, but at times parts of their already skimpy apparel. This resulting atmosphere is what most scholars of psychology refer to as the emerging passive-aggressive behavior. There you go.

In preparation for my summer retreat during the month of June, I was like the proverbial bull in the china store as I maneuvered my mini shopping cart from aisle to aisle through my favorite book store. This store offered an atmosphere not unlike a trade show with rows and rows of draped individual small tables throughout the aisles which seemed to add that much more square footage to advertise and promote authors and new releases. These arcades and display tables were managed independently by their own sales associates, a title by which they preferred to be addressed. There you go. 

It was noticeably busy for a mid week morning in June. I carefully rechecked my BlackBerry organizer which for the most part tagged along with me like a faithful poodle with its unconditional love. From to time it would vibrate or other times it would emit a childlike whine to inform me of some event I had previously entered and may have completely forgotten about it. I lovingly referred to it as my dementia levee which faithfully protected any memory cells from overflowing my aging brain’s levee. A tap or two on  the sensitive touch screen revealed  nothing exceptional or urgent other than a memo to remind me to make a date to see the movie “Sex and the City” With Sarah Jessica Parker, Kim Cattrall. There you go. 

Why then was this excessive marketing atmosphere so evident throughout the store? Did the book industry secretly generate a Tiger Woods’ moment of mass marketing?  This certainly would have been the best kept secret, yet the solution was facing me right between the eyes. Historically, increased activity at book stores and movie houses has proven to be an accurate and reliable early leading indicator of impending recession as people at large have more free time. Ironically some business benefit from recession in the same way as the demand for steel increases during periods of war. 

Suspense novels are my passion and among others there were two on my short  list – namely “A prisoner of birth” by Jeffrey Archer and “The Pillars of the Earth” by Ken Follet. I also keep in touch and have a burning desire to be current with professional journals and especially editorials which, with some basic writing skills and strategetly placed references can be confused as scientific material. 

Over the many years of reading, I have developed an almost Sherlock Holmes analytical personality for articles. No more so than dentists are impulsively attracted to “the work” on one’s teeth or an architect inspecting the symmetry of a well placed keystone. These editorials/articles can often be detected by the format of their presentation, which is usually in the form of a question rather than the more accepted form of peer reviewed scientific study complete with investigating phenomena or purpose, an accepted methodology protocol and a conclusion. The pure sciences are becoming more and more diluted as such editorials begin their long “hear-say” or gossip walk through the hallowed corridors of famed teaching institutions.  Such articles presented under the guise of scientific material are for the most part self serving and do little to advance clinical efficacy with less unforeseen mishaps.  

However, there are the pundits of an evolving world where analytic jurisprudence is popular and where asking questions like, “What is law?” “What are the criteria for legal validity?” or “What is the relationship between law and morality?” and other such questions that legal philosophers may engage. (Wiki). 

An article this summer caught my attention under the heading of ethics and jurisprudence.  Here goes that question format - “Informed consent for Local Anesthesia - is it necessary?” There is implied dictum which takes the blame away from the operator and places it on a compound (amides) which dentists have been using successfully since 1947 to induce local anesthesia. If ever there was a case for longitudinal and sample size data, our stats people would have a heyday.   

Life styles through all aspects has changed and dental offices were no exception. I was as attentive to my oral health as I was to my physical health and over the  years I had noticed gradual subtle changes such as more pre clinical involvement with hygienists but perception is reality. I also noticed the office in greater detail. The Italian leather couches, slate tile floors and backlit etched glass in the patient lounge, exuded a definite warmth and elegant atmosphere. My dentist was considered to be one of the best, hence the ambience to go with her status. 

From the patient lounge I  was taken into a room with soft music and current magazines like Ophra, Vogue, Sports Illustrated, which all appeared to have been delivered that very morning. The dentist greeted me and after some small talk, asked me to place a tiny pill under my tongue which she explained would dissolve in a few minutes. Her assistant returned in about half an hour and led me into the operatory. By this time I was feeling very relaxed and comfortable.The local anesthetic solution was delivered through a computer-like electric tooth brush (minus the brush tip) and I felt absolutely nothing…no stick, not anything. I felt very relaxed throughout the procedure.  

This is where, in my humble opinion, and together with my graduate degree in pharmacy, may leave room for a clinical study to determine the use of oral or even intravenous sedation in general dentistry. The question is whether to circumvent the pain associated with what some dentists refer to as “pumping”. Is there need for added pharmacological interventions ( use of muscle relaxants) when a slower delivery ( 60 seconds) would have proven just as effective and with reduced cost to the office?  The term “ Infants practicing on mom’s high heels’ is probably not inappropriate here.  

To suggest a case for advocating informed consent for the use of local anesthetics after 60 years of successful clinical use in dentistry appears less substantive phenomena to identify such rare sequellae such as temporary amaurosis, paresthesia and even death which would seem to be classified as operator error rather than of a biochemical origin.  All clinical evidence would seem to beg the question. “Does this track record reasonably qualify to put local anesthetics (amides) under curfew or to “throw them under the bus?”

There is without doubt in general dentistry, a need to address the needle phobic patient, however a sudden move to give patients a “high” may increase patient traffic  prone to chemical addictiveness as the word get around, but with consequences not every dentist is willing to spend time, effort, legal and peer review in their selective associations. 

Anesthetics and aesthetics — they even sound as though they work together. Informed consent seems rather like infants practicing on mom’s high heels.  However for general dentistry with limited experience of these  powerful opioid analgesic with a potency approximately 81 times that of morphine (wiki) may increase the traffic you may live to regret.

Comments to author.  mailto:localanesthetics@yahoo.ca    M.Sc. PharmD. CCPE   WWW.Anestheticnews.com

When did this all happen? To my astonishment there were Toto toilets and a spa? This has got to be one of the best kept secrets…WOW!  Times were when your twice a year visits to the dentist were the most nerve shattering and fearful experiences with which one had to endure. Just to look at the red asterisk on my calendar followed by Dr. Watson, automatically drove up my blood pressure.

Recently I developed an acute pain in my lower right jaw and had to get to the dentist in a hurry. Yes! the diagnosis was a seriously infected molar and a root canal, AKA,  an endodontic procedure had to be performed ASAP. I must admit I had not been getting regular check ups, so I had no one to blame but myself. A few painkillers kept me through the night until my appointment the next morning.

When I arrived for my appointment, feeling less pain because of the painkillers, I noticed the office in greater detail. The Italian leather couches, slate tile floors and backlit etched glass in the Patient Lounge, exuded a definite warmth and elegant atmosphere. My endodontist was considered to be one of the best, hence the ambience to go with his status.

I was taken into a room with soft music and current magazines like Ophra, Vogue, Sports Illustrated, all appeared to have been delivered that very morning. I thought to myself, “where have I been”?  The dentist greeted me and after some small talk, asked me to place a tiny pill under my tongue which he explained would dissolve in a few minutes. His assistant returned in about half an hour and led me into the operatory. By this time I was feeling very relaxed and comfortable.

The local anesthetic solution was delivered through a computer-like electric tooth brush (minus the brush tip) and I felt absolutely nothing…no stick, not anything. I felt very relaxed throughout the procedure. When he was finished about one hour later, all I felt was a tiny residue of the anesthetic but was quite awake without any pain.I was escorted back to the ante room and relaxed with a magazine for about 15 minutes.

Here is where the surprise and fun started.This Dental Practice in which every aspect of its facilities had been intentionally designed to reflect a much more relaxed, serene and contemporary environment for the patient and which incorporated both a series of Dental Spa like services as well as Non-Dental Spa Services was extremely well planned. The more traditional Spa services such as massage, manicures, facials and pedicures was performed in a dedicated, private Spa Treatment room separate from the rest of the clinic.

I had written the day off because I knew I would be in no condition to return to work. I was offered a complementary spa-like services which included a wide variety of treatments and services. It was as if I had entered into the 22^nd century. I walked out of that office feeling like a million dollars. This experience has stayed with me ever since.  I have been told that such facilities are quite the trend even in small towns. I have already booked my follow up appointment, this time the asterisk is in Green. Comments to localanesthetics@yahoo.ca 

Author: M.Sc. PharmD. (patient’s story on file).        

Dentists may be currently looking at significant leading indicators without recognizing they are the real Four Pinocchio’s. There is nothing false about them.  Virgil’s epic poem of The Trojan horse may have already entered into the courtyard. However me thinks the shrinking of the world wide GDP, the $8 trillion housing bubble and the lack luster of the China Olympics are permanent impressions. These indicators are the final cast. From here they go directly to disposable income.

Disneyland is the name of the four theme parks around the world. (Anaheim, Paris, Tokyo and Hong Kong. Is there room for more Pinocchio’s?  How about adding the following for good grace?  Al Gore inventing the internet, John Kerry was a sharp shooting Rambo, Bill Clinton drifted around Harlem mixing with black folk, and Barack Obama claims he never heard the Reverend Wright’s racial comments. And to be current, now Hilary claims she was under sniper attack in Bosnia during 1996.      

In the board room of today’s large conglomerates, the term “leading indicators” is probably on the title of each power point slide presentation. This term is as critical as a GPS “never-lost” system offered at any major airport car rental service or to be more precise, the three-stage SM-3 missile capable of a bull’s-eye at 130 miles above the
Pacific Ocean.

Today’s financial tight rope that CEO’s must balance is probably as taxing as “Black Monday” of 1987 which took a 34% free fall over a three week period before the parachute finally opened.

In a democracy we do have the right to free speech so long as one does not cry “fire” in a crowded theatre. However; in the same voice there is no way of predicting with infinite accuracy, whether there will be a domino effect after the recent Bear Stearns and JP Morgan Chase’s shot gun marriage arranged by the Federal Reserve with the expected plunge of the Stock markets worldwide. Unfortunately most of these 14,000 employees will loose their jobs and their dental benefits.

In such uncertain times, dental discretionary income is on the front line. The cruises, the exotic vacations, the summer cottages; even the car replacement, are all put on hold. It is therefore understandable that certain types of personal care will be under a hierarchy list. The tummy- tuck or the botox treatment may have to take second place to a root canal, a broken filling or a painful ache when you are having your morning coffee. And finally, the Whitening, the Bonding, the porcelain veneer, the crowns and implants will unfortunately be excluded until the situation improves.  

There was at least one sanguine voice, that of U.S. President George Bush against the backdrop of a global credit crisis reassuring us that its ( U.S.) biggest consumer economy remained “fundamentally sound”. Does this qualify as a fifth Pinocchio?

A year ago it all seemed within easy reach. The streets around
Tiananmen Square were celebrating the countdown to the Republic’s first ever Olympic Games with choreography and fireworks, the likes of which no other nation could match the harmless beauty of such awe.

As trivial as the opening paragraphs appear to be, there is a serious side and a suggested prescription for the “R” word.

In the recession of 1987, dentists and their suppliers felt the brunt of the lack of disposable income. However the irony of certain cosmetic intervention is that very high end and expensive reconstruction procedures are recession proof simply because there will always be the filthy rich who can afford what they want in spite of a shrinking worldwide GDP.

In order to understand the putative relationships between excellent oral education and a lack there of, is to understand the inverse square law.  As preventative care of both deciduous and permanent teeth increases, there is a corresponding decrease in overall dental imperfections and the need to treat simple caries.

Dentistry has gone through many changes away from “drill ’n fill”. Thanks to fluoride and years of community education and training to the public at large. Practices have moved on to cosmetics and other converging technologies.

This unfortunately is the quid pro quo for general dentistry until the economy turns around. Back In 1987, revenues for general dentistry were less geared to cosmetic procedures. We were in a totally different clinical situation where the emphasis was on acute procedures and treatment. After year 2000 they was a massive swing to cosmetic procedures.    

According to Maslow’s hierchy of needs, we could be at best, one tier down on the familiar pyramid of esteem needs, or at worst, one tier up from biological and physical fulfillment.

The following is my prescription to ride through the “Perfect storm” of the “R” word.  

• Stay liquid (cash).
• Pay with cash or debit Card.
• One credit card with zero balance each statement.
•  Retire 8 cylinder vehicles.
•  Caution in stocks other than bargain blue chip.
•  Lock in low long term mortgages.

Comments to mailto:localanesthetics@yahoo.ca   visit http://www.anestheticsnews.com“    Author: M.Sc. PharmD.

Dentistry is in transition and so are life styles. What a sudden move away from drill and fill!  We are into implants, laser technology and whitening for life marketing spins. If ever there was a case for poetic justice, this certainly is it. Aristotle himself a man for change, argued the case for poetry over history because it demonstrates what must or should occur rather than what the pundits forecast.

The man dubbed the father of modern dentistry in the 17 th century Pierre Fauchard would be as uncomfortable in to-day’s dental operatory as a pilot from World War II in the cockpit of the Airbus 380.

Dentists still have to work around the foreboding needle phobia. However, the change of the future looks encouraging with the first FDA approved needle free anesthesia product for scaling and root planing.

This is the story of Frank and his wife Flavia. They were the perfect couple. Flavia was a bit trendier and into the change from the traditional soccer mom, but by no means could one describe her as “the vanilla flavor of the day”. She had the smarts, and a solid head for business, probably groomed by her father who, like many Italians emigrated from Italy to find their fortune in the Western world, the land of opportunity. Frank and Flavia were comfortably set. They were off to a good start after their wedding, with the help of her dad and family, pretty well owned their first home sooner than most of their friends. 

Flavia had been pressuring Frank to get some cosmetic work done on his teeth. The daily espresso coffees and his mother’s blueberry pies were beginning to seriously test the strength of a solid Roman Catholic marriage. Flavia’s desire to pop an impromptu kiss on Frank was starting to wane because of his discolored teeth. She wondered how can “I persuade him to change? To go for a dental check-up”? Her goal for Frank was to have his teeth cosmetically changed to show off the fashionable celebrity white-teeth-smile and nothing was going to stop her desire for hope and change.

The whitening of teeth has become a billion-dollar business and celebrities have had no small part in raising the bar for the perfect smile. Another cosmetic fashion statement which is showing its colors is the art of tattooing one’s body parts. I mentioned this purposely, because a visit to the tattooing studio is far more popular that a visit to the dentist, although, ironically there is a common factor, namely pain. Why is this?  Why is it that people will pay huge sums of after-tax dollars to have a tattoo sculptured in sensitive parts of the anatomy and yet be hesitant to visit the dentist? Maybe vanity is more powerful than oral health! Or maybe the School of Body Art has out-marketed the college of dentistry?  How often have you seen a young woman/man flashing a tattoo, but in need of obvious orthodontic or other dental work?  We have to rely on anecdotal reports in the absence of a truly scientific study.

Back to my friends Frank and Flavia. Researchers have come to the rescue with a product that brings effective needle-free anesthesia for patients during scaling and/or root planing procedures. Oraqix®  fits the perfect scenario for a patient who is needle phobic. This product is the first FDA approved system for the above indications. There are some very desirable properties to Oraqix; apart from a rapid onset of action, the return to sensitivity is within twenty minutes, thereby making it the perfect product for example, a lunchtime appointment. Sensation is restored before leaving the dental office. Uncontrollable chewing of the lip is a common after-effect of residual anesthetics. Oraqix® allows the patient to return to normal activity without the embarrassing drooling.

Hopefully this addition to dental armamentarium will allay the fear of the dreaded needle. Fear of finding other latent problems incurring a cost is an irrational decision. Why should one have two standards for maintaining perfect health?  Oral health is no less important that physical health. The diagnosis of oral cancer is by far more often seen by the dentist than by medical doctors. If for no other reason it makes good sense to keep the oral cavity healthy and free of possible terminal diseases.

Four out of five Americans claim a desire for whiter teeth. Never before have so many options been available. Nu-pro® White gold® is a dentist prescribed take-home system that has been designed to address the patient’s tooth whitening requirements and offers two formulations with dramatic results in one to two weeks. Who are the best candidates for do-it-yourself whiteners? Before you spend a dime on whitening your smile, your dentist will explain what is best for you and the reason why. Teeth should be healthy without cavities or recession of the gums thereby exposing sensitive root structure.  If whitening agents come in contact with an open area on a tooth with a clear path to the nerve center of your tooth, you won’t care what color your teeth are because they will have to peel you off the ceiling.

 You need to have a proper evaluation by your dentist.   A talk to your dentist will determine if you do have tooth discoloration and what is the cause. There are two major ways teeth become discolored. Teeth naturally discolor as we age, and we all have lighter or darker teeth, just as we have different complexions. Everyday habits and food consumption penetrate the tooth’s enamel to cause extrinsic and intrinsic stains: There are as many reasons for tooth discoloration as there are solutions. Over-the-counter whitening doesn’t work if the discoloration comes from an injury to a tooth, for example. Also, if you have teeth that have tooth-colored fillings or crowns that are dark or discolored, again, over-the-counter whiteners do not whiten porcelain or tooth colored filling materials.

Stains can be caused by foods such as coffee, tea, red wine, and nicotine. Rule of thumb, if it stains your carpet, it can stain your teeth.  What kind of results can we expect from an over-the-counter product? Today Over-the-counter whitening products work differently and better than ever before because the technology has changed so dramatically. Will your teeth look as different as if you had full mouth veneers? No. But if you have a pretty smile, that you want whiter and brighter, the newest over-the-counter options are very effective. Here’s a look at some of the latest options.  Most people hate the messy trays you stick in your mouth. What are the alternatives?

Crest White strips, night effects (liquid strip gel). Crest White strips continue to be the OTC gold standard in whitening — and a beauty secret for millions of Americans, (mostly women). When you look in dressing cabinets, you see them right next to the lipsticks. Whiter teeth give women confidence and make them look younger and prettier. A great new whitening product is hitting store shelves now. It’s called Night Effects and it’s very exciting because it works while you sleep. The first generation products made to whiten teeth while we sleep included a tray and stuff oozing out of it. I dare you to sleep with that unit in your mouth and not destroy your bed linen. Bearing in mind that these are all Over-the-counter products. Dental prescribed take-home products are still the most effective. So what has been improved for the OTC shopper?  

Night Effects is great for a couple of reasons: First, it’s good for people whom for whatever reason, cannot whiten during the day. Second, the coating sticks to your teeth. You’ve heard me say that for a product to work, the whitening agent has to stay in contact with the teeth. The problem with some of the other over-the-counter products is that they tend to quickly wash away when they come in contact with saliva, food or drink. Night Effects appears to be the first paint-on product to address this problem. The patent process they use is as follows. Immediately after applying the gel, the product forms a liquid strip coating that stays on your teeth overnight. The liquid strip slowly releases the whitening ingredient into your teeth to remove stains and loosen stain-causing build-up. In the morning, you simply brush the liquid strip coating and stains away.

 Researchers have overcome the overnight challenge by developing a silicon-based gel applied with a brush. Secondly, it is not water soluble like other paint-on products. Because of this new technology, the whitening gel stays on your teeth for hours while you sleep.  Over-the-counter whitening serves a selected market, however for the clinically accepted procedures, it is best to have your dentist involved.

Please click on the prescribing info button to the right of the screen  for information about containdications, warnings, cautions and precautions.

PHA01-0108-1 

Comments to author. mailto:localanesthetics@yahoo.ca M.Sc. PharmD. CCPE WWW.AnestheticsNews.com    

Gloss phobia, more commonly called the fear of public speaking, is thought to be the most common of all phobias. As many as 75 percent of all people are afraid to speak in front of an audience. Without going in to all phobias and their rankings, my observation is that needle phobia in the dental office is by no means abnormal and ranks up there among the highest.Dentists still have to work around needle phobia. However, the future looks encouraging with the first FDA approved needle free anesthesia product for scaling and root planing.

This story is about my friend Sergio and his wife Lina. They were the perfect couple. Lina was a bit trendier, but by no means could one describe her as “the flavor of the day”. She had the smarts, and a solid head for business, probably groomed by her father who, like many Italians emigrated from Italy to find their fortune in the Western world, the land of opportunity. Sergio and Lina were comfortably set. They were off to a good start after their wedding, with the help of her dad and family, pretty well owned their first home sooner than most of their friends. 

Lina had been pressuring Sergio to get some cosmetic work done on his teeth. The daily espresso coffees and his mother’s blueberry pies were beginning to test the strength of a solid Roman Catholic marriage. Lina’s desire to pop an impromptu kiss on Sergio was starting to wane because of his discolored teeth. She wondered how can “I persuade him at least, to go for a dental check-up”? Her goal for Sergio was to have his teeth cosmetically improved to show off the fashionable celebrity white-teeth-smile and nothing was going to stop her. 

The whitening of teeth has become a billion-dollar business and celebrities have had no small part in raising the bar for the perfect smile. Another cosmetic fashion statement which is showing its colors is the art of tattooing one’s body parts. I mentioned this purposely, because a visit to the tattooing studio is far more popular that a visit to the dentist, although, ironically there is a common factor, namely pain. Why is this?  Why is it that people will pay huge sums of after-tax dollars to have a tattoo sculptured in sensitive parts of the anatomy and yet be hesitant to visit the dentist? Maybe vanity is more powerful than oral health! Or maybe the School of Body Art has out-marketed the college of dentistry?  How often have you seen a young woman/man flashing a tattoo, but in need of obvious orthodontic or other dental work?  We have to rely on anecdotal reports in the absence of a truly scientific study. 

Back to my friends Sergio and Lina. Researchers have come to the rescue with a product that brings effective needle-free anesthesia for patients during scaling and/or root planing procedures. Oraqix®  (Please click on the prescribing info button to the right of the screen  for information about contraindications, warnings, cautions and precautions).
fits the perfect scenario for a patient who is needle phobic. This product is the first FDA approved system for the above indications. There are some very desirable properties to Oraqix; apart from a rapid onset of action, the return to sensitivity is within twenty minutes, thereby making it the perfect product for example, a lunchtime appointment. Sensation is restored before leaving the dental office. Uncontrollable chewing of the lip is a common after-effect of residual anesthetics. Oraqix allows the patient to return to normal activity without the embarrassing drooling.

 Hopefully this addition to dental armamentarium will allay the fear of the dreaded needle. Fear of finding other latent problems incurring a cost is an irrational decision. Why should one have two standards for maintaining perfect health?  Oral health is no less important that physical health. The diagnosis of oral cancer is by far more often seen by the dentist than by medical doctors. If for no other reason it makes good sense to keep the oral cavity healthy and free of possible terminal diseases. 

Four out of five Americans claim a desire for whiter teeth. Never before have so many options been available. Nu-pro® White Gold®
is a dentist prescribed take-home system that has been designed to address the patient’s tooth whitening requirements and offers two formulations with dramatic results in one to two weeks. Who are the best candidates for do-it-yourself whiteners? Before you spend a dime on whitening your smile, your dentist will explain what is best for you and the reason why. Teeth should be healthy without cavities or recession of the gums thereby exposing sensitive root structure.  If whitening agents come in contact with an open area on a tooth with a clear path to the nerve center of your tooth, you won’t care what color your teeth are because they will have to peel you off the ceiling. 

You need to have a proper evaluation by your dentist.   A talk to your dentist will determine if you do have tooth discoloration and what is the cause. There are two major ways teeth become discolored. Teeth naturally discolor as we age, and we all have lighter or darker teeth, just as we have different complexions. Everyday habits and food consumption penetrate the tooth’s enamel to cause extrinsic and intrinsic stains: There are as many reasons for tooth discoloration as there are solutions. Over-the-counter whitening doesn’t work if the discoloration comes from an injury to a tooth, for example. Also, if you have teeth that have tooth-colored fillings or crowns that are dark or discolored, again, over-the-counter whiteners do not whiten porcelain or tooth colored filling materials.  

Stains can be caused by foods such as coffee, tea, red wine, and nicotine. Rule of thumb, if it stains your carpet, it can stain your teeth.  What kind of results can we expect from an over-the-counter product? Today Over-the-counter whitening products work differently and better than ever before because the technology has changed so dramatically. Will your teeth look as different as if you had full mouth veneers? No. But if you have a pretty smile, that you want whiter and brighter, the newest over-the-counter options are very effective. Here’s a look at some of the latest options.  Most people hate the messy trays you stick in your mouth. What are the alternatives? 

Crest White strips, night effects (liquid strip gel). Crest White strips continue to be the OTC gold standard in whitening — and a beauty secret for millions of Americans, (mostly women). When you look in dressing cabinets, you see them right next to the lipsticks. Whiter teeth give women confidence and make them look younger and prettier. A great new whitening product is hitting store shelves now. It’s called Night Effects and it’s very exciting because it works while you sleep. The first generation products made to whiten teeth while we sleep included a tray and stuff oozing out of it. I dare you to sleep with that unit in your mouth and not destroy your bed linen. Bearing in mind that these are all Over-the-counter products. Dental prescribed take-home products are still the most effective. So what has been improved for the OTC shopper? 

Night Effects is great for a couple of reasons: First, it’s good for people whom for whatever reason, cannot whiten during the day. Second, the coating sticks to your teeth. You’ve heard me say that for a product to work, the whitening agent has to stay in contact with the teeth. The problem with some of the other over-the-counter products is that they tend to quickly wash away when they come in contact with saliva, food or drink. Night Effects appears to be the first paint-on product to address this problem. The patent process they use is as follows. Immediately after applying the gel, the product forms a liquid strip coating that stays on your teeth overnight. The liquid strip slowly releases the whitening ingredient into your teeth to remove stains and loosen stain-causing build-up. In the morning, you simply brush the liquid strip coating and stains away.  

Researchers have overcome the overnight challenge by developing a silicon-based gel applied with a brush. Secondly, it is not water soluble like other paint-on products. Because of this new technology, the whitening gel stays on your teeth for hours while you sleep.  Over-the-counter whitening serves a selected market, however for the clinically accepted procedures, it is best to have your dentist involved.

 (Please click on the prescribing info button to the right of the screen  for information about containdications, warnings, cautions and precautions.

PHA01-0108-1
 

mailto:localanesthetics@yahoo.ca  M.Sc. PharmD. CCPE.

Dentistry in transition! At face value this is a rather positive impact statement, given the general opinion held by the populace at large. However one must admit there are certain phrases, which our thought processes will not allow our brains to compute. It is like the parent being ambivalent about their kid’s promotion to a higher grade, yet being well aware Johnny’s skills are realistically one or two grades behind. There is the standard form letter, which accompanies this report card. ”It would be psychologically damaging to the kid if we had a ten year old sitting with eight year olds.” That is a fact of life, of which there is little we can do outside of cry victim.  

I accept that. However the term profound anesthesia is a dental term, referred to in any edition of Dr. Malamed’s handbook on local anesthesia or any other similar textbook. It is as explicit as the term pregnant. One is either pregnant or not.  My question obviously then is, why do we hear the explanation, “were it not for the dream team, O.J. would not be playing golf today”. There is an assumption that being completely numb, is like picking a lotto ticket or a good lawyer. To put it bluntly, a hypothesis consists either of a suggested explanation for a phenomenon or of a reasoned proposal suggesting a possible correlation between multiple phenomena (Wiki). 

For a dentist to truly eliminate residual sensation or even the slightest evidence of pain to the patient requires a pharmacological intervention which is achieved by reversing the polarity charges across the nerve sheath and by so doing, will block sodium transport. In a nutshell that is how the dentist freezes you. There is no magic; smoke, mirrors or even cartridge warmers. In fact, nothing other than the skill and the years of training and understanding certain biochemical interactions and of course the anatomy of one’s mouth. Some dentists can also arrive at the end result, (namely your comfort), by using other techniques to block sodium transport in either one specific area or to one or all quadrants of the mouth. This can be achieved at one sitting.  

For those patients who still suffer through a dental appointment, you should seek out one of the many thousand of dentists who have mastered that technique. Remember you are either pregnant or not. The same rule applies for being frozen. Now to be fare, the patient can be confused and equate pain with pressure. Pain is felt along the nerve, it is persistent and very recognizable. On the other hand pressure is transient. Its can quickly disappear as it appeared. Pressure will not follow you home and the slight soreness will disappear even without medication in most cases. However, one must accept that we are dealing with variables. Anatomical variables compounded by the ever presence of Murphy’s Law can and does throw a spanner in the works. There will be those challenging days in any dental operatory. 

Ah! Think of the beauty and the protection for our teeth. Never has our world been so versatile as it is today. Times were when people conversed, it was common practice to place their fingers to cover their teeth or an attempt to conceal mal odor. Dentists have collectively deleted that era with their skills of art knowledge of gum disease. Especially at this time of the year where folks get together to celebrate, it is the confident radiance of wide smiles across the room as though they were saying, “look at the work my dentist did”. These smiles are as fashionable today as it is to tote around a 450 ml of Evian water. Let us not change that trend. The patient must be frozen. Not only soft tissue. 

However what continues to be unexplainable is the ever-increasing incidences of trauma resulting from achieving profound anesthesia. This is the conflict that one has to deal with when they hear the term “Dentistry in transition”. As one popular dentist explained this scenario to me, “It is this expanding team based reconstructive approach which mandates the use of convergence technologies in order to ensure timely and accurate continuing education. His final tip was to concentrate on moving records, not patients.”   

If this terminology is aimed at a trend towards cosmetic dentistry and away from the traditional drill and fill, it does not negate the increasing failure to achieve profound anesthesia and the accompanying problems of physical trauma. It should never be a question of how much pain is the patient willing to endure to finally toss the bed-side glass with their dentures to have a permanent set of implants. Pain should never be a bargaining factor. Of course there is a price to be paid, but the patient has already made that decision, whether it be Whitening, Bonding, Porcelain veneers or crowns. The objective should be the same as it was in dental school when you delivered your first ever injection to a fellow student and he/she reciprocated. You made sure you did not cause pain to your buddy and that you did indeed freeze your fellow student. If this situation has changed and failures seem to be on the increase, what has changed?  Is it the converging technologies and the accompanying stress of entering un-chartered waters? Why is this? The ability to achieve anesthesia should not be relevant. 

At any addictive or compulsive behavior center, your first bit of advice one receives is that you are on your way to recovery simply by admitting there is a problem. If this problem is on the rise it may be completely out of your hands, however it still has an impact on your daily activity and unfortunately in dentistry, the denial to communicate will continue to fray that weak spot on the line and one day it will snap. 

Andy Warhol is credited with the following: “An artist is somebody who produces things that people don’t need to have”. Dentists are frequently referred as being artist. Earlier I referred to the beautiful smiles by which we are surrounded today. However there is no need to have to go through hell to acquire this. The action potential of local anesthetics and other agents are the domain of bio-chemistry and pharmacodynamics. While respecting the inevitable convergence of technologies in dental offices in this dynamic profession and life styles, Be kind, take your time. “It sure was good while it lasted”. Now it’s time to pay the piper. It’s all over but the crying. Too late to do anything but moan about it now.” (Chris Kristofferson.)

Contact us at localanesthetics@yahoo.ca  M.Sc. PharmD. CCPE   Please visit WWW.AnestheticsNews.com  Tel. 905-597-5688