I’m Feeling That Good Vibration

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FIRST OF ALL, a big welcome back after the holidays, and I hope that all my loyal readers had a happy and healthy New Year! To start our new year off, we are going to do a . . . PRODUCT REVIEW! Every once in a while something innovative catches my eye, something that really spikes my interest, something that I feel will be a simple meat-and-potatoes addition to my practice. What I mean is, something that I can add to my everyday practice routine that is reasonably priced and will be a benefit to me and ultimately to my patients. In 2009, at the Greater New York Dental Meeting, I passed a small booth introducing a new product, a vibrating dental wand to augment the dentist’s injection technique. Since I have been using an instrument called the VibraJect and have had some degree of success with it, I thought that anything similar was worth a look.

The product wasn’t even ready for purchase yet, but after hearing a description of it and an explanation of the theory behind it, my mouth was watering, and I was eager to try it. Well, about nine months later the wait was over. Thus, ladies and gentlemen, without further delay, I present to you the DentalVibe (Figure 1.)

At first glance, you may think that you are looking at a curing wand or power toothbrush with a forked end, but the DentalVibe is a sleek, ergonomically designed dental instrument to aid in the administration of local anesthesia at all injection sites (mandibular block, buccal, and palatal infiltrations). The instrument weighs less than three ounces and can easily be carried from operatory to operatory. Its slim, lightweight, ergonomically sculpted, and balanced design makes it incredibly comfortable and easy to use. It is finished off with a series of strategically placed finger grips that facilitate comfort and control in any area of the mouth. The design also makes it non-threatening to a patient—who is probably already anxious. It has a charging stand, and a single charge lasts the full day of use (Figure 2). The two-pronged disposable intraoral vibrating tips are easily removed and replaced. These comfort tips are specifically designed with a pressure-sensing feature, causing the unit to shut off temporarily if excessive force is applied during use. The two prongs are fantastic for retraction, and they deliver twice the vibrating effect. It also has a strong LED for intraoral illumination of the injection site.

“So why and how does it work?” you may be asking. Located within the dorsal horn of the spinal cord is a neurological “gate” that can either block pain signals or permit them to travel up the spinothalamic tract to the brain. (The existence of this gate was proposed by Drs. Ronald Melzack and Patrick Wall in 1965.) The sensation (impulses) of touch or vibration travel very quickly along thick, myelinated, A-beta nerve fibers at 75 meters per second. In contrast, the sensation of pain travels slowly along thin, unmyelinated, C nerve fibers at 37.5 meters per second. When the two sensations occur at the same time, the vibrational sensation reaches the sensory area of the brain first, causing a release of inhibitory interneurons, preventing the activation of projection neurons, resulting in a closure of the gate to the sensation of pain. Because the brain can readily adapt to a constant stimulus, negating a closure of the pain gate, the micro-sonic oscillations of DentalVibe’s comfort tips are pulsed in a controlled synchronized wave pattern. Along with enhanced amplitude, the device also sends a soothing percussive or tapping stimulation deep into the oral mucosa, gently exciting the submucosal sensory nerve endings. This pulsed re-stimulation maintains closure of the gate, blocking the pain of an injection. The vibration is also an absolute distraction to the patient.

Does it work? You bet it does! I have been using the DentalVibe for more than two months, and I am happy to report that the majority of my patients have reported less discomfort during anesthetic administration, particularly with mandibular blocks, long buccal, and palatal injections, which can induce the most pain.

The technique is simple. One quick tip: be sure to tell the patient what to expect when using the DentalVibe. Even though the design is non-threatening, a heads-up about the vibration is helpful. A second tip: make sure that the needle is placed and inserted as close to one of the vibrating tips as possible, for this placement will cause the needle to vibrate as well as the tips, which enhances the effect. Gentle massaging of the injection site, through the DentalVibe’s VibraPulse Technology, prevents a swelling of the bolus of anesthetic solution as it is injected submucosally. This causes a dissipation of the solution providing a faster, more profound anesthetic result. So it is important that you not remove the instrument immediately but leave it in place after the injection has been given.

There is a great instructional video on YouTube. To access it, just click here. I strongly suggest that you watch the video for a detailed description of the injection techniques using the DentalVibe. It will give you much greater insight into the device and its use than any verbal discussion could.

So, overall, I give this product 5 stars out of 5, and I feel that it would be a great addition to all of us syringe-slinging hombres.

January - March 2011

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Figure 2