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Professional Courtesy Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine

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Comfortably Numb
– by Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine

Everyone can agree that the ability to provide a comfortable and effective anesthetic injection is one procedure that patients can clearly judge with zero dental knowledge. A few years ago a colleague shared a handout with me from Dr. Steven Kammeyer with the heading "Do you want to get numb?" The pages described the relationship between people having acidic body chemistry from acidic foods in the diet, muscle recovery after exercise and advancing age.

The proposed solution was to ask patients to avoid acidic foods prior to dental appointments and to drink an eight-ounce glass of water with a tablespoon of baking soda the night before and again four hours before treatment. This would neutralize the patient's acidity and provide a favorable body chemistry to allow our anesthetic to be effective. The reasoning behind this information was sound but execution was difficult because patient compliance can be challenging even when the request is in their best interest.

Fast-forward to my April 2010 column "For Dentists, By Dentists," in which I mentioned the imminent release of a new product in the anesthetic market that promises to reduce the familiar "bee sting" that patients feel as anesthetic is injected. The company is Onpharma, and its products are the brainchild of Dr. Mic Falkel. They will officially launch at the Chicago Midwinter Meeting later this month. Onpharma's "Onset" product line consists of a mixing pen, cartridges of sodium bicarbonate 8.4 percent, USP and cartridge connectors. Once assembled, you have the ability to buffer the pH of a carpule of lidocaine with epinephrine in less than 30 seconds.

So what, you say? When the acidic pH of the anesthetic is buffered to be closer to the physiologic pH of the patient, the injection is more comfortable. Additional benefits that the company cannot officially claim at this point are: improved diffusion of the anesthetic, which means fewer missed blocks and more rapid onset of numbness. I was a participant in one of their focus groups and as a result, I had the opportunity to be one of the first dentists to try the finished products.

Dentists are natural skeptics so I immediately put Onset to the test on my staff. Granted, I know the sample size is not significant, but I had a deadline to meet. One afternoon, I recruited three volunteers from my team and gave each of them an infiltration on both sides to see which of the benefits above were perceived by my subjects. The treated carpule was marked on the metal hub and then placed into the syringe and the syringes were mixed so neither the volunteer nor I knew which syringe contained the buffered solution. I also submitted to this test at the hands my anesthesia-certified hygienist.

The test was a success and we ranked the benefits in the following order based on frequency of comments: anesthetic effect was profound and long-lasting, onset of numb feeling was faster and the injection was more comfortable. In spite of the small sample size, I'm convinced enough to continue using this product on my patients and monitoring the results moving forward.

I would be remiss if I didn't address the next most obvious question – how much? There are a number of variables that will influence individual pricing based on quantity of use and volume discounts that might apply. You can expect this process to cost approximately $6 per use. Initially, that number seemed a bit high to me, but I started to think about the time I have wasted on patients with a "hot" tooth, patients who take longer to get numb and others who report problems getting numb with previous dentists. In these cases, I think the cost can be justified. What price do you place on your sanity at the end of a long day? Naturally, I think we will see pricing come down as use of this new product grows and manufacturing efficiencies take root. In my opinion, a cost of $3-4 per use would bring the product closer to universal acceptance.

I would encourage you to consider this product for your own practice by visiting the Onpharma booth at the Chicago Midwinter Meeting, or visit the company's Web site, www.onpharma.com, where you can get answers to all of your questions. Please share your thoughts and comments on Dentaltown.com by clicking on this month's cover image on the home page, locating my column in the online table of contents, and clicking "Add Comment" at the end of this column.

If you have questions or comments for me, my e-mail is tom@dentaltown.com
Dentaltown Magazine
September 2025
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