Nasal Spray alternative to Needle?

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2TheApex: Yes!

Last June the FDA approved an anesthetic nasal spray (Kovanaze) for use in restorative procedures on teeth #4 through #13.  It takes two squirts 5 minutes apart (a third squirt may be needed sometimes).  One big advantage, in addition to calming patients with a needle phobia, could be pulpal anesthesia without lip numbness for esthetic cases.  Use for root canal treatment or biopsy has not been studied yet.  Kovanaze is reported to be available sometime this fall.  Recent Study  Manufacturer Press Release

Explanation with diagrams from Spear Education

What’s the best way to avoid post-operative muscle pain for your patients?

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Mouth Prop

2TheApex:  Use a bite block

Whenever a patient can tolerate a bite block/mouth prop, aka “tooth pillow”, we use one.  Since using them routinely, I perceive a decrease in post-op myofascial pain complaints.  And it also makes the access easier and the treatment more smooth when the patient doesn’t need to be constantly reminded to open their mouth.  We explain to the patient that, “We plan to use a mouth pillow for your comfort.  This way you can relax your jaw and you don’t need to hold your mouth open for the entire procedure.  If you don’t like it just let us know and we can always take it out.”  We tie a piece of floss to it so it can be removed quickly if needed.

 

One poke or two??

lokalna-anestezija

2TheApex:  Two inferior alveolar nerve blocks (IANB) are more effective than one in both symptomatic and asymptomatic patients.

A recent article published in the Journal of Endodontics showed that administering 2 carpules of local anesthetic was significantly more effective at achieving profound lip anesthesia.  3169 people participated in the study with failure rates of 7.7% with one carpule, and 2.3% with two carpules of 2% Lido with 1:100,000 epi.  Although this may seem like common sense, it is the first article to show that increasing volume will increase IANB success rates.  This study only examined anesthetic success in terms of lip numbness, not as a pain free procedure.  As we all know, pain can still be present during the procedure even with profound lip numbness. However, adequate anesthesia will almost never be achieved without first achieving lip numbness as a sign of a successful IANB first.

Can you call in a RX containing Hydrocodone?

2TheApex:  Not any more (as of today)

Effective today any medication containing Hydrocodone is Reclassified as Schedule II.  Yes, Hydrocodone combined with Tylenol is now Schedule II.  (Click here for the DEA ruling on this) This means you CANNOT give an oral order for Hydrocodone.  The pharmacy will need a physical prescription brought in to the pharmacy.  Back to writing (or printing) and signing paper again.  No more phoning it in unless it’s an “emergency.”  Click below for the rules in our area.

Wisconsin           Minnesota         Iowa

Weekend pain control after October 6, 2014.  First determine the patients pain level and how they are currently trying to control it.  Sometimes patients are inadvertently doing things to make the pain worse. (Like placing ice on an swelling caused by infection)  Be sure they are taking OTC pain medications properly.  Taking 800 mg Ibuprofen every six hours with an Extra Strength Tylenol (500 mg) staggered between the Ibuprofen can manage most pain we encounter.

Other options:  Call in for Schedule III (Tylenol III) or call Hydrocodone in as an “emergency” and most states will allow you 7 days to get them a physical prescription.

Another medication that works well for dental pain is Ultram (Tramadol) Schedule IV

If you think the pain source is primarily inflammatory a Medrol dose pack can be very effective.

When prescribing, the patient’s heath history is paramount as well as current medications and allergies.  A proper diagnosis is always critical to managing a patient’s pain.

What do you plan to prescribe for a patient, if needed, after hours?