Scaling and Root planning (SRP) has become an important part of the soft tissue maintenance program of most dental practices, as people are living longer with most—if not all—of their natural teeth.
These people will live happier, healthier lives with a full and solid dentition that enables them to better chew and digest their food. And this also contributes to their overall psychological wellbeing.
SRP requires the administration of local anesthesia if patients are to undergo this treatment in a comfortable manner. One or several injections of local anesthesia are necessary to provide adequate anesthesia per quadrant to be treated. Usually the onset of the anesthesia takes 2-5 minutes and lasts for 2-3 hours post treatment. Some patients don’t mind having an injection, however, most patients would prefer not to receive one; and then there are the patients who are so fearful of a needle that they would do anything to avoid it, including not receiving SRP treatments. Another objection by just about every patient is the 2-3 hour uncomfortable numbness they must endure post treatment. Some patients will forgo SRP treatment because the prolonged post-treatment numbness is not only uncomfortable, it’s disruptive to their busy schedules.
What Is Oraqix?
Until recently, the administration of injected local anesthesia was the only way to provide the necessary patient comfort level for SRP. However, in September 2004 Oraqix,1a non-injectable (approved) for local anesthesia specifically created and designed for SRP, was introduced to dentistry by DENTSPLY Pharmaceutical. Oraqix is labeled as a periodontal gel, although it appears as a liquid in a 1.7 g carpule. Each carpule of Oraqix contains 2.5 % lidocaine, 2.5 % prilocaine in a 1:1 ratio by weight, and thermosetting agents (poloaamen 188 purified, poloxomer 427 purified Hydrochloric acid [ph adjustment] and purified water). It is the thermosetting agent that enables the liquid anesthesia to become a gel at body temperature.
So How Does It Work?
Oraqix is different from conventional injectable local anesthesia in how it works and how it is applied. Conventional local anesthesia is injected into the attached gingival tissues above the apex of each maxillary tooth to be anesthetized for SRP, or an inferior alveolar and long buccal mandibular block for the mandible quadrants. In each case multiple injections are required. Usually onset of anesthesia is 2-5 minutes. However, the surrounding areas of the dentition, in addition to the teeth to be treated, are also anesthetized and remain so for up to 2-3 hours post treatment.
Oraqix is applied into the periodontal pocket (only the teeth to be treated), through a specific blunt tip applicator. The application is absolutely painless because it is literally depositing a liquid substance into the periodontal pocket. Once into the pocket and exposed to body temperature, the liquid becomes a gel with a 30-second onset of anesthesia. None of the surrounding tissues, except those of the periodontal pocket, are affected. And the duration of the anesthesia is 20 minutes.2 One to two carpules are required to anesthetize an entire quadrant. Additional anesthesia can be applied as needed, up to 5 carpules, with no adverse affects.3
With Oraqix, a patient can receive SRP treatment comfortably without an injection and without postoperative numbness, as it will totally dissipate in approximately 20 minutes.5 It should be understood that Oraqix may not provide adequate comfort for every patient, and it will not replace conventional anesthesia, which is required for restorative or surgical procedures. But because it is specifically recommended for SRP use only, it will be useful and desired for most patients that require SRP therapy. Why? Because most patients, if they can achieve adequate comfort during SRP without an injection and without prolonged numbness, will choose not to have traditional injected local anesthesia.
It is a great service to the patient, a great benefit to the doctor, because Oraqix is a non-injectable anesthesia and can be administered by a certified dental hygienist, and for SRP procedures the dentist does not have to leave his or her operatory. However, the greatest benefit is that new patients who require SRP procedures, but are deathly afraid of the needle, will be able to undergo the SRP therapy comfortably and without fear!
Although specific on label use for Oraqix is for SRP therapy, there are also some off label uses such as gingivectomies, cord placing, or laser troughing of crown preparations on endodontically treated teeth. It may also have a use for small biopsy removal.
Conclusion
Oraqix, which was specifically created for SRP procedures, provides immediate onset, adequate anesthesia that will last for 20 minutes. Because it is a non-injectable anesthetic it will be the preferred anesthesia for patients who are fearful of needles and those who prefer not to have the uncomfortable 2-3 hours numbness post-SRP treatment. Because providers and patients haven’t got time for the pain!
References
- Friskopp, Nilsson and Isacsson J Clin Periodontal, 2001 28: 453-458
- Same as # 1
- Friskopp and Huledal J. Clin Periodontal 2001: 20 425-429
- Donalson, Gelskey, Landry, Matthews and Sandhu
- Friskopp, Nilsson and Isacsson J. Clin Periodontal 2001: 28 453-458