Wednesday, November 12, 2008
Every day in my office, I get people telling of the awful past of dentistry. They recall long, grueling appointments with no numbing whatsoever with smoke coming out of their mouth. Marathon Man the movie in living color. All that has changed over the years. With the advent of amazingly efficient local anesthetics, high-speed electric handpieces, and better materials, dental appointments are more tolerable than ever. Now the complaints about the appointment come later, long after the appointment is over, when the effect of the local anesthetic lingers through the next meal time. In recent years, I have even had people request that I not use a local anesthetic to avoid the hours of being numb. On the road to making patients ever more comfortable in the chair, the new problem then lies in being able to have sufficient local anesthetic to achieve pain free preps, but limit the amount of residual numbness.
While Carbocaine has been a nice alternative, I have experienced that pulpal anesthesia doesn’t last long enough. Its lack of epinephrine is basis for the blessing of a quick return to normal, but is a curse if the appointment goes longer than intended. It would be nice is if someone could invent a way to shut down the local anesthetic as soon as we were done using it, but not before. Enter Novalar.
Novalar is a pharmaceutical company behind a new injectable called phentolamine mesylate, otherwise known as OraVerse™. The chemical is basically a vasodilator. It’s packaged in the same type of carpules that you use every day in your practice. The idea is that you give a normal injection of a local anesthetic to a patient, and toward the end of the appointment, you would give them a second injection of OraVerse. In this case, there would still be soft tissue anesthesia, so there would be no pain from that injection. You would then inject the equivalent of whatever you did for the local anesthetic, for example 1 carpule of Lidocaine = 1 carpule of OraVerse (up to 2 carpules). The phentolamine begins to open blood vessels, and presumably allows the local anesthetic to be carried away.
So how well does it work? Novalar took OraVerse through 20 university and private practice research centers across the country. They did randomized controlled double-blinded studies, on patients ranging from 4 to 92. They found that the median time it took for the patient’s lip sensation to return to normal was reduced by 55% in the maxilla, and by 62% in the mandible. Pediatric patients, age 6 to 11 experienced a 47% reduction in the maxilla and a 67% reduction in the mandible in the time it took to get back to normal lip sensation. As a practitioner, the second statistic was most important to me, since anecdotally it seems that people bite their tongue more often than their cheek. It seems like it might be best to inject the OraVerse before you finalize your temp or polish a composite fill, so that it’s in and working before the patient even gets up from the chair.
Novalar has much more information available to you, such as detailed data of their trials, and the full prescribing information. Of course, as with any drug, it comes with the usual medical warnings and precautions. , But for most people 6 years old and older and that weigh at least 33 lbs., this is a relatively safe medication.
It’s hard to imagine a patient that wouldn’t want to be numb for a shorter amount of time. Like the first time local anesthetics began to be widely used, OraVerse seems to be the newest game changer in dentistry.
(Disclaimer – Dr. Rohde has not used this product, nor recommends it. This report is for informational purposes only. Dr. Rohde is not an employee of Novalar, and does not hold any asset in the company. At the time of this publishing, Novalar is not involved with advertising with Dentalcompare.)