Forums › Erbium Lasers › General Erbium Discussion › what percent of your patient get numb?ow numb do
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PatricioSpectatorI was watching Emeril Live the other night and he was talk about the difference between a receipt and a formula in cooking. I began to wonder if the difference between those who get 90% plus teeth adaquately numb with the laser and those more into the 50% area has to do with moving from a recipe(watts and settings) to a formula(ingredients and getting the right mix at the right time).
I thinking about what we do here to establish confidence and trust in our patients. The way we get to know most of our patients on a personal level and work to create a mind set in all we do for them of a comfortable pain free environment. We have worked hard to develop a reputation over the years of being gentle.
Chairside body language and staff interaction along with getting in step with the patients mannerisms and the rate at which they can be challenged with any given procedure and then working within that rate.
I do not expect it to hurt the patient in fact I tell the patient I am not allowed to hurt them. Most are confident in this and work with me tolerating some reasonable discomfort knowing they can stop me at any time as we work together. We proceed in a manner which monitors any discomfort and adjusts for it early.
The whole formula in an office taken together, the ambience, the reputation, the approach and the mechanics of care all create a success mode which delivers in our particular case over 90% success for routine restorative and periodontal treatment. Some are better than 90%.
Point is I think the sensitivity problems are most often formula problems and not watts and settings. I am wondering if this is why it seems to me I get good anesthesia at 1.5w for most teeth and the reason why there doesn’t seem to be a recipe for success which works for every one expecially newbies trying for 100% laser anesthesia. It is not what you have it is the way you present it that makes for the greatest success.
OK! let me have it guys.
PatI c
smileagainSpectatorGreetings Pat
Great letter- my feelings exactly re: patient comfort. Patients are told in my office that they will “feel nothing.” I am not sure that I am able to accomplish this w/ the laser. I have a Waterlase and wonder if I was taken in by the marketing!? You say that you can get anesthesia at 1.5W – what do you mean exactly by this? Do you feel confident that you can do a preperation without the patient feeling anything?
With thanks, Jerry Rosenfeld, DDS
Robert GreggParticipantDang Pat, you’re deep!
I’m with you all the way on this as well. I like your parallel thinking.
Lasers have made me appreciate my clinical practice in ways that others find very……different.:confused:
Bob
SwpmnSpectatorEmeril is the man! My favorite quote, “I don’t think people should be eating to live, I think people should live to eat!”.
Realistic, “wet-gloved” expectation for most of us to prep un-anesthetized patients with an Erbium laser: 50%.
That’s about what I’ve found after almost two years. The “Defocused Technique” where you bathe the tooth for 60-90 seconds at high settings helps somewhat. Others may strongly disagree with me.
Couple of examples:
This morning, preparation of #11 disto-lingual Class III composite with laser. Theoretically, this should be an easy tooth to anesthetize, right? Clinical requirement to complete restoration: 3 carpules of anesthetic.
This afternoon, Class V preps on #21 and 28. Theoretically, one would expect these preps to be sensitive and more difficult to place without local anesthesia. None was required.
My point is, just like today, placement of restorations using the laser without anesthesia is unpredictable. Many factors are involved and I believe the most important factor is the patient. Personally I believe the majority of patients who can tolerate laser composite preps are probably the same patients you could prep unanesthetized with a high speed handpiece.
Al
Glenn van AsSpectatorHI guys: great posts. I did several things to help me with patients and sensitivity.
First I acknowledge that most patients will feel something. This pain in most cases is tolerable but it is there.
I ask them if they feel something typically a cold sensation or discomfort to raise one finger (not their middle one I tell the adults) and on a scale of 1-5 for the pain tell me how bad it is. If they get to 4 or 5 then I lower the settings, desensitize more or evaluate how much further I have to go.
I had to numb someone up today after I finished the first occlusal on a 15 year old male the second one I had to numb up.
In another kid he told me he didnt want the laser……it took too long he told me (he had it before around a year ago). This was the first time anyone had complained about time.
In closing another thing I do is use the rubber dam with alot of patients even without anesthetic except one touch topical from Hagar and I often will tell the patient that if they can stand the clamp on the tooth that they wont need a shot ……..I phrase it like that or I say the needle.
They often take a sigh afterwards knowing that for them the worst is over and they will be ok.
I can tell you that the second time around most laser patients are a breeze, its the newbies that require alot of TLC and explanation.
In closing the scope and watching the procedure really helps as they know how much longer they have to go and disassociate themselves from the process when they are watching.
Just some ideas but in closing Pat , Dr. Don Coluzzi told me years ago to put the anesthetic away, as we are taught in dentistry that whenever the patient feels anything when we numb them that we need more anesthetic and most patients will feel something but verbal skillls confidence in the technology , knowing a few tricks of the trade all help to increase the success rate.
Glenn
2thlaserSpectatorOk, time for me to “chime in”. I agree with all of you, pre-verbal desensitization is the first step in successful anesthesia with the laser. Like Glenn, I ALWAYS tell them they WILL feel something. Mostly a “cold” sensation, like ice cream freeze on their tooth. Now, as many of you have heard me say, I haven’t had to anesthetize anyone since last Feb. for any routine procedures, except about 50/50 on Endo procedures. My staff really is well taught in their verbal skills to work this through prior to my walking into the operatory. Next, I re-enforce those ideas while I set up my laser and it’s settings, right in front of them. Mostly, I try to use humor, it really is the “ice breaker”. Patience, and persistance is the rule here. IF you are patient enough, and persistant, you will gain greater control over your technique, and the anesthetic effect will get better and better, I promise. DON”T RUSH INTO THE DENTIN! You will be surprised how easy it will become. I always say, if you were to wait for the anesthetic, then drill, you have that 10 min to kill. After 2 min of defocused “anethesia” with the laser, and I “chat” with the patient the whole time, guiding them through what I am doing, it is so much faster than the old methods. Another thing, don’t let your assistant keep asking, “are you ok?” every time the patient “seems” to feel something. Let the patient tell YOU. Just remind them once or twice, no need to implant into their grey matter that it SHOULD hurt. That is the old style of dentistry. We laser users are still amazed that we DON’T hurt people, at least I am. Even after a year! And what a year it’s been. I have more to share, but I got to get my son to school, and me to the office. More to come tonight!
My best to ALL of you, you all are wonderful to share in this forum together, thanks!
Mark
PatricioSpectatorJerry,
Thanks for your comments. In the earlier days I was trying to find a way to cut down on the water spray in the front of the mouth and reduce the more pronounced pulsing of the laser at 4-6watts for the patients benefit and mine so I began to use 1.5w at the preset. I belive it is 11% Air and 7% water. I find I can treat well over 90% of all anterior teeth and most bicuspids at this setting. I use 30 to 45 seconds depending upon the patient I am working on and in some cases I go to 60 t0 75 seconds when I know they are squirrely. I generally aim primarily at the cervical but cover the entire facial and in the case of the bicuspid I work either facial or lingual and occlusal. I also enter the work site at 1.5 just long enough to assure myself all is well and to get an idea of what setting I want to use to prep the tooth. I probable proceed a little slower than others at the beginning so as to deepen the anesthesia before i go to the deepest area of the cavity. If I get some sensitivity I immediately go to a small round to decondition the patient and continue to remove the deep decay. This usually works fine and then it is back to the laser again working my way to the more sensitive area at a pace which seem to be within the patients tolerance.
Some patients tell me they feel something cold and some have said a little tingling but all agree this is the better way. I would say it is better to get them numb the first time once they feel more than they want it is more difficult to over come this with more numbing.
Hope this helps to explain my approach.
Pat
smileagainSpectatorThanks Pat for your reply
You answered many of my questions and painted a very nice visual picture
Jerry Rosenfeld DDS
Avon, CT -
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