Vibraject Research

Research and reviews of Vibraject:


Investigaciones y revisions de Vibraject:


Forschung und Überprüfungen vom Vibraject

Efficacy of a vibrating dental syringe attachment on pain levels

Murray et al (Queens University Belfast 2006); Study using 400 subjects to test the effectiveness of Vibraject in reducing the discomfort of intra-oral injections. Discomfort more than halved when Vibraject used.


P. MURRAY, K. TERRETT, E. LYNCH, and D.L. HUSSEY, Queen's University of Belfast, United Kingdom
Aim: To assess if a commercially available vibrating dental syringe attachment, VibraJect LLC (USA), could reduce pain experienced by patients having intraoral injections for dental treatment.
Methods: Patients selected for the study were due to receive a routine dental injection as part of their treatment. The patients fell into two groups. Group A received one injection using the vibrating dental syringe attachment. Group B, the control group, received one injection using conventional methods. The patients were then asked to grade the injection pain using a visual analogue scale from 0-10. Zero was marked as no pain up to 10 as unbearable pain. The site of injection, the type of injection (infiltration or IDB), the operator and the pain score were all noted for each patient. No other pain relief adjuncts, such as topical anaesthetic gels, were used on any of the patients. Results: Subjects receiving the conventional injection methods had a mean pain score of 4.6 (± 0.414) The VibraJect group had a mean pain score of 1.71 (±0.235)(P<0.05). Certain sites had larger decreases in the mean pain score using the VibraJect. These included the upper anterior segment infiltrations and lower right IDB injections. Conclusions: The vibrating syringe attachment resulted in reduced pain levels on receiving intraoral injections.
Abstract ID#: 36945 Password: 187001 Submitter's or presenter's Email: e.lynch@qub.ac.uk

First Author

Presenting
P Murray Oral Health Research Centre Queen's University of Belfast RVH Belfast, BT12 6BP United Kingdom Phone Number: 00442890250403 Email: e.lynch@qub.ac.uk

Second Author

K Terrett Oral Health Research Centre Queen's University of Belfast RVH Belfast, BT12 6BP United Kingdom Phone Number: 00442890250403 Email: e.lynch@qub.ac.uk

Third Author

E Lynch, BDentSc, MA, PhD Restorative Dentistry Queen's University of BelfastSchool of dentistry Grosvenor Rd Belfast, BT12 6BP United Kingdom Phone Number: +442890240503 Fax Number: +44 2890438861 Email: e.lynch@qub.ac.uk Membership Number: p338465

Fourth Author

David L Hussey Oral Health Research Centre Queen's University of Belfast School of Dentistry Grosvenor Road Belfast, BT12 6BP United Kingdom Phone Number: 44-2890 240503 Fax Number: 44-2890438861 Email: e.lynch@qub.ac.uk Membership Number: P19613

VibraJect® Dental syringe gate-theory vibrator

Needle Phobia Information Centre report 2009; 'The Vibraject system does what it says it does… The NPIC would like to see this become the standard of care in dental offices'.


Review by the Needle Phobia Information Centre (15/08/2009)

Description: The VibraJect device is a very interesting implementation of the Gate Theory - it reduces pain from dreaded dental injections by vibration. It is a miniature vibrator that snaps onto a dental syringe. The intense vibration overwhelms the patient's nerves and therefore 'distracts' the brain from perceiving the lower-intensity signals coming from pain nerves. The patient feels vibration rather than pain.

The VibraJect system is not a substitute for dental local anesthesia injections. Rather, it helps the patient tolerate anesthetic injections. Many needle phobes will tell you that they fear the pain of dental injections more than dental procedure pain. The VibraJect system was developed to solve this dilemma.

The VibraJect system consists of the vibrator, a set of rechargeable batteries, a battery charger and printed instructions.

Review: the first thing you notice when you turn on the VibraJect is just how intense a vibration that this tiny little device can generate. WOW! Its immediately easy to see how it works. The manufacturer claims (backed up by clinical studies) that the device offers more pain blocking than dermal anesthetic paste which is the current standard-of-care.

When we first tried it we ran into our first problem - the dentist said that his technique is so good that such a device is simply not necessary. Overcoming such professional arrogance is a big challenge facing the manufacturer of this product.

"I insist" said the Keith Lamb, the NPIC director. Mr. Lamb is admittedly hyperalgesic (unusual pain sensitive) so it was difficult to overcome the perception of the needle pain. Still, the manufacturer's claim that it is as good anesthesia paste seems to hold true. The super-intense vibration of the needle in one's gum is a bit hard to get used to. The last thing patients want to feel is someone moving the needle around...that is, except pain.

The VibraJect system does what it says it does. Given how fearful we all are of dental injection pain, give us topical paste AND VibraJect AND very very slow technique. Bring it on, Dr. Dentist, we want it all.

Cost and Availability: the VibraJect system is marketed toward dentists, not patients. Therefore it suffers from the most common problem that needle phobes face when it comes to anesthesia - availability. You can't simply buy one from a pharmacy or over the internet. If you want this treatment, you will need to ask your dentist. If enough patients ask (demand?) it, perhaps it will become a standard treatment.

To the VibraJect manufacturer - we'd like to see a way that a patient can buy this (from your web site?) and carry it with him to the dentist office, preferably without a prescription but even a prescription requirement is acceptable to us. The patient can then tell the dentist that they must use this device. Just knowing that the patient can control this feared aspect of the dental visit can bring them a great sense of relief even fore the needles come out.

Summary: The VibraJect system is a quick and effective non-drug topical dental anesthesia device that requires virtually no training.

The NPIC would like to see this become a standard-of-care in dental offices.

VibraJect vs. the Wand for the control of injection pain

Vibraject vs. the Wand Quarnstrom et al. 2005. No statistically significant differentce found between the effectiveness of the two systems.


ABSTRACT

A VibraJect device was compared to a computer controlled injection device to control pain for injection of local anesthesia. This study was performed in a general dental practice. Nineteen injections were done with the Wand handpiece of the CompuDent ™ system by Milestone and seventeen with the VibraJect by VibraJect LLC. Twenty-four were maxillary infiltrations twelve were mandibular blocks. Patients reported the level of pain for the needle piercing their tissue, the injection of solution, and their overall evaluation of the injection. No difference was seen for piercing the tissue, injecting the solution or overall report of pain.
DISCUSSION

Two different techniques were used to control the pain of local anesthetic injections. No difference could be shown between the two. When the practitioner compared the two different techniques, the Wand is a lightweight probe attached to a computer controlled injection device by a thin plastic tube that carries the solution to the wand. A foot pedal controls the device. It takes a few injections to get accustomed to the foot pedal. This device allows two speeds of injection only the slow speed was used. It is also possible to aspirate by taking your foot off the foot peddle. The VibraJect was clipped to the syringe body and requires little if any change from the normal injection technique. The body of the vibrator should be oriented so it does not rest on the patient's teeth.
CONCLUSION
This study tends to indicate there is little difference in the pain perceived by a dental patient when injected using the Vibraject as opposed to injecting with the wand.

by Fred Quarnstrom, D.D.S. F. A. S. D. A., F. I. C. D., F. A. G. D. Diplomate, American Board of Dental Anesthesiology Diplomate, National Board of Dental Anesthesiology Sun Hee Bang-Pastore, D.D.S. Ruth Woldemicael, D.M.D. David Chen, D.D.S.

A Relatively "Painless" Way to Avoid Pain

Andrew, S. N.; Comparison of Vibraject, the Wand and Quicksleeper systems


Nancy Andrews, RDH, BS

Most dentists will agree that of all the services that can be performed for patients, eliminating the fear and pain associated with anaesthesia would perhaps be at the top of the list, while also removing significant stress from clinical practice. Some clinicians, however, honestly think their injections are painless, explaining that patients never complain. Patients may not complain, but that may be because they do not expect a truly “painless” injection. The question is, can they learn to expect painless injections? A small percentage of patients do not consider injections painful irrespective of the technique used. A similarly small percentage of patients interpret all injections performed—regardless of the technique used—as excruciating. Most patients, however, fall somewhere in between, ranging from those who feel pain and hate or fear injections but tolerate them, to those who rarely feel pain and are generally relaxed and comfortable with injections. The purpose of this article is to present methods to move patients into the latter category.

THE IMPORTANCE OF PAINFUL INJECTIONS

Most undesirable reactions to injectable local anesthetics are a response to the act of injecting the drug, not the drug itself.1 Syncope and hyperventilation, possibly resulting in medical emergencies, are the most common psychogenic reactions.2 Pain associated with injections is attributed to needle insertion/manipulation and drug delivery/deposition in tissue.3 Dealing with fearful, anxious patients is the most commonly reported challenge in controlling pain.4

ABOUT 50% OF PATIENTS CONSIDER INJECTIONS PAINFUL AND FEAR THEM.

Fear of dental injections contributes to postponement of dental treatment. About half of patients questioned consider injections painful and are fearful of them. More than 50% of non-attending public have phobia of dental pain associated with dental injections, and 90% have at least mild anxiety about receiving an injection. Other factors that reduce patient acceptance of dental treatment are a dislike of prolonged numbness after treatment and uncomfortable numbness of patients’ lips and tongue.2

STRATEGIES TO REDUCE, BLOCK, OR MASK INJECTION PAIN

There are three aspects of injections that elicit pain: initial needle penetration, advancement of the needle to the injection site, and injecting the drug. There is also one “wild card”: fear, or preconceived beliefs about pain and/or risk of injections.

Applying a topical anesthetic before injection is the most popular way to control initial needle penetration pain. Conflicting study conclusions and anecdotal information on the effectiveness of topical gel in preventing needle insertion and manipulation pain suggests that topical gels can be effective, but the duration of action may vary from 5 to 40 minutes.5 Patient reactions to taste and the time spent waiting for the topical to take effect may be negative outcomes. Concerns about toxic sequelae and adverse effects related to the amounts of drug absorbed through the mucosa suggest that alternative means of injection pain control are desirable.

Transcutaneous Electrical Nerve Stimulation (TENS) devices are reportedly well accepted by some patients in lieu of topical anesthetics in clinical studies, but require additional time, may not be effective on phobic patients, and are less commonly used.3 Sharp needles have been shown to cause less pain and trauma than dull needles. Because it is common to give at least several successive injections, the very simple technique of changing the needle after two or three injections will reduce immediate and/or recovery pain.

Visual, auditory, and tactile stimulation is another technique for distracting the patient’s attention. Manually shaking the patient’s cheek is a crude method of creating such a pain-masking sensation and can be effective, but may be inconsistently so. While cheek shaking may effectively distract the patient’s attention, aggressive cheek shaking may leave the cheek sore or bruised.

Giving "slow” injections allows time for the anesthetic to precede the advancement of the needle and for more passive flow of the anesthetic through tissue, thereby reducing tissue tearing and associated pain. This technique is a pillar of virtually all clinical instruction strategies for manual anesthetic injections, but a slow injection may vary significantly between clinicians as well as in each clinician’s hands from one time to the next. Demanding schedules may also not always allow injections to be given slowly enough to completely avoid pain.

Electronically controlled devices meter out the anesthetic slowly, overcoming inconsistent hand pressure and variations in perception of time or pressure-resistance. If time allows, these devices have been shown to be consistently effective and increasingly popular. According to Dr. Stanley F. Malamed, professor of anesthesia and medicine at the University of Southern California School of Dentistry, “Any intraoral injection that a dentist finds uncomfortable for a majority of patients can be administered more comfortably using a computer controlled system.” 4 Patient perception of alternative technology designed specifically to reduce pain may also add a placebo effect with some benefit.

There are several electronic devices that employ microprocessors to control the volume and pressure of local anesthetic delivery. The Comfort Control™ Syringe (CCS) (Dentsply/Professional, York, PA; Figure 1 View Figure) and the CompuDent™ (formerly the Wand™, Milestone Scientific, Livingston, NJ), both rely on slow anesthetic delivery to reduce pain.

CompuDent uses a floor foot pedal to initiate the flow of anesthetic through long tubing to the handpiece at a rate and pressure designed to be below the patient’s pain threshold. The handpiece is held in a pen grasp designed to facilitate greater tactile sense and control and easier rotation than the traditional syringe grasp. The pre-puncture technique incorporates the bevel of the needle on the tissue, the pressure of a cotton-tipped applicator applied to the end of the needle forcing anesthetic into the tissue, and then the slight rotation of the needle to pierce the tissue. The anesthetic pathway is developed by penetration and slight rotation of the needle through previously anesthetized tissue. Once the needle arrives at the injection site, the delivery of the anesthetic is below the patient’s pain threshold (Figure 2 View Figure).

The CCS has a two-stage delivery, beginning at a slow rate, automatically increasing to a preselected rate after 10 seconds. Five injection rates are available.

Both electronically controlled devices are usually used with topical anesthetics. They both require less force, resulting in less needle deflection and easier needle rotation. Both devices require electrical outlets, and room for the control units. Methods that rely on slow anesthetic delivery are technique-sensitive, require more chairtime per patient, and therefore increase the cost of treatment. Despite the cost of these devices and time pressures many busy practitioners face, the value of removing or significantly reducing injection pain is worth the investment for many devoted customers.

THE GATE CONTROL THEORY

The brain’s ability to perceive only one sensation at a time gives rise to the strategy of causing a sensation other than pain that supersedes the sensations generated by the injection. Techniques or devices that create pressure or vibration have been shown to inhibit painful sensations if they stimulate the appropriate nerves prior to or at the same time as painful stimuli. The patient perceives only pressure or vibration because those sensations block the pain signal. The gate control theory refers to a physiologic phenomenon rather than a simple distraction, but the two may exist at the same time. A mechanical device is available that performs this vibratory action very effectively and consistently. VibraJect® (ITL Dental, Irvine, CA) is a small battery-driven motor that vibrates at 10,000 cycles per minute and attaches to standard syringes with autoclavable clip-on motor brackets (Figure 3 View Figure). The vibration feels slight to the operator, but is precisely designed to stimulate nerves so that the pain threshold is raised and the injection is imperceptible to most people. It snaps onto most syringes and requires virtually no extra time or space. Some clinicians hesitate to use such a device, because they consider the gate control theory an unproven idea, and view the technology as a simple distraction that might get in their way. Other concerns are that the vibration might affect the operator’s tactile feel or alarm the patient; however, motivated clinicians report overcoming these concerns quickly. When the VibraJect is used on traditional syringes the speed of the injection is controlled manually and slow injections are recommended. The VibraJect may also be used with the CompuDent for virtually undetectable injections, according to the manufacturer’s literature.6

The two sensory cells in the oral cavity most likely associated with the pain reduction phenomenon created by vibration like that generated by the VibraJect include free nerve endings and mechanoreceptors, or tactile nerves. Free nerve endings, which perceive temperature and pain, have no myelin sheath and respond with relatively low intensity and speed. Tactile nerves are larger, insulated with myelin sheaths, and respond with higher speed and intensity. These nerves transmit tactile sensations of pressure and vibration. The rapidly transmitted pressure and/or vibration messages reach the brain first, thereby preventing pain signals from being perceived.

CONCLUSION

Eliminating painful injections is worth considering—even if patients rarely complain. Fear of painful injections contributes to postponement of, and may reduce patient acceptance of, dental treatment as well as contributing to the stress of practicing dentistry. Giving comfortable injections is unquestionably a skill and a source of pride for those who have mastered it. Being able to depend on painless injections is appealing for obvious reasons, including the probability of attracting more patients.

The Comfort Control Syringe (CCS). The Compudent System (Image courtesy of Milestone Scientific). The VibraJect device. (Image courtesy of ITL Dental). Nancy Andrews, RDH, BS Educational Consultant Laguna Beach, California
Figure 1 The Comfort Control Syringe (CCS).

Figure 2 The Compudent System (Image courtesy of Milestone Scientific).

Figure 3 The VibraJect device. (Image courtesy of ITL Dental).

Nancy Andrews, RDH, BS
Educational Consultant, Laguna Beach, California

REFERENCES

1. Daublander M, Muller R, Lipp MD. The incidence of complications associated with local anesthesia in dentistry. Anesth Prog. 1997; 44(4):132-141.

2. George M, Niessen L. Stop the pain—assessing patients’ anesthetic options for nonsurgical periodontal therapy. Woman Dentist Journal. 2005;3(5):24-30.

3. Quarnstrom F, Bang-Pastore SH, Woldemicael R, Chen D. VibraJect VS. The Wand for the control of injection pain. Available at: http://www.itldental.com/Vibraject_vs_wand.php. Accessed September 26, 2006.

4. Goff S. Care with Comfort: DPR Exclusive Anesthesia/Sedation Survey. Dental Products Report. October, 2006:34-44.

5. Yagiela J. Safely easing the pain for your patients. Dimensions of Dental Hygiene. 2005;3(5):20-22.

6. VibraJect Web site: http://www.itldental.com. Accessed September 26, 2006.

Reproduced from 'Inside Dentistry' Jan 2007

What’s the Buzz?

Question: What’s the buzz about anesthesia?
Answer: VibraJect.
It has been quite a while since the days of “Painless Parker,” and dental anesthesia has come a long way in being a more comfortable procedure. Key to that advancement has been the use of a vibrational device attached to the anesthetic syringe.



Howard S. Glazer, DDS

The brain recognizes changes in pressure and temperature and translates that information into pain. Furthermore, the brain can handle only one impulse at a time. To compensate for the puncture the syringe needle makes through tissue (read as pain), many dentist use the “wiggle and jiggle” technique when injecting into the mucobuccal fold, hoping this action distracts the patient. Such distraction causes the nerve endings to sense only the vibrations and not the sensation of the pressure associated with the injection.

A vibrational device attached to a syringe uses this same concept of tricking the mind to recognize only the sensation caused by the “wiggle and jiggle” vibrations. The VibraJect® R3 (Miltex, Inc, York, PA) offers a simple and easy-to-use solution that can anesthetize patients quickly in a more comfortable manner (Figure 1 View Figure and Figure 2 View Figure). Use of this two-piece device is simple: Just clip the VibraJect motor unit (a small battery-operated unit) onto the barrel of a conventional and/or intraligamentary syringe, turn it on, and use any standard technique for injecting the patient.

Not only is this device ideal for “normal” patients, but even more so for those patients who have a phobia of dental injections. The device also can be used with pediatric patients 5 years of age and older (as recommended by the manufacturer). In almost all cases, the need for topical anesthetic is eliminated, which saves time and money. A key point to remember when attaching the clip is that it must not cover or touch the anesthetic cartridge.

The system is useful with all types of routine dental injections. Typically, the most painful area for the patient to endure an injection is the palate. This, of course, is because the already taut tissue is stretched further when a bolus of anesthetic fluid is introduced, causing a great deal of pressure. The VibraJect enables a less painful palatal injection because it delivers small amounts of anesthetic solution over a period of time.

To anesthetize the mandible, most dentists were taught to use a regional block technique. While this technique is viable, three adverse effects are associated with the procedure: the risk of “missing” the site (ie, the area surrounding the inferior-alveolar canal orifice), second, the risk of paresthesia, and third, the patient’s lip and tongue may remain numb for several hours, thus impeding the ability to speak and function in a work or school environment. This author no longer gives traditional mandibular block injections. Following is a technique for mandibular injections that helps to eliminate these adverse effects and provide a positive experience for patients. The technique can be used for maxillary injections. In both instances, the technique relies on a very slow drip deposition of anesthetic fluid and using vibration, via the VibraJect.

VibraJect Injection Technique
Supplies

Conventional aspirating syringe (Miltex, Inc) for maxillary injections
N-Tralig® (Miltex, Inc) syringe for mandibular injections
VibraJect R3
Articaine hydrochloride 4% with epinephrine 1:100,000 (Septocaine® Gold, Septodont USA, New Castle, DE)
30-gauge, extrashort hypodermic needles (Septodont USA)
Mandibular Technique
Step 1: Approach the midline of the buccal sulcus with an N-Tralig syringe with a 30-gauge extra-short hypodermic needle, loaded with Septocaine Gold. Clip the VibraJect onto the barrel, close to the hub of the syringe. The syringe should be vibrating.

Step 2: With the long aspect of the bevel of the needle parallel to the long axis of the tooth, begin a slow drip (2 to 4 drops) of anesthetic fluid when approaching and entering the buccal sulcus.

Step 3: After entering the sulcus, slowly drip anesthetic fluid until resistance is felt at the periodontal ligament.

Step 4: At the periodontal ligament, deposit another 2 to 4 drops while penetrating slightly beyond the ligament.

Step 5: Next, repeat Step 1 through Step 4 for the mesiobuccal and the distobuccal aspects of the tooth, remembering to inject slowly.

Step 6: Approach the midline of the lingual sulcus. Again, have the long aspect of the bevel of the needle parallel to the long axis of the tooth and slowly drip anesthetic fluid when approaching the sulcus.

Step 7: After reaching the lingual periodontal ligament, slowly deposit another 2 to 4 drops of anesthetic fluid while penetrating slightly beyond it.

Step 8: Repeat Steps 1 through 5 for the mesiolingual and distolingual aspects of the tooth, remembering to inject slowly.

Maxillary Technique
Step 1: Attach a 30-gauge extra-short hypodermic needle loaded with Septocaine Gold onto an aspirating syringe. Clip the VibraJect onto the barrel close to the hub end. The syringe should be vibrating.

Step 2: Approach the mucobuccal fold in the apical area of the tooth with the long aspect of the bevel parallel to the long access of the tooth, and slip the tissue over the bevel by elevating the lip and slowly deposit only a few drops of anesthetic fluid.

Step 3: For the palatal injection, again approach the palatal surface near the approximate apical root end of the involved tooth with the long aspect of the bevel parallel to the long access of the tooth.

Step 4: Puncture the tissue, and slowly deposit only a few drops of anesthetic fluid.

Tips

Recharge the batteries overnight; do not leave the batteries in an unplugged charger.
Do not autoclave the motor unit; simply wipe it with any cold sterilizing solution.
The first time a patient says “ouch,” it is time either check the technique and/ or recharge the battery.
The injection should be a very slow drip technique.
A Benefit to Patients and the Practice
Undoubtedly, an extra benefit is the practice building that will result when patients tell family and friends about their painless injections. This technique also saves time by eliminating the time it takes for topical and block anesthesia to take effect. With this technology, dentists can treat multiple quadrants, often eliminating the need for additional appointments. This time savings also has economic benefits, creating time to treat an additional patient each day and ultimately adding to the practice’s bottom line. After becoming comfortable with this technique, dentists will be not only high-tech, but also making happy, loyal, and referring patients.
vibraject anesthetize patients vibraject anesthetize patientsThis article was written by Howard S. Glazer, DDS.

Figure 1 and Figure 2 VibraJect® R3 offers a simple and easy-to-use solution that can anesthetize patients quickly in a more comfortable manner.

Reproduced from 'Inside Dentistry’ Vo l6 No 9 Dec 2010
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