No more needles? Nasal spray anaesthesia in dentistry.

Many patients nowadays struggle with the fear of needles. Often the behavior provoked by phobias hinder or prevent the proper dental treatment, sometimes leading to deplorable consequences. Will the proposed innovative method of anesthesia help to overcome the fears and lead the aichmophobics to a healthy, beautiful smile?

A dentist – doctor Mark Kollar – made a breakthrough discovery in rather unfortunate circumstances. He was tossing hoops together with his friends, till he took a ball into his face. During the subsequent straightening of the nose, the doctor used a spray of tetracaince on the surface of the nasal mucosa. That’s when the dentist realized that his upper teeth have become numb. This has inspired a further research concerning the needleless anesthesia in dentistry obtained with the use of nasal spray.

A study published May 20, 2013 in the Journal of Dental Research indicates that the experimental nasal spray may be equally effective in anesthesia within the jaw as the conventional injections with lidocaine. Spray which had been developed by St. Renatus of Fort Collins, Colorado has passed the third phase of the research, giving hope to obtain the approval of the FDA as early as in 2014. Its unique composition was inspired by a mixture of tetracaine hydrochloride and oxymetazoline used in otolaryngology. Along with anesthetic properties, it also reduces the risk of bleeding by its blood vessel constricting properties.

During the second phase of the study the research team examined 45 adult patients and divided them into two groups. The first group received anesthesia using a nasal spray (consisting of three doses of 3% tetracaine hydrochloride, and 0.05% oxymetazoline hydrochloride) and a placebo injection, the second group got a traditional injection with lidocaine (2% lidocaine hydrochloride with epinephrine 1:100 000) and a placebo nasal spray dose (saline). The degree of analgesia was evaluated by applying pressure of 20g/cm3 with the use of a prober at four points:
– distal to the apex of the tooth in the position of the maxillary first premolar at the deepest point in the buccal vestibule
– apical to the maxillary lateral incisor at the deepest point in the labial vestibule
– at the incisive papilla of the hard palate
– at the junction of the alveolar process and hard palate medial to the maxillary second premolar

16.7% of patients in the tetracaine group required additional anesthesia as compared to the control group, in which the number of subjects experiencing pain was 6.7%. The researchers found no significant changes in the heart functioning, oximetry and systolic blood pressure, and only irrelevant variations in the diastolic BP. The side effects consisted only of: serous rhinorrhea, nasal congestion and sneezing, but all the symptoms have passed without the need of any additional treatment implementation.

The great advantage of the spray anaesthesia is the lack of a needle, which makes many patients feel anxious and reluctant to getting any dental treatment. The lack of needles has its additional benefits such as reducing the risk of cross-contamination, the risk pricking with a contaminated needle, and more problematic disposal of sharp objects. Patients undergoing the tests with the use of the nasal spray, did not complain about the unpleasant numb lip and speech difficulty in contrast to a traditional anaesthesia. In addition, it should be noted that the anesthetic given by means of a nasal spray is far less harmful to the kidneys, liver and lungs, as it does not circulate in the bloodstream (according to an article in the Innovation News). Administration of anesthesia by the nasal spray can be a great option for chidren often exposed to the stress associated to the use of needles and a relatively long anesthesia procedure. Moreover, according to surveys conducted in the United States up to 70% of patients would be willing to change their dentist if another one was offering nasal spray instead of needle anaesthesia. Although the debut of the new anaesthetic product is expected further in time, it already managed to gain its popularity among dental patients.

Written by: Maria Bilińska

1.Journal of Dental Research. 2013;92:S43-S48.

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