Forums › Laser Treatment Tips and Techniques › Soft Tissue Procedures › TAC Solution for Topical Anesthesia
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Betty BarrSpectatorI am a pediatric dentist. My sister and I are partners. We have 2 Waterlase. We love the Oraquix for soft tissue topical anesthesia but it is sooo expensive (ŭ a carpule). What do you recommend? I have heard that TAC is good. Are there any complications? What is the actual chemical composition and % of the various components? I very much appreciate your input.
Glenn van AsSpectatorHi Betty, Ron Kaminer can be best for this as he knows alot about the topicals that are available and he has a compounding pharmacy sell some.
I am using EMLA for most things or UltraCare
I know others are using TAC gel or Tricaine Blue
Ron has a DRK liguid gel that he sells which is flavoured as well which may be good for the kids.
I am sure he will post his comments soon but there seem to be alot of different options occuring for topical soft tissue anesthetic for adults and kids.
Glenn
dkimmelSpectatorLido 20% Tetracaine 4% Phenylephrine 2% Plus some secret caries and marginal flavor.
Works great.
Profesional Arts Pharmacy
888-237-4737
Ask for a sample.
Use my name or the Forums name.
whitertthSpectatorDRK Liquid is a liquid topical , comes in Gel as well….that works great… Whites pharmacy in Louisanna sells it…Dog Boudreaux is the pharmacist…( I have no financial interest in it)…iT WORKS GREAT…
Similar to what Dave recommended but it only has 10% lidocaine…studies show it is no more efficaceous at 20% than 10 but systemic affects are possible with 20% lido….DRK comes in three flavors cherry, mint and chocolate….Try it you will love it…(Edited by whitertth at 11:16 pm on Mar. 23, 2005)
whitertthSpectatorDRK Liquid is a liquid topical , comes in Gel as well….that works great… Whites pharmacy in Louisanna sells it…Dog Boudreaux is the pharmacist…( I have no financial interest in it)…IT WORKS GREAT…
Similar to what Dave recommended but it only has 10% lidocaine…studies show it is no more efficaceous at 20% than 10 but systemic affects are possible with 20% lido….DRK comes in three flavors cherry, mint and chocolate….Try it you will love it…(Edited by whitertth at 11:15 pm on Mar. 23, 2005)
(Edited by whitertth at 11:16 pm on Mar. 23, 2005)
adelddsSpectatorI must say that DRK liquid is amazing. I bought it about a month ago. I have used it to do frenectomies after leaving it there for 5 minutes. This is a must have!!!
Marc
Nick LuizziSpectatorIs there any merit to the idea that one of these topical agents placed at the apex of the tooth and use the erbium in a defocused mode at 20Hz at the apical tissures to achieve and anastetized pulp?
Nick LuizziSpectatorIs there any information on this or have I just bombed?Nick
LoydSpectatorAnyone got the address and phone number of White’s Pharmacy? I’d like to order some of the DRK?
whitertthSpectator318 631 2005 ask for doug
comes in cherry, chocolate, pina colada, and mint
kellyjblodgettdmdSpectatorI’d like to echo the efficacy of the DRK Liquid. Ron gave me a sample in January and we haven’t stopped using it since. Phenomenal stuff. Patients really appreciate it.
In response to Nick’s question about applying to apical tissue and using an Erbuim laser @ 20Hz: I don’t know what benefit the Erbium would have by using it on soft tissue in conjunction with the topical? The topical is certainly effective enough by itself for soft tissue anesthesia. If you are asking if you could anesthetize the tooth pulp this way, I think it is a potentially dangerous proposal. You’d have far better results just sticking in the needle and administering a local, but without the risk of ablated soft tissue.
I have found that if true, predictable pulpal anesthesia is desired with a laser, then use a Nd:YAG w/ a 100-150usec pulse-width @ 20Hz defocused for 30-60 seconds, depending on the tooth. I’ve been able to do this successfully even with root canals. It’s truly unbelievable to watch.
(P.S. Thanks, Ron, for the great topical!)
Kelly
SwpmnSpectatorQUOTEI have found that if true, predictable pulpal anesthesia is desired with a laser, then use a Nd:YAG w/ a 100-150usec pulse-width @ 20Hz defocused for 30-60 seconds, depending on the tooth. I’ve been able to do this successfully even with root canals. It’s truly unbelievable to watch.Kelly:
This certainly piqued my interest.
Are you saying that you are routinely anesthetizing teeth with your Nd:YAG? To me the concept makes a lot more sense than using an erbium.
Why is the Nd:YAG fiber used in a defocused manner and what is the distance? If you place the fiber in contact with or 1-2mm from enamel do you see ablation? I see enamel ablation with erbium lasers even when highly defocused.
What would you estimate to be your overall success rate where you do not have to resort to chemical anesthesia? With erbium lasers, I estimate mine to be about 67% for composite placement.
I see you are using the technique for root canal therapy. Have you used Nd:YAG anesthesia for routine composite placement or crown preparation? What is the typical duration of the anesthesia? If the patient experiences discomfort, have you been able to “reanesthetize” using the Nd:YAG?
If the patient presents with a sensitive tooth(reversible pulpitis), how does the Nd:YAG anesthesia technique go? Does the patient experience pain while the laser is applied for anesthesia?
Lots of questions but thanks for you help when you have the time,
Al
Nick LuizziSpectatorKelly, Thanks for the input. I am very interested in your confidence that predictable anastesia is attainable with the Nd:yag. So have you tossed your needles and syringes out? Would you be alittle more specific on duration? Best regards, Nick
kellyjblodgettdmdSpectatorHey guys – I’m glad this got some interest going. I’ll try to answer all the questions and share with you my experiences. I’m sure a guy like Bob Gregg would have more information than me.
Are you saying that you are routinely anesthetizing teeth with your Nd:YAG? – Only when patients REALLY don’t want a shot, but they have sensitive teeth. Often with the Er lasers, I find that the air and water make it challenging since it’s so cold on the teeth. As an example, I had a 10 y.o. boy come in who had had a traumatic injury to #9. The tooth was vital but half of the clinical crown was broken off. The dentist he was seeing would work on him after giving him a shot, but he said he could always feel the pain. No amount of chemical anesthetic was able to produce pulpal anesthesia. With 60 seconds of energy applied to his tooth w/ the Nd:YAG (200mJ/pulse, 20Hz, 100usec pulses – 240 Joules total) at a distance of about 1cm, the tooth was totally numb. I could tell because prior to starting, I scraped the dentin surface of his tooth which he responded to by squinting his eyes and saying “That hurts!” After the laser light was applied, we did the same scraping to which the patient didn’t even flinch. We were then able to work on the tooth (quickly) without him feeling anything for the duration of the procedure.
Why is the Nd:YAG fiber used in a defocused manner and what is the distance? – I don’t want too focused of a beam hitting the pulp. I want a larger surface area being covered so that I’m able to have an effect on all the pulpal tissue.
If you place the fiber in contact with or 1-2mm from enamel do you see ablation? – No, I wouldn’t see ablation on the enamel w/ the Nd:YAG, unless there were some stains or something dark. But still, I stay away due to the reasons previously mentioned.
What would you estimate to be your overall success rate where you do not have to resort to chemical anesthesia? – I know it sounds crazy, but it’s been 100%. But so much of that it case selection. I agree and have had similar results w/ the Er laser. I also have learned to tell patients when I’m using the Er laser that they will probably feel “something”, but it is generally more comfortable than a shot.
Have you used Nd:YAG anesthesia for routine composite placement or crown preparation? – More for composite placement. I haven’t used it for crown prepartation. I haven’t had a patient that needed a crown that was that worried about the shot. (Lucky, I suppose)
What is the typical duration of the anesthesia? If the patient experiences discomfort, have you been able to “reanesthetize” using the Nd:YAG? – I have found that I can get 5-10 minutes of solid anesthesia. I haven’t had a patient say they felt anything after the initial “anesthetic” dosing, so I don’t know if I could re-anesthetize. My gut tells me that I could.
If the patient presents with a sensitive tooth(reversible pulpitis), how does the Nd:YAG anesthesia technique go? – Awesome. Since there is no air or water to stimulate the tooth, the 1064nm wavelength travels through the enamel and dentin to affect the pulp and the patient feels nothing. I always start out farther away, however and slowly approach the tooth stopping at about 1cm away. If I’m aiming at dentin, I’m really careful to stay away, unless I’m planning to remove that dentin (as in a root canal).
Does the patient experience pain while the laser is applied for anesthesia? – I haven’t had a patient mention any discomfort while applying the laser during the “anesthesia” period. It’s really quite comfortable, from what they say.
I’d like to mention that if I’m doing restorative care with my YSGG laser, I usually don’t use the Nd:YAG first. I’ve only had 2 patients where this is necessary. But usually if I use the Nd:YAG for anesthesia I want to “haul ass” when I set it down, so I’ll use handpieces to get done fast. So far, it’s been 100% successful. Again – case selection I think has been the most important part.
To answer Nick’s question – I use anesthesia daily (injectable, that is). This just happens to be one of the tricks I keep in my bag for when I need it.
Kelly
SwpmnSpectatorKelly:
Thanks for sharing and taking time to answer questions. Interesting concept.
Has anyone done a study to try and quantify such reports as yours and also with the Er laser? Perhaps using pulp tester? Hopefully these are in progress.
Al
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