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Thank you for tuning into my Big Grins Pediatric Dentistry Blog. We will soon be releasing two videos on Kovanaze, the new dental local anesthetic, which is sprayed into the nose rather than injected. That’s right, no needles! The videos will introduce parents and dental practitioners to the drug and its uses, then we will have a longer video showing the ins and outs of how to give the drug, dosages for children, and how to incorporate it into a pediatric practice.

Why the videos you ask? That’s a good question. My thought is because I did two scientific studies on the drug, but the drug did not get approved for children despite its safety and effectiveness. I feel like I am the one to explain the research behind the somewhat hasty FDA approval, in case any other pediatric dentist wants to use it. Also, my brother owns a video production company, so we can. I was hired by St. Renatus only to do the studies 2 years ago, but I have always maintained my independence from the company. That is why I will give you the straight talk!

First off, the bottom line. Kovanaze works to numb the top teeth. Many early adopters, like myself, are touting its uses and needle-free anesthesia. However, my thought is dentistry, in general, will be slower to adopt the product due to the following reasons or obstacles:

1) The dosage. Current guidelines call for two dosages, 10 minutes apart and dosage to restoration 14 minutes. That is a long time to keep a patient idle in a chair, especially a kid. It will be hard to incorporate this change of procedure into a busy practice with a shot to restoration, which takes 5-7 minutes. Patients hate the shot, but they also value their time!
2) The price. Two 200micoliter sprayers constitute one dose, and for some adults, a third dose may be necessary. The cost to the dentist is $45-$70. How will that cost be passed on to the patient? Most dentists code for a procedure, not numbness to do a procedure, so it’s going to be a change in mindset for the patients and the dental staff. It may be a no-brainer for a boutique dentist office, but adding extra time and cost to an appointment will make more than a few patients hesitate.
3) It’s new. Beyond phobic patients, most patients know what to expect and most dentists are comfortable with their techniques now. If your dentist gives rushed, painful shots, chances are Kovanaze is not going to make it in the door. If your dentist really tries to help patients with their best techniques for painless anesthesia, Kovanaze may be like other gizmos over the years that never caught on.

Of course, all technology starts expensive and comes down in price, and every procedure was once new and untested. We are going to have to get used to it, and that means some of us will have to give it a shot (pardon the obvious pun) and teach the rest of us. Let’s give it a try!

Here are a few tips for delivery now, and make sure you watch our video later:

1) The first dose is the hardest to give due to the learning curve. Once you have followed the drug insert, save the dosing sprayer and clean it. Then, you can practice with it! I use a two-handed approach since you need to push the plunger firmly and quickly to aerosolize the drug, and you don’t inadvertently stick the tip too far up a patient’s nose while spraying. Practice a controlled fast spray. Too little and the drug will drip onto the lip, too forceful and the angle won’t allow the drug to coat the nasal passages. It takes a few tries to do it well.
2) Tell the patient what to expect. You will tell your patients the spray will be quick and make their eyes water. It will feel refreshing, but they may get an after taste they can rinse away with a drink of water. When the teeth are numb, their nose will also feel stuffy like it’s congested. The roof of the mouth may feel numb, but not their lip. Their front teeth may also feel wooden or solid. All that is an indication the medicine is working.
3) Be confident with your prep. The patient will be numb, but they will not feel what they did before with other outlets regarding lip numbness. While that assurance is gone, you can ask about the nose feeling as a confirmation. For the young children, the tooth prep went easy, but the band and wedge placement was when some kids complained. You can handle that like you do now, oftentimes just acknowledging the wedge feels tight, and it will put the child at ease. In our study, we couldn’t do that. Topical or a ligajet will also work.
4) Use nitrous oxide. Just because the nose may feel stuffy, that is no contraindication for use of the goofy gas. I use it routinely on patients and know that nitrous itself is a powerful placebo as well as a therapeutic tool. It allows the child to be distracted so you can work faster and easier.

The bottom line is parents trust you to help their kiddos and however you do that, if you do it with confidence and a sense of humor, parents and kids are likely to accept it. Will Kovanaze make treating patients easier? If you are like me, you can immediately think of a handful of patients you can really help with the no needle approach. Will this technique translate to the other patients? Time will tell, so let me know! Thanks for reading and please send comments to me at greg@gobiggrins.com.

Yours,

Greg