Dentaltown July 2017 - 105

by Charles D. Schlesinger, DDS, FICOI

Course description
This course details the concept of anesthetic buffering. The
benefits are multifold and are not only supported by the science in
the literature but also backed by clinical evidence.

Abstract
Attaining profound local anesthesia is the foundation of almost all
that we do in dentistry. Without the crucial aspects of anesthesia, the
benefits of modern dentistry would be unobtainable. In this clinical
study, the effectiveness of buffered anesthetic was measured against
standard unbuffered local anesthetic carpules. The conclusion of
this limited study showed a 37-53 percent decrease in onset time,
compared with standard anesthetic solution.

Charles Schlesinger, DDS,
FICOI, is a dental implant
educator and clinician who has
been lecturing internationally
for the past decade. He
graduated with honors from
The Ohio State College of
Dentistry in 1996. After
graduation, he completed a
general practice residency
at the VA Medical Center in San Diego and then went on
to become the chief resident at the VAMC W. Los Angeles.
During his time in Los Angeles, he completed extensive
training in oral surgery, implantology and advanced
restorative treatment. Schlesinger maintained a private
practice in San Diego for 14 years before moving into
an executive position for a dental implant company. In
2016, after leaving the corporate world, he founded The
CD Schlesinger Group to continue educating doctors
in implantology. Additionally, he continues to provide
comprehensive implant care to patients in a private
practice setting in Albuquerque, New Mexico.

Educational objectives
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At the end of this program, participants will be able to:
Understand the mechanism of nerve conduction.
Review how local anesthetics work.
Understand the deficiencies of acidulated anesthetic.
Discuss the benefits of buffered anesthetic.

With the advent of modern local anesthesia materials and techniques, the dental practitioner can, in most cases, attain an effective
level of anesthesia that allows the patient to remain comfortable for
the duration of dental treatment. This reduction in pain has been
reported to reduce the stress associated with dental encounters.
The use of buffered anesthetic has been well-documented in
medical and dental journals. Local anesthetics form the backbone
of pain control in dentistry; they are the safest, most effective drugs
in medicine for the prevention and management of pain. Two basic
classes of local anesthetics exist-amino esters and amino amides.
Amino esters have the ester link between the intermediate chain and
the aromatic end, while amino amides have an amide link between
the intermediate chain and the aromatic end. (Fig. 1).
Long practiced and recommended in medicine, buffering is
still a relatively new concept in dentistry. One reason has been
that our pre-sealed, single-use anesthetic cartridges are not easily
alkalinized. Unlike medicine, which routinely uses multiuse vials,
dentists use carpule-based syringe systems.
For the local anesthetic base to be stable in solution, it is formulated
as a hydrochloride salt. As such, the molecules exist
in a quaternary, water-soluble state at the time of
injection. However, this form will not penetrate the neuron, because
this acidification decreases the bioavailability of the compound.
The time for onset of local anesthesia is therefore predicated on the
proportion of molecules that convert to the tertiary, lipid-soluble
structure when exposed to physiologic pH (7.4).
Tortamano, et al., found that the mean onset of pulpal anesthesia

Fig. 1: Chemical structure of the two classes of local anesthetics

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Table of Contents for the Digital Edition of Dentaltown July 2017