Dr. Dan Davidian received his Bachelor of Arts at East Carolina University. He continued on to graduate from UNC School of Dentistry with his Doctorate of Dental Surgery. Dr. Davidian has completed additional training and received his sedation training with the American Dental Society of Anesthesiology. He is the founder of Anutra Medical and the inventor of The Anutra Local Anesthetic Buffering and Delivery system.
In this episode we discuss:
– The benefits of buffering anesthetic
– The first FDA approved syringe
Tell us a little bit more about your practice?
So I am a sedation dentist and I have a lot of high care patients. I talk a lot about sedation, and have done some CE’s on local anesthetic and really, I know that, local anesthesia or failed local anesthesia is where most phobias are born. So I get new patients coming ins saying “The doctor couldn’t get me numb” or “I couldn’t stay numb,” and all these other scenarios I hear all the time, so failed anesthesia is really what causes a lot of these phobias. Thats also something that causes a lot of stress in our lives as dentists, so if we miss the mark on a shot and we have to do it again and wait another 15 mins, it can cause stress in two ways. It can cause stress in a way that our whole schedule gets blown sometimes, or in the way where we don’t want to hurt anybody and every time we go into drill on somebody that is not numb, it can kinda get to us. As far as anesthesia goes, its something in our lives that we sometimes take for granted. Its almost a commodity now and we use it just like water, so buffered anesthetic or local anesthetic has really allowed me to change the way I think about that process and how I can do it more efficiently. Thats what got me thinking about developing the Anutra System.
When did you start doing buffering for the first time?
It was all born from the question, “Why don’t dentists buffer?” It was my father who was an anesthesiologist was buffering his shots for over 50 years. So I came up with a lot of different excuses why we didn’t buffer and the dinner conversation was about all the advantages of buffering and so I started buffering pretty much since the beginning of my career. I realized that if we leveraged a lot of the techniques that the medical model has discovered we could really make buffering more available to dentist. We ended up having to reinvent the syringe, so now we have one that is modeled after the dental syringe and its got some really cool features that we build in. It allows us to give between 1 mL and 6 mL, besides that 1.8 mL dose that we are married to now. It allows us to buffer much more simply because dentist don’t want to have to be chemists chair side, and so a lot of times trying to get the anesthetic ratios are tough so we tried to develop a system that would make it easier to buffer and would change the delivery system as well.
Can you describe the Anutra System?
Its a stand-alone device that just kind of sits on the counter and you load it at the beginning of the week. So you are actually able to take your lidocaine and your bicarbonate and load the machine at the beginning of the week. You attache the lure-lock syringe to the device itself, and you just turn the knob on the top of it one click for each mL you need of anesthetic. It allows you to have the flexibility on how much you want to buffer. When i go in for a scaling or root planing case or a set of thirds, I am going to pull a full 6 mL into the syringe and what I love about it is being able to give a lot of different shots without having to come out of the mouth. What I also love is that for a maxillary tooth, I can give a 1/2 mL of buffered anesthetic and thats plenty, I really love the flexibility it gives me.
Can you tell us a little more about the science behind it?
I think the point is that buffered anesthetic is much more potent, and I think thats what a lot of people don’t understand. They don’t realize that when we buffer an anesthetic, about 5000x more of the available molecule is in there. Lidocaine starts as a salt and they add hydrochloric acid to it, so that HCL is added first of all to dissolve the powder and they add more to stabilize the preservatives of the epinephrin, so the reason that its so acidic is because it has to stay in that acidic environment to stabilize all of those preservatives. So if it was to be buffered before it was sent out, the shelf life would be very very short. So the only way to buffer is to do it chair-side because shelf life diminish. There is also some talk about carbonated anesthetics. So carbonated anesthetics are when you add bicarbonate and lidocaine to produce CO2 and that CO2 in itself has its own anesthetic properties which is really cool if you want to use it as a topical. If you dry the tissue really well, you can add that CO2 rich anesthetic right on the tissue and use it as a topical and it will actually start to penetrate the membrane. In dentistry, because we use so many nerve blocks, we really want to use the science of the anesthetic in a lot of different ways and that CO2 rich carbonated anesthetic really helps us leverage the speed of onset. The body uses the bicarbonate to buffer the acidic lidocaine to a more of a 7.2 or 7.4 on the ph scale and secondly everyone has a different buffer capacity and some populations have more diminished buffer capacity than others. In my practice I see a lot of fibromyalgia patients inherently because those patients have had really bad dental experiences. Before I used to buffer all of my shots, I use to think that maybe these patients were a little bit more sensitive or maybe its all in their head, but if you look into the research, these chronic fatigue syndrome patients have lowered buffering capacities. So pre buffering or adding the bicarbonate to the anesthetic before we put it in allows us the advantage of not relying on the patients system to convert it all over, so it makes the results more predictable.
Why do you think dentistry has avoided buffering for so long?
Because we are creatures of habit. We have developed our systems around a failed anesthetic system. So we developed a system of where we need that fifteen minutes for the anesthetic to kick in to go check on hygiene or go check our emails, so we have convinced ourselves that we go give the patient the shot, leave for twenty minutes, go check hygiene, come back to check if they are numb, and so on. What we know from the business world is that uninterrupted work is 30 to 60% more efficient which means if we can sit down, give a shot, do our work and get up, we are 30-60% more efficient.
So what makes the lure-lock syringe so great?
I am really proud of that honestly. It is the first FDA approved syringe. So we have this old metal syringe where you have to literally thread a stainless steel up on to this old syringe, it takes time. The lure-lock allows us to change the needles really easily. So for me, thats important, because I like a sharp needle, so sometimes I used to not change my needle, and its not because I didn’t want to change the needle, it wasn’t the cost of the needle, it literally was because it was a pain to screw the old needle off and a new one on. With the lure-lock I can change them out really quick. We also included a kinesthetic feed back, at every mL it will have a little click. That just allows me to know how much I am giving without looking at the syringe. We modeled this syringe with all of the ergonomics of a dental syringe but we built in all these features which kind of allow us to be more efficient.
Where can we learn more about your product?