Look Sharp:

A closer look
at the new law

ULTRA SAFETY PLUS

THE SAFE INJECTION SYSTEM.
. / Disposable or Asthe world leaderin dental pain control 2 , Septodont solves
/" Autoclavable the increased need for safe simple solutions to meet new
~.... Sterile Hand le
safetyregulations.
Sheat h has tran spar en t barrel
so aspiration isclearly visible,
Overthe years Ultra Safety Plus hasproven its efficacy
and ease of usebecoming the standard for needlestick
/ protection on all dental local anestheticprocedures. In the
United Kingdom , Ultra Safety Plus already represents over
4S% of the injection sys temsusedin the dental groups
Reloadabl/
ideal for exte nde d / and hospitals :
procedures.
UltraSafetyPlus isoffered in an assortmentof needle
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www.septodont.co.uk

~ ~
Units R & S, Orchard BusinessCentre, P8 P1 0 P13
S! Bamabas Close, Allington, TECHNIQUES AND INJECTION ULTRA SAFElY
septodont Maidstone, Kent ME1 6 OJZ ANAESTHETICS TECHNIQUE PLUS septodont

~ ~
Tel : + 44 (0)1622 695520 Article by: Peter Raftery Articleby: Douglas Miller How to use guide
Email: information@septodont.co.uk TheWessex Dental Private General Dental
Specialist Centre Practitioner, North London
 P2. EDITOR
Editor's Comments
Managin g Director
Welcome to "Red & White" our new publication bringing
news, views and information regarding the wide range of
Septodont products and services in the UK.
Septodont was founded over 80 years ago and has
offered a wide range of essential products for the
denta l profession ever since . The vast majority of these
products are packaged in our unique red and white
boxes which have co me to represent the quality and
value of the item within. The red and white Septodont
logo is your assurance of quality, beyond the CE mark
and regulatory approvals which some may take for
granted.
In this issue we focus on local anaesthesia, from the
available drugs and clinical techniques to Ultra Safety
Plus, our clinically proven safety syringe system wh ich
offers easy compliance for every practice since the
introd uction of new laws which ban needle recapping.
Our aim is to promote the best and safest practice of
clinical dentistry.
Our clinical authors are unpaid and any opinions are
their own, we hope that you find the articles enclosed
Informative and helpful in your clinical practice .
Tel: + 44 (0)1622 695520 I Email: informat ion@septodont.c o.uk I Web : www.septodo nt.co.uk
RED&WHITE
Moira Crawford is a freelance journalist who writes
regularly for a number of journals. We commissioned
her to research and write an article on the new legal
requirements associated with sharps safety.
Dental needles are something that we take very seriously
at Septodont, hardly surprising since we manufacture
around 200 million of them each year! We hope that you
find Moira's piece informative and helpful in considering
what changes, if any, you may need to implement in
order to ensure that risks taken by you, your staff or
patients are minimised.
Should you require further information regarding any
Septodont product there are now many resources
available online and various ways to contact us.
Page 12 will help you locate and contact your local
Septodont Product Spec ialist directly. For news and
event information we invite you to follow our Facebook
page . Should you prefer to email or call we will be
pleased to assist in any way possible . We would also
like to hear from other budding authors who may wish to
contribu te towards our next issue.
.1 ... ...... .. .................. ........................... .... ............... ... . . . . . . ..
LOOK
SHARP
Safer sharps - taking care of your team
A needlestick injury in the practice IS a nightmare - and one
that occurs all too frequently. A small informal survey by
Denpian suggested that one in five practices had experienced
a needlestick injury in the last 12 months - a figure which is
probably widely replicated. with many injuries going unreported.
Of course a number of sharp instruments are in use in dentistry,
but manyinjuriesare caused during the resheathing/recapping
and disposal of a needle after use in orderfor the syringeto be
dismantled andthe appropriate parts sterilised.
An injuryto a dentist or other team member, most often the
dental nurse, from a potentially contaminated needle, sets in
motion a verydistressing and worrying period for the individual
involved, as well as significant expense for the practice in terms
of testing and the staffmember's absence from work - let alone
the issues that follow if the individual has been exposed to a
blood-bornevirus, particularly hepatitis B, but also HIVand
hepatitis C, for which there is as yet no immunisation or cure.
All employers arealready required under existing health and safety
lawto ensure that risks of sharps Injuries areadequately assessed
and appropriate control measures arein place. But on 11 May
this year, the Health andSafety (Sharp Instruments in Healthcare)
Regulations2013 cameinto force, implementing aspects of the
2010 European CouncilDirective (201 0/32.EU) on sharps that
Ultra Safety Plus
- Avoid the unnecessary use of sharps. Needles, scalpels etc
I The UltraSafetyPlus Rangedesignedto preventneedlestick injury
Units R & S, Orchard Business Centre , St Barnabas Close, Alling to n, Ma idstone, Kent M E16 0JZ
GUEST AUTHOR .P3
Article by: M oira Crawford
[ Freelance health writerand
former dental editor
were not already specifically addressed in UK legislation. These
new Regulations, produced and to be enforced by the Health
and Safety Executive (HSE)now focus on risk control. Theybuild
on the existing law and provide specific detail on requirements
that must be met by employers and their staff. Whilethey are
written for all healthcare workers, they are particularly relevant
in dentistry because of the highnumber of injections that are
given, and also because most dentistry is carried out in individual
practices. rather than large healthcare organisations. For the
purposes of the legislation, the practice owner is deemed to
be the employer, and as such, responsible for implementing
the regulations throughoutthe practice: a particulartyimportant
point where theremay be several surgeries, associatesand staff
involved, perhaps on different premises. An essentialaspect of
the regulations is that procedures need to be understood and
agreed by all staff, and appropriatetraining given both on safe
practice and the protocols to follow in the eventof an injury.
'A small informal survey by
Denplan suggested that one in
five practices had experienced a
needlestick injury in the last
12 rnonths' ...
Safer sharps
Theaspectsof the new regulations that most clearly apply in
dentistryrefer to the use and disposal of sharps(section 5). They
follow the principles of the hierarchy of risk control measures set
out in the COSHH (Centrol of Substances Hazardous to Health)
but alsorequire that employers consider additional risk control
measures:
will always be essential tools for medical anddental care but
the employer should ensurethey areonly usedwhenrequired,
substituting needle-freeequipmentnow available for certain
medlcaJ procedures where appropriate.
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 P4. GUEST AUTHOR
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I The Ultra Safety Plus Range designed to prevent needlestick injury
Where it is not possible to avoid the use of medical sharps, the
new Sharps Regulations require employers to use 'safer sharps'
whereit is reasonably practicableto do so. The regulations define
a 'safer sharp' as one which incorporates features or mechanisms
to prevent or minimise the risk of accidental injury. A numberof
syringes and needles are now available with a shield or cover
that pivotsto coverthe needle after use, eg Ultra Safety Plus
(Septodont).
The following fact ors should be considered:
I the devicemust not compromise patient care;
I the reliability of the device;
I the care-giver should be able to maintain appropriate
control over the procedure;
I other safetyhazards or sourcesof blood exposure that
use of the device may introduce;
I easeof use (taking into account the existing clinical practices
commonly in use by the relevant health professionals - but not
assuming custom and practice is safest);
I is the safety mechanism design suitable for the application?
The following are relevant:
I if activation of the safety mechanism is straightforward,
it is more likely to be used;
I if the safety mechanism is integral to the device (ie not a
separate accessory) it cannot be lost or misplaced;
I for many uses a single-handed or automatic activation
will be preterable;
I an audible, tactile or visualsignal that the safety
mechanism has correctly activated is helpful to the user;
and
I the safety mechanism is not effective if it is easily reversible.
Tel; + 44 (0)1622 695520 I Ema il: information@septodont. co.uk I Web : www. sept odont.co. uk
RED&WHITE
The RegUlations concedethat a safersharpwill not completely
removethe risk of an injury, for example if the patient moves
unexpectedly, but should reduce it. However. a London teaching
hospital (1) introduced disposable needles and syringesand
brought needlestick injUries down to zero, even amongtrainees
learning to usethem.
If a suitable safer sharp is not available to reduce the risk of injUry,
the employer should ensure that safe procedures for working
With and disposal of the sharp are in place. If a practice owner
should decide to use one of these. a full risk assessment should
take place, with the agreement of staff. and this should be fully
justified and minuted.
The British Dental ASSOCiation points out that there is rarely
one definitive approach to reducing/managing risk, and their
approach is to provideadvice and guidance to allow practices
to make an informed decision to reduce or eliminate a risk rather
than to be purely prescriptive.
A BOA spokesperson commented: 'The regulations require
dental practices to assessall activities wheremedical sharps are
used and where it is reasonably practicable to do so, substitute
traditional, unprotected sharps, with safer sharps devices.
Every practice is entitled to establish what is reasonably
practicable for them. If through risk assessment a dentistcan
show that it is not reasonably practicable for safersharps to be
used, then traditional unprotected sharps can still be used in
conjunction with suitable procedures for safe use and disposal.
Advice on implementing the Sharps Regulations is available to
BOAmembers.'
Dr Roger Matthews, Chief Dental Officer at Denplan, and an
expert in risk management, stressed that it was imperative that
dentists should undertake risk assessment in this area, and that
all clinical staff should be trained appropriately as to what to do
in the event of a needlestick injury and be vaccinated against
hepatitis B. 'There is verylittle occupational health oversight
occurring after needlestick injuries,' he warned. 'After rigorous
risk assessment, their options areto consider one of the safer
alternatives or, if the assessment concludes it is not reasonably
_ I
practicable to do so, the dentist should take sole respcnsibility
for this, keeping chairside staff well away from the sharps, and
the sharps container should be at the chairside for the dentist to
dispose of them.'
Recapping/resheathing of needles
According to the regulations (section 5; 1: c), needlesmust not
be recapped after use unless the employer's risk assessment has
identified that recapping is itself required to prevent a risk (eg to
reduce the risk of contamination of sterile preparations). In these
limited cases, appropriate devices to control the risk of injury to
1 employees must be provided. For example, needle-blocks can
be used to remove and hold the needle cap and so allow safe
one-handed recapping, according to the regulations. This is a
particular areafor concern in dentistry where in some practices
needles may be 'parked' in order to top up anaesthetic during a
procedure, and while dismantling a non-disposable syringe after
use.The needle may be passed several times between dentist
and nurse during use, which can pose a significant potential risk
to both.
Martin Foad, RegUlatory AffairS Manager at Septodont, has
highlighted dental syringes and needles as a particular area
of concern because, unlike medical needles, those used in
dental anaesthesia are sharp at both ends. Medical syringes
are fully disposable, unlike many used in dentistry and, finally, a
medical needle uses a Lure lock, whiledental needles have to be
unscrewed in order to disengage them, which poses additional
risk of a needlestick injury. 'Once aspiration has taken place, the
needle is contaminated with potentially infected body fiuids,'
he warned.
JacquelineJackson, one of the authors of the teaching hospital
report,' is now Divisional Manager at the Eastman Dental Hospital,
where disposable needles havebeen introduced in line with
other dental schools. UCLH has had a policy for some years that
needles should neverbe resheathed. 'Safer disposable syringes
and needlesarethe only way forward,' she said. Shebelieves
it shouldn't be too much of a shock to many dentists. 'Young
dentists going into practice will havetrained with safety needles
and will only be used to using them, and more mature dentists
who havedone postgraduate courses will also be familiar with
them and willbe using them back in their practices.'
Martin Food of Septodont believes that there should be no place
for resheathing of needles in dentistry, and notes that the new
regulations don't make specific mention of dentistry and its
differences with medical practice. 'One-handed recapping of a
dental needle is not possible in the same way.' he commented. 'If
a practice decidesto go down the road of still using the standard
dental syringe, and say they have done a risk assessment and
identified that recapping is safe, by using a needle-block such as
Aim-Safe, they need to minute that, because if a COC inspection
should observeand queryit they will need veryrobust reasons to
defend it.' he warned. Kent dentist Dr Sia Maanisets great store
by taking careof his team, and alwaysusesa safersharp, Ultra
Safety Plus. 'Dental treatment is highly focused and intensive,
Units R & S, Orchard Business Centre, St Barnabas Clo se, Allington, Maidsto ne, Kent ME160JZ
GUEST AUTHOR .P5
carried out under pressure of time.' he said. 'It makes sense to
simplify the procedures and reduce as far as possible the risk
to yourself and your team by using a safer sharp, rather than an
extra, less effective device.'
Seeking clarity for dentists on this, Martin Foad has checkedwith
the HSEdiractly. 'They have stated that racapping should occur
onlywhen exceptional circumstances dictate, and that otherwise
IT is expected that an alternative device willbe used which
incorporates a safety mechanism within the syringe.' he confirmed.
'I do not believe that there is any casefor not using one routinely.'
The new regulations require that securecontainers and
instructions for disposal should be placedclose to the work area.
Statf should be fully trained in the use of safer sharpsand their
disposal (section 6), and procedures for recording, notifying,
investigating and following up should be in place in the event of
an injury(sections 7 and 8), and known to all involved. All these
procedures should be regularly reviewed WITh the involvement
and cooperation of the whole climcal team.
Disposable syringes
Some dental syringes can be modified to conform to the new
ragulations, although the metal syringe cannot. A1tematively, some
majormanufacturers and supp!lers have new sinqle-use cartridge
syringesspecifically designedto overcome the risks, but they are
not yet widely used in practice. One of the reasons for this may
be cost, though the London Hospital trial found that once the
costs of the syringeand sterilisation had been taken into account,
the disposable syringes and needles wereactually cheaper (18p
compared to 25.8p). MartinFoadagrees. 'There is a difference of
iust a few penceper procedure.' he argued.
Dr Sia Maani from Kent believes that cost should not come into
it. 'If you respect and care for your staff and your patients as a
professional, you put their safety first.' he said. Are you taking
care of your team?
'The regulations require dental
practices to assess all activities
where medical sharps are used
and where it is reasonably
practicable to do so, substitute
trad itional, unprotected sharps,
with safer sharps devices' ...
References
1. Zakrzewska JM, GreenwoodI, JacksonJ. InLroducing safety syringes into a UK
dental school - a controlled study. Br Dent J 2001 ; 190;88 -92
,.,
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septodont
 P6. CASE STUDIES RED&WHITE A NAESTHET ICS .P7

.......... .. ...... ... ....... ............ ......... ................... ....... ...........

Sia Maani Anaesthetics
Case Study
.... ....... ..... ...................... ..... .................................. .... ..... Scandonest 2% Special Scandonest 3% Plain
Dr Sia Maani owns 10 Dental and Implant Centre in West Mailing,
Kent, and has been using Ultra Safety Plus for around five years.
use Ultra Safety Plus and Dr Maani is pleased that the mod ei he
uses is fully disposable. A sharps bin is kept discreetly near the
2 % mepivacaine with 1 :10 0 ,00 0
ep inep hr ine inj ect io n solut ion
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3 % m epivacain e injection solution
Indications
Having trained in Sweden, where he was accustomed to a 'safer operatory and the needle and syringe are dropped in immediately. Indications Local orloco-regional denialanaesthesia
sharp' system, he was keen to find a system in the UK to protect Local or loco-regional dental anaesthesia (andchiropody procedures)
both himself and his team. 'In dentistry you are using needles Dr Maani is passionate abo ut taking the best pc ssible care of his Features andBenefits FeabJres andBenefits
all the time and there is a high risk of needlestick injury: he said. patients and his team, seeing it as an essential aspect of being Mepivacaineisthe preferred moleculefor short procedures and periodontal treatments Formulation without vasa-constrictorfor specificmedical situations
a professional. 'When I am wor king I am 100% focused on my Terminal sterilization ofprooucVcartridges, the Gold Standard method lor Terminalsterilization of prooucVcartridges, the Gold Standardmethod for Hea ~h
'As a professional I want to protect my team and myself, as well
patient and I want to take steps to minimise any risks to me or my Health Authorities around the wand Authorities around thewand
as patients, as far as possible from the risk of an injury from a
staff,' he said. 'The price difference is minimal burt the real issue 100%latex-tree 100% latex-freee
potentially contaminated needle. Once it is locked, there is no way
is safety. Every process has an element of risk. If you respect and Presentation: Box containing 5 blistersof 10 x 2.2 ml glass cartridges Presentation: Box conIBining 5 blisters of10 x 2.2 ml glass cartridges
of getting a needlestick injUrywith Ultra Safety Plus.' He was also
attracted to the product by the reduced discomfort that IT offered care about your colleagues and patients, your concern is to look
after them and reduce that risk as far as possibie.'
patients and the co ntrol it provided. 'My patients say that they Septanest 1:100,000 Septanest 1:200,000 /
can scarcely feel IT: he said. All staff have found it easy to learn to -"" - ~

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4 % articaine with 1 :100,000 4% articaine with 1:200,000
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epinephrine inj ec t io n solution
Indications
Local or loco-regional dental anaesthesiainpatients ofat
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Indications
Local orloco-regional dental anaesthesia inpatients
least 4 years old ofatleast 4 years old
Featuresand Benefits Featuresand Benefits

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Fast onset toavoid delaybeforeeffective analgesiais achieved Fast onset toavoid delay before effectiveanalgesia isachieved

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100% latex-free 100%latex-free
High epinephrine concentration toimproveblood control on the procedure's site Terminal sterilizationofproducVcartridges, the GoldStandard method for
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Terminal sterilization of product/cartridges, the GoldStandardmethodfor Health Authorities aroundthe world

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, local orloco-regional dental anaesthesia

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in a metered aerosol
FeabJres and Benefits
Indications Lidocaine is theGoldStandard in dental analgesia
, , Production 01 topical anaesthesia and disinfection of the mucous Terminal sterilization ofproouct/cartridges,the GoldStandard method for
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membrane inthe buccalcavity, especially: Health Authorities around the wand
before the performance ofalocal or nerveblock injection 100% latex-free
prior to the extractionofmobile,deciduous orpermanent teeth Presentation: Boxcontaining 5 blistersof10x1.8 ml glasscartridges
prior tothe adjustment and fittingofcrownsand bridges or the Box containing 5 blisters of 10 x 2.2 ml glass cartridges
adjustment ofbands in orthodontic treatments
Dr Godfrey Cutts prior to the lancing ofsub-mucosal abscesses
XylonorGel

Case Study
Dr Godfrey Cutts , a practice owner in Nuneaton, Warwickshire,
has been using Ultra Safety Plus for over 15 years, and would not
consider reverting to conventional needles. He was impressed
when he saw the product demonstrated at a dental show and
was quick to make the change, many years ahead of the recent
regulations. 'The safety aspect of these needles is what did IT for
me,' he said. 'To make the traditional needles safe you need to
approach them with a capping device, which is not necessary with
--
priortoscaling
Features andBenefits 5% lidoc ain e analgesic gel
Easy dosageof activeingredient fhanks tothemetered spray Indications
Precise and safe applicationwith the included nozzle Topical analgesiaoforal mucosa before anaesthetic injection
~
Uitra Safety Plus.' In 15 years since adopting the product there has Fast acting, gives anesthesiawithin 2-5 mns andlasts 10-20mns Temporary pain reliefduring short and simple dentaiprocedures ~ -
not been a single needlestick injury in the practice, he said. HealthAuthoritiesaround the world Gag renex eliminationwhen pertorming radiographs or impressions - - U:::='"_
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Presentation: Metered aerosol dose containing 36 gofsolution FeabJres and Benefits
Using the product was very easy to learn, and it is in use Gel consistency prevents wash away to improve activity
throughout his four-surgery practice. 'Going over to using it is a Fastacting,givesanesthesiaWithin 2-5 mns
nobralner;' said Dr Cutts. 'It is so simple and safe to use, and the Improves the patient's comfort during many procedures
cost of using it is very similar to that of a co nventional needle. No Mintflavoured gel
other product I have tried is comparable.' Presenlation: 159 tube

Te l: + 44 (0)1622 695520 I Email: information@septodont.co.uk I W eb: www.septodont.co.uk Units R & S , Orchard Business Centre, St Barnabas Close, A llin gt on , Maidstone, Kent ME16 OJZ
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 P8. GUEST AUTHOR RED&WHITE l GUEST AUTHOR .P9

............... .... ... ........................ ......................... ... .. . . . . . . . . . . preparation to great effect by many clinicians, me Included. than the IANB alone 21 or when supplemented instead with buccal

CLINICAL
Leaving safety aside and considering instead the publications on the
efficacy of ertcane injection techniques, there is a wsg ht of evidence
from well-designed studies demonstrating articaine'sbenefits -
particulariy in instances when a lidocaine IADNblock has failed.
lidocaine for pulpal anaesthesia in mandibular teeth 22.
When all else has failed, another sucplementary route to local
anaesthesia that I find useful is the intra-pulpal Injection. In the
absenceof profound anaesthesia, if the patient is able to tolerate

OPINION
Modern dental anaesthesia
A rticle by: Peter Raftery
Specialist Endodontist
The WessexDental Specialist
Centre, Fareham
Injection technique
The common local infilt ration and regional block injections, familiar
to all Dentists, work in the majority of instances but, as mentioned
access cavity preparation untilsuch a time as a small hole into
the pulp chamber can be made - pressurised deposition of
local anaesthetic into the pulp chamber brings about almost
instantaneous anaesthesia. ~ is interesting to note that this effect

... .... ... ........ .... . ................. ................... .. . ... ... ... .......... .. ... earlier, the IADN can fail to anesthetise clinically normal pulps and
this rate of failure is around 8 times higher with inflamed pulps 16 .
seemsto be more mechanical than pharmacological sincesaline
performed equally as well as lidocaine 23
Working full-time in clinicalendodontics I would estimate that Articaine preparations for dental use were first introduced in Detailedexplanations as to why inflamedpulps are more resistant
approximately 9 out of 10 cases I treat are non-vital teeth, the Germany in 1976, the United Kin9dom in 1998 and the United to local anaesthetic are beyond the scope of this article but in brief Conclusion
remainder being the dreaded so-called 'hot pulps' of irreversible States in 2003. An excellentdetailed review on articaine was Simply loading a 4% articaine cartridge into a syringe does not
pulprtis. The differences betweenthese two types of case in published in the BDJ in 2011 by Yapp 6 which concluded articaine
I Once depesited, the LA drug in solution establishes
guarantee profound anaesthesia but it is a genuinely different
equilibrium between pesitively charged (dissociated)
terms of the requisite local anaesthesia (LA)for access cavity to be "a safe and effective local anaesthetic druq to use in all agent to other amide LA (lignocaine, prilocaine). I use it routinely
ionic form and the uncharged molecular form. Inflammation
preparation could not be more different. In fact the owners of the aspects of clinical dentistryfor patients of all ages, wrth properties but find rt invaluable in certain clinical situations such as 'hot pulps'
reduces tissuepH, maintaining a greater proportion of LA in the
necrotic pulps often ask me what "that machine" (the Electronic comparable to other common local anaesthetic agenls." wherea greaterlipid solubility means more of the administered
dissociatedform, unable to cross the lipid nervemembrane to
Apex Locator) beeping in the background does, implying that their dose can enter neurons 24 by virtueof its molecular structure
A 2010 systematic review 7 on the efficacyand safetyof articaine exert its effectin the way the molecular form can.
dentist skip LA injections for root-treatments; an "ouch" from the and a lower systemic toxicrtyof the drug ailowsarticaine use in
in dental use yielded a meta-analysis - a powerful statistical tool
patient in response to a file tip boring into the alveolus seemingly
for distilling evidence - and the pealed data from nineseparate I The increased blood flow through inflamed tissues clearthe concentrations higherthan other amide lAs 25.
indicates canal patency and working lengthl l don't follow this deposited drug from point of need more quickly.
clinical trials concluded that articaine was superior to lignocaine References
practice and advocate effective pre-operative local anaesthesia for
in anaesthetic efficacy in the first molar region and just as safe I LA binds to sodium channels on pain nerve(nociceptors) 1. GordonSM, Dionne AA. BrahJm J. Jabir F. txcoer R 1997. Blockade of peripI1eraJ neuronalbarrage
all endodontic procedures to minimise pest-operative pain long reducespostoperative pain. Pao, V70:209-1S.
a drug. Dr John Meechan, the UK Chairman of the Dental membranes; inactivating them. These 'paralysed' nerves 2. Kaufman E, WeinsteinPo Mi~rom P 1984. Difficulties in achieving Ioca1 anesthesia.Journalof the
afterthe pharmacologic effect of the drug has worn off '. As for the
Directorate Drug and Therapeutics committee, commented on cannot initiate or propagate nerve firing ::::; anaesthesia. When A1nericanDental Association, V108:20&8.
hot pulps - I am normallyasked to manage these becauseof the 3, Kanaa M. WhitworthJ, Meechan J 2012. Aprospectiverandomizedtrialof drtferent: supplementary
this analysis urging caution that the lack of a universally accepted tissues are inflamed, nociceptor membranes preferentially localanesthetic techniquesafterfai!ure of inferioralveolar nerveblockin patients withirreversible Plrlp~is
"ouch" persisting despite concerted attempts at LA; the dreaded
outcome measure adopted among these ninestudies to indicate express slightly different sodium channelsthat require more in man(JbU!ar teem. JoumaI of Endodontics.V38; 421-S,
missed Inferior alveolardental nerve(IADN)biock. 4. Yusof Z, Han L-J, Peon p. Ramli A 2008 , Eviderce-Based Practice Among a Group 01Malaysian
'successfui local anaesthesia' will haveaffected the robustness of lidocaine to be rendered inactive. DentalPrecncoes. Journal01Dentalscocetoo. V 72; 1333-42. see FtgllB 2 - freeaccessVia
Failing to achievesufficiently profound local anaesthesia can the findings on the efficacy (but not safety) of articaine 8 . Google SCholar.
be dispirit ing, but is not particularly rare. In 1984 Kaufman et
A quick Pub Med search of the literature shows that the purported
I Some of the chemicals releasedin inflamed tissues cause 5, Smith & Pell 2003.PasadluIe use to prevent death and major trauma retBted10 gravFtationai chal-
lenge: systematiC review of randomisedcontrolled tiials. British1v\edk;aJ JoumaI, V327;145961.
al 2 reported over a 5-day periodthat 13% of generai dental a reduction in the threshold necessary for nociceptor firing 6. YappK. Hopcraft M. Parashos P 2011. Articaioe; a review 01the aee we . British DentalJoumal.
safetyissue regarding dental use of articaine, in which articaine
practitioners experienced a failure of local anaesthesia meaning meaning more nervesin a greaterarea require blocking. V21O: p323-9.
has been suggested to be neurotoxic, has been raised in some 7. KatyalV 201O.The ettcacy and safety of articaine versuslignocaine U1 dentaltreatments:a meta-
that 10% of treatments had to be abandoned. The most occasionaldental casereports authored or co-authored by Haas 9-14 anatysis, Journal of Dent~try, V38P 307-17.
Once a block has failed one has the choice to abandon treatment 8. Meechan J 2011. Articaine am ~gnocaine. E,,;deoce-BasedDentistry. V 12: 21-2.
commonly reperted 'miss' being the failed IADN blocks. Failed Yet in the fields of opthalmological surgeryand surqeryof the hand (as per Kaufman, 1984 2) or to make further attempts at achieving 9. HaasD & Lennon D 1995. A 21 year retrospectr-estudy of reportsof paresthesia fOllowing local
IADN (lidocaine)blocks in patients with irreversible pulpitiswere and foot, where articaineuse is widespread and long-standing, anesthetic aonosnatco. Journalottre GanadianDentalAssccatcn, V61:319--30.
LA. This can be another attempt at the (missed) IADNblock or by
evenmore common (32%) as reperted in a morerecentUK study ' . there is not a Single reported case of paraesthesia. The sporadic
10. Haas D, HarperD, sese M, YoungE 1990. Comparison of etcere am prilocaine eresiresa by
one of the supplementary routesto local anaesthesia described by infiltratiOn in maxillaryand mandibulararches. /IoosthesiaProgress. V37: 230-7.
When considering local anaesthesia, like all clinicians, I will select dental publications suggest an increased risk of paraesthesia of Meechan 1'. The most prevalent of these being an Intra-osseous 11. Gallen A & HMSD 2009. Retrospective reWJv.i of Idultaryreports of nonsurgicalparesthesia in
dentistry.JournaloIlhe canadian oena sescceeco. Vl5 ; 579,)
an anaesthetic agent and injection technique. the lingual nerve following articaine use for IDN blocks but do not injection or n tra-liqarnentaryinjection. A recent study has looked 12. Garisto G, GallenA. tawerce H.TenenbaumH, Haas D 2010. OCCurrence of parestres a after
explain why - if the drug were neurotoxic - does rt not affectall at the efficacy of these choices,as well as a buccal infiltration dental local anesthetic: administratiOn in the United States. Journal of the American DentalAssoc
ratiOn. V141; 83644.
Anaesthetic agent nerves equally? It seemsthat the lingual nerve, structurally similar to of articaine, in just this situation ' . Clinicians familiar with Albert 13. HaasD &. LennonD 1996. A ~ 0I 1o:::al anesthetic induced paresthesia In Ontario111 1994
My own preferred agent is an articaine4% preparation with other peripheral nerves throughout the body, is most often affected Einstein's definition of insanity ("Insanity: doing the same thing (abstract 1834). Journalof DentalReseard1 V 75; P 247,
by articalneand only during the IANB approach. I find rtdifficult to 14. MillerP & Haas D 2{XXJ. Irddence of Ioca1 anaesthetic induced neuropathies in Ontariofrom 1994-
adrenaline 1:100,000, having recently left behind my previous over and over again and expecting different results.") won't be 1998 (abstract 3869), Joumal OfDental Research. Vl 9 (Spec Iss):627.
accept that articaine per se is harmful when there is a wortdwide surprised to hear that the most effective LA strategyfollowing a 15.MalamedS 20JLNSf".oe ir4ury causedby mandibularblockanaJgesja. International Joumalof Oral
standard: lidocaine 2% preparation wrth adrenaline1:80,000. I say and Maxillofacial Surgery2006:35: 876-877)
scarcity of reports linking paraesthesia wrth articaine use in Gow- missed lidocaine IADN block is not another attempt at a lidocaine
"preferred" because whilst I do not cancel patients rtwe haverun 16. Hargreaves K & KeiserK 2002. Local anesthetic faJ~ure in eoooocotcs: Mechanismsand Manage-
Gates mandibular nerveblock, incisive/mental nerve block, or IADN block. This option performed poorest rendering only 32% ment. Endodontic Topics, V 1.p26-39.
out of Septodont's finest, I will aiwaysreach for the qold ampoules 17. MeechanJ 2002. SUpplementary routes to localareesresa internationalEndodontic Journal,
maxillary injections, be they infiltration or nerveblocks 15. of symptomatic pulps numb. The best option was the buccal
giventhe choice. This preference is based on a mixture of my past V35: p 885-96.
experiences and the available evidence. Whilst it would be difficult The retrospectivestudies suggesting an increased risk of infiltration of articaine which rescued the situation in 82% of 18. Matthev>Js A, Drum M, AeaderA, Nusstein J, Beck M 2009.Mcaine forsupplemental buccal
mandibular inflttrabon anesthesia in patients with irreversible pulpitis when ee inferior aNedarnerve
to effectively share my past clinical experiences in any meaningfUl neurotoxicity with articains are biased from a patient recruitment cases, outperforming intra-osseous (68%) and intra-ligamentary block fails. Journal of erccccotce. V35;343-6,
way here, I can try to distil someof the recently published evidence. perspective terms and not the high levels of evidence preferred (48%) approaches. This abilityof articaine, infiltrated buccal to an 19. Corbett I, Kanaa M, WhitwOrth J. Meechan J 2008 . Articaine infittration toranesthesiaot rrarot x r-
Iar first molars. Journalof Endodontics, V 34: 514-8.
when making definitive clinical recommendations. Mere correlation irreversibly pulpitic tooth, in allowing continuation of endodontic 20. JungI, KimJ, Ktm E. Lee C. Lee 5 2008. An evaluation 01buccalinfittraoons and inferioraIveotar
When confronted WITh any new evidence from the dental lITerature access cavity preparation in most cases wherea Idocaine IADN nervebocks in pulpalanesthesia lor mandibular First molars.Journalof Endodontics. V34;p h-S,
doesn't prove effect and whilst Yapp 6 cailed for further RCTs on
it is necessary to consider its provenance. The methodology of any block has failed was also shown by Matthews 18. 21. Kanaa M, Whitv>Jorth J, Corbett I, Meechan J 2009.Articaine buccal infittrationenhancestheer-
articalnesto determine whether any increase in paraesthesia is fectiveoessof lidocaine inferior alveolar nerveblock. International socccco tc Journal, V42:238-46.
study can influenceits quality & so rtis worth bearng in mind the likety 22. Haase A ReaderA.Nusstein J. Beck M. DrumM 2008. Comparing anesthetic: efficacyof encaoe
attributableto articaine, Haas 11 concedes that "rtwould take an I am not aware that this practice (of infiltrating articaine buccal to
strength of the evidence 4 , for example results from a well-designed versus joocere as a supplemental buccal infittrationof themandibularfirst molarafteran inferiOr
unrealistically largetrial or cohort to detect statisticallysignificant mandibular teeth) is widespread but its performance in recent well- atvooIar nerveblock.Joumal 01the Ame!ican Dental AssociationV139 :1228-35.
Randomised cornroledtrial (RCT) can be a morerobustmethodfor 23, van Gheluwe & Wallen 1997. IntrapulpallOJection: Factors relatedto effectiveness, Oral SurgSlY,
differences for an event as rare as nonsurgicalparaesthesia". designed studies seemsset to change that. A buccal infiltration
determining true effect thanauthors opinions following case-reports Oral Medicine. OralPathology, OralRadiology, and Endcdontology, V83:38-40.
and so on. Where possible it is appropriate to base clinical decision Since it is unlikely that any strong evidence will be forthcoming of articaine alone performed as well as IADN blocks with lidocaine 24. Becker & Reed 2006. Essentials of localanesthetic pharmacolcgy. AnesthesiaProgress, V53:
98-109.

..
making on the highest quality evidence pcssiblebut wrthout blindty soon, or ever, linking articaine use in dentistrywith anynegative 19 and IADN blocks wrth artlcaine 20 in achieving pulpal anesthesia 25. oenerA, RahnR.KirchW 1007. Clinicalpharmacokineticsof etceoe. C~nical Pharmacokinetics,
overemphasising methodology to the exclusion of all evidencenot effects, I expect that articaine 4% will continueto be chosen and in healthy volunteers. Separate studies, also in healthy volunteers, V33: 417-425.

,.,
derived from RCTs 5. This is a concept that willbe revisited to help used without any side effects over and above those realistically demonstrated that lidocaine IANB injections supplemented with
inform the argument on the safety of articalne use in dentistry. expected from use of any alternative local anaesthetic agent or buccal infiltrations of articaine were significantly more successful
. .. . .. . . . .. . . . . .. . . . . ..... .. . . . .. . . .. .. . . . . . .. .. . . . . .. . . . . ...... . . .. .. ... . .. . . . . . . . . . . . . . . . .. . .. . . . . . . . . . .. ... . . .. . .. . . . . . . . . . .. ... . . . . . . . . .. .. . ... .. , . .. .. ... . . . .. .. ... ... . . . .. . .. . . . .. . . . . , . .. .. . ... .. ..... ... . . . ... . .. ... . . .. . . .. ... . . . .. .... . . .. . .. . . . . ... . ...
~
septodont

Tel; + 44 (0)162 2 695 52 0 I Email; informati on@sep todont.co .uk I Web; www.septodont .c o .uk Uni ts R & S, Orchard Bu sine ss C entre, St Barn ab as Close, A llington, M aidst one, Kent ME1 60JZ
 P10. GUEST AUTHOR RED&WHITE I; P13. USER GUIDE RED&WHITE

............ .................................. ..... ............... .................... . .

MY How to use ULTRA SAFETY PLUS

...... ................... ... ........... ................ ...............................
RECOMMENDED Article by: Douglas Miller
~
TECHNIQUE Private General Dental
Practitioner septo dont -s-s

~
Douglas Miller Dental Pract ice ,
Alternative to IANBs North London
.. " .
Dr. Douglas Miller qualified at Guy's Dental Hospital, As w el[ as being conservative of LA solution, the area of tissue Remove the sterile Ultra Safety Plus Grip the barrel firmlyand fully insert Grip the handle plunger (part B) and put
from its protective wrapping. the cartridge into the open end of your thumb behind the finger holder.
London where he has served on the dental staff in both the anaesthetised is relatively localised and the tongue is [eft un- the device. Introduce the handle tip of the barrel yI
anaesthetised, enabling restorative proc ed ures in the sa me (Part N, to the back end of the cartridge.
Prosthodontics and the Sedation and Special Care units.
appointmen t on both [ow er quadrants, w ithout bilateral [ANBs.
Douglas is actively involved in the latest dental techniques Also , the patient can im mediately assess the smoot hness of a
and procedures both in the United Kingdom and the U.S.A., recent ly placed restoration w ith their tongue .
where he has studied at the acclaimed Pankey Institute.
Douglas is renowned for treating dentally phobic patients. An advantage over, say, the Stabident system , or a computer-
con trolled LA delivery system such as The Wand , is that the
[ have a specia l interest in the t reat ment of de ntally anx ious
tec hnique does not involve t he purchase of any special syste m-
and pho bic p atients and have bee n successfully using a loca'
base d equipment. [ have used this tec hnique fo r all routine
anaesth etic (LA) techniqu e wh ich is reliable. predictable and
restorative procedures : restorat ions, roo t canal treatments, and
gives far great er patient comfort than infer ior alveolar nerve
even ext rac tio ns in t he p osterior mandib le (ad m inistering an Pull back to obtain aspiration to Push forward to expel a bit of Remove the needle cap Now slide the sheath protecting the
blocks ([A NBs). complete the injection. fluid and then place the needle into and discard . needlebackwards until it is right against
adjunctive lingual infiltration of articaine 4%). injectable area the handleand it "CUCKS".
Painless IANBs are not always ac hievab le, quick in onse t, or
A po tent ial d isadvantage of this techn ique is the possibility
capable of achieving profou nd anaesthesia.1 Th ere is also the
of increased freque ncy of admi nistration of the LA solut ion
po tent ial for nerve damage ind epend ent of t he LA used.?
into the circulatory system but this has happ ened surprisi ngly
The technique [ emp loy is as follows: [nitially, I apply to p ical infreq uent ly: A retrospective aud it of this techn ique, carried out
anaesthet ic gel and then give a buccal infiltration alongside in my practice, involving 110 adm inistrat ions , showed only one
the t ooth [ intend to anaesthet ise. After wa iting fo r on set of incident of inadvertent administration of anaesthet ic so lutio n into
anaesthesia from the jnfilt ratio n, I adm inister 0.1 m l art ica ine 4% the circulatory system. and the aud it highlighted oniy one faiiure
w it h 1:100,000 ad renaline (Septanest 1:100000. Septodont), to gain satisfactory an aes thesia; in a p atient with an irreversible
both m esially and distally of the tooth to be treated, on t he pu lpitis requ iring roo t treatment, on a low er second molar.
buccal side , p lacing t he needle up to the periosteum level, Once the procedurehas been com- If injection is fully complete, slide the protective Remove the cartridge from the You then pull the finger grip back up the
This tec hnique has proved an im portant addit ion to my skill set pleted, slide the protective sheath sheath towards the final locking position, which syringe by pulling back t he plunger plunger until it comes to the O-ring
approximately 5 mm below t he papilla. [ use a 30G , g mm towards holding position, which is is the second notch at the end of the barrel. fully and remove the handle. handlethen push the plunger back into
and has not only save d time and given m uch more pred ictable
lengt h need le wh ich is short. sharp, and strong (Septoject the first notch on the barrel. There will be an audible "click". This has now the cartridge and remove. Now the injection
anaesthetic resu lts ; it has also been great ly welcomed by my locked the needlesafely into the can be disposed of safely.
Evohrtion, Septodont). Occasiona lly the needie w ill pene trate protective sheath.
pat ients.
the cortical p late, bu t t his is not necessary, or des irab le.

'I have used th is technique for all

routine restorative procedures: SPECIAL NOTE
restorations, root canal Should you need to insert a second cartridge, take hold of the
handle of the injection device and pull the finger grip of the handle
If you would like to receive an
Ultra safety Plus Training DVD,
treatments and even extractions back towards the thumb ring. Now insert the tip of the plunger into
the empty cartridge which is still inside the injection device r: ;~:.-:-.-
please contact Septodont.

in the posterior mandible' ... barrel. Pull out the cartridge using the pliable O-ring situated at
the end of the plunger. Remove the cartridge from the plunger and
dispose of safely. You are now ready to insert a fresh cartridge 0-
and proceed as from step 1.
References
1. Malamed S F. Is the mandibular nerve block passe?
J Am Dent Assoc 2011: 142 Suppl3: 38-7$.

I Photo 01position for needle placement. (Note: placement of LA solution

should be both mesial and distal to the tooth to be anaesthetised)
2. PogrelM A. Permanent nervedamagefrom inferior alveolar nerve blocks:
a current update. J Calif Dent Assoc 2012: 40: 795-797 .
The protection you trust.
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The quality you expect. Ultra Safety Plus
Te l: + 44 (0)1622 695520 I Email; information@septodont.co.uk I Web: www.s e pt o d ont. c o. u k Te l; + 44 (0)1622 695520 I Email: information@septodont.co.uk I W e b: www.septodont.co .uk
 ABRIDGED PRESCRIBING DATA .P11 MAP .P12

..
ABRIDGED PRESCRIBINGINFORMAn OH:
UGNOSPAH SPECIAl
COP.I'OSOOtl LkticaJne Itjdrodllonde 2%,Adrenatine ~) ta1ra1e ecessee asbase160.000 Tl-EfIAPElJTJC ItOCATIONS; local ereestesalor denlaIprocedures I1f iIIdtraoon (J" nerve bIoc:k fljec:lions.. DOSAGE N()
ADMlttSTRATlOPt MAs: 1 C<I1Itt,je is generaIy!lJffdert Do noteceeo 3 cartneIges.AOOIescenlS belween 14and 17andthe ekIerly: usual eose 1 8 fd Do nct e.u::eed 16 mI Ol6:t'en bef'.WEIll6ln:l 14, lBlaI ecse 1 35ml. DoflOl eceeo2.7
m OtienbelWeeI'I 3l1v:16:0 9101.81U. Doru. use troer 3 years rJage CCiJR4- OCAl()NSN/O PfECAUllONS FOO USE: l.IIJtJSPAH Sf'E(1I>,lis l:OIIlr.rilllcateel f1 patJenIS oMth a 1ltI:lvIn I'HSlcty oI l1yperseos1tM1y 10 kX:aI eaesrecs
of the arride ~ OI loarry ctrf')Of'lef'l Olthe ~ km1J1atOl lXiNOSPAN SPEQAl M lO!he eeseeeOf avasoc:onstn:Ior laCtErolfle) in the lcrrrJJ!a rscontririlckalel:l i'I paIienIs$Ullefil'(!/r(m: arll'llal t\ypertEnsoJ. lXrIII'Iay!isease,
vaswlar carooc eseese (partiCUlarly seceee toaa.J!l! rte.Jnati: JeveI) SPECIAL WARNfJ3,S- for tJOleSs:ittIal elenlaI use ~. ligJ'lOSPafl Spec:iaI stoJ(l be use<! withcauIJon 11 ~ WIth perlttleIaI vaseu8" csease or tecateeseese
ResusotabYe l!QIJIlIIlflllllt)'Qefl ancJ O!!e resuscilatM! drugs stouklbe (\\'aiit*!lOr irIned.ate use C8Itioo Sh:U:I be eeceec 'totlen the prcd..d ISeneeeeo dr1ng eart11X~ or10rm:i'l9 women. Do not~ rno abD:d~I. septodont

~
~atal $IlOl*l be perIormed before ~ ~Jl,O slowly. Locaarnes1tleIiC pn'O!d lte$ s/Il)j:J be use::l WIth e.autm weeeee ISII'IlIalTVmliooarDIor sassli llie regOl cI qecm. 1te IoM'!sl Cbsage trrall esw il eIfl.'t1Ne aeeseese
stnJl:j De used.Thel31Jb;les'1olj:j be used 00orepatert IUilg ooe sessm 01 ~ rrit ~ AwKi ccrwrent use withMAll,ll'ic;dc <m:lepressants orpheoolllIaziles Cm:menl~ ofvascp'esstr m.gs an:!
er~-twe ~ itlJ;lS may cause see-e. per9stalI ~ cr ct'f~ ac:e:03nls- eeaceccses 01~ Sd:.db'lI:a3a!h'es ae ~'ed. Cm:u'rent use oIlle1a<Oere"g1C ~ agMtsmayre&Jll n ~
ard tJa(tp"oo-IJ'SRAIlf EfFECTS~ ~. <mrOOsage or00ftshed tierarce rna'>' resAin:l!llCiIaWy (I' ~ess<n ITI1rieslalkrts c/ ee central lll!f\OJS ~em.lletYessanl car~ mafilestalD'lS aM aIerglc: reeaos
Pfi.W.1ACEUOCAl. f'ftCAlJlO'iS: SUe II the <r'gl\11~, in a'*Y PU be!lM 2!i-CancI lJC*!ClllOOl ll!1C- Dora 1reeze.1'tWlMAC8JOCAl FOOM. SWtiln b iie:fiOn C013ined n 18 !.-.cl 22 fd dIn3Il3tr"GjeS.1.GAl CATfmClY
POM. f(Jl RJmfl r.fOOMA'OON COOTACT n ~ LnOCEto..rm !H'TOOONT I..MTED.lbts A&S,Ordiafa Business ceee. s Barnabas ccse. AIrgton, J.\aid';trle. Ke11 1>El6OJZ,lK PI.. 00313;0019.A~ ncn)to
Ioensed llental v.to:llesaler Ft.rther irVCrJnat(Il and SPes ~ onreaes.
SCAHOONEST 2% SPECIAl
COt.lfl()gfK)ti Mepvacai1e ~ 2%. Ai:tt'fIalile (EprlepIrtiejtese 1/100,(0). TIfilAPB..JOC 1NOCA'JlWS: Local eeesrese ro- de!taI ceceares IJt inliItra1ioo Of nme l*:d ~ [)()SNjf Nf) ADt. ISffiATlJN: Mulls.1
~Icr ro..me I\IOflC. Do no: exceed3c:artOO;jes. Chb erT_ HJe 6 to 14:uswIcose 1 6 mI.Do IYJt eceee 3_3 mLAqe 3 b6 1 1 b2.2 mI.Do notuse under 3)WSof age. OO'lIRAlta:ATOISANO ~ FOR USE. SCJo1IXHST
REGIONAL PRODUCT
2'lI. S'EClAL ISaJIlraflflc3ted il patients oresentIIg alUgy toarmde~ ~ Of toany~ of lh! lcrmOOlloo. SCNIlONEST 2% SPECW. due101fle eesece cI a vasoanstn::la' {alterI<*1eI. isClJIIra"!lUcaIed in 00IlenIs
sutrerinO 1n:nI; <fll!I'ial!l'tpertef1SlOl'\.lXlIUI3IY disease. vatwIar affecbon OftJIl!er MMJOf1nt)ebC anb~ treatmenl SProAL WAfl1IINGS_Fa- pn1ess:i:'J'IaI oentlII use only. Shol*I btl used 'Mlh eautiOfl i'l pa\ierllS 'MIll ~ vascular SPECIALISTS ACROSS
disease, heoatiC If.sease. 18'1<11diSeaSe. atstcJy or diStlrtlaOCeS of cardia: r!lyItm Of heartt*x:k. ~ Of 1lllat'e11 respm:ry fuoclD1_ResusdlalM! elJJi(lmerlt. 0XV0!l1 ld 0ll'8 1'8SUSC1l311Ve ~ should be il'.'aiIab!e lor~ use
Caulk:rI $I'I(IlJ(l be ~CiSed I'oflen the prtW:l is ~ llInng ~ pregmrcyor 10RlfSIlg 1'oOlllel1. Do rot .;ect i'1lD a bloOd wsseI_AspOl(Il stuJll be pedormedbelOre injecIJ(rI_~ $ICM4y_Local aJJaeS1heIIC proc:eWes sIWd
be usedwithcalfiOn wtIere mere is sepsis aJ1dItY hIIammatioo in the ~ cl llfecllOO. The klYwesl 00Sage It'GlresultS inelftW.<e ~ stuJt.lbeused.The ~Ud shOlJd IYJt be ~ rePea\e(lt)' al!hesamesilu. Thel31rKi;le THE UK AND IRELAND
should be used (1'1(lie patienIduM;l (lie sessKIloI lreatmelltOflly MEAACllOt.lS A\OO COOC\Irrenl useWilh L1leno\l'Iiazines. Y3SOl1essOf drugs and ef9)t-tjpe 0ll')'1lX:iC thJ;IS. betIatteoergi(: l)vgS andChIoroICml, halo1hane. ~,
~. u otherret3tedagents.Paluce !bies 01 WIaeSthetK: SOOJtiOI'I il seoawes areem~ IJllDESIRABLE EFfECTS: HJ-persensrtMty. overdosage Ofdimllllshed lIteraICe' mayfeM it elltitalory Of delJres$anIlIIaI1rtestaOOns of the
C$lraI nelVOl.lS ~ ~ cartlicrJasr.:ular mani1esIaliOflS <V"(1 aflefgic reactiOnS PHARMACElJOCAl PAEC.aJJ11ONS S10re i1 the orJJinaI package. Irl a dryplace bOON 2S Carv:l prolecl from ~ PHARMACEUTICAL FOOM:SoIut1oo lor
i$tb:r1 ront3oed ifl18 and 22 ml denialeartndges. l EGAlCAlEGOOt POIHOR FLffiHER 1~.fOO MA.TION CClmACT Tl PFro..CT lICENCE IO.DER SEPTOOONT (J.ITED,l1MsM S:Orchard BusIness centre, $I Barnabas Cbse. A1ling1(ll,
MaidsIone. Kent ME16OJZ. 1J< PI. 0831:Y0026. AvaHable from yrJJ Iil;;erOO dootaI wholesaler M.rttIer informationall:!SPes avarl<ie 00 r~
SCAHDDHEST 3% PLAIN
COMPOSITION: MepivacainehyaochJcride 3%.THEfW'EUTIC INDICATIONS' local arraesthesia lorDenial andchirq:o:ty ~, DOSAGf. .AND AOMlNISTMTIGl - Jl denliStrY.A(lJlts 1 cartriliJe lorcoutlne wcrk 00001 e~ 3cartriO;leS
Chi l~eo from4 years of ageand 00ler: recommended oose: 0.Q25 fIll/kg troy weight 00fIOt e~ceed 0,1 mi l kg tIOOyWt'!ght. - In d1tr~, hiJlts 2.210 4 mI, DoMl exceed 4 4 mt1digit IJ'rd 6 mgI kgbody weic/lt l 24h CONTBA-
ItlDiCATIONSANO PRECAUTIONS FOR USE: SCANDONEST 3%PlAIN IScontra-infljcatedIn pa~ents presentiog Sl)e(:iflC aliergy10 amide type anaesthetics. SPEOAL WARNINGS Forprofessl()r1al dental use onty, $toJ1d be lJSeIl withcautionIn
pal1enls withnepaUc disease, renal diseaseora hlstOl'y ofdisturbances ofcardiacrIlyttlm orheart b~ock. Resuscl!ati'leeqlIlprTlenl. llXYi1enandother resuscitative drugs shouldbe available torimmO,ate use Gauton should be e~erciSed when the
prClduct ISadministered duringearly pregrJallCy or10nursingwomen. Do fIOt lnject intoa blOOd vessel. AspiratiOn snoulclDeper10rmedbefore in;ection,Injectslowly localalliles!ttetic procedtlf6S shOuld De usedwilh caution where thefe is sepsis
and/orInflammationInthereg ionofinfection.The IowestOOSilgethatresu!ls Ineffectiveanaestl1esra ShOuld be lJSeIl,Thecartndg should be used ononepatientdunng onesessionof treatment only.lmERACTIONS Reduce closes ofanaesthetic
5OIutiOfl If sedaUves areemployed. UNDESIRABLE EFFECT& Hypersensitil'ity. overdosage ord:minisMdtolerance may result In'excitatrny ordepressant manifestations of thecen tral nervoussystem, depressant card iovascularmanrteslallOflS and
allergicreactlons_PHARMACEUTICAl. PRECAUTIONS: Storein the original pack.'lge, ina dryplacebelow25"Candprotectfrom light. PHARMACEUTICALFORM: SolutionforinJ(;tioocontainedIn18 and2.2mldental cartridges, LEGAl CATEGORY
POM. FOR FURTHER INFORMATlON CONTACT THE PRODUCTUCENCE HOlDER' SEPTODONT LIMITED.UnitsR&S, Orchard BuSiness Centre. 51Barnabas Close. Allington.Malostone,Kent ME16OJZ, UK. Pl 0831310023 Ava ilable trom \'OUr
lICenseddental Wholesa ler.Further infonnatioo andSPCs availableonrequest
SEPTAN EST 1:100,000
COMPOSITION:Artica ltiEI HydrochlOOde 4%,Adrenaline{1NN ep:nepMneJ tartrate expressed as base1:100,000 ThERAPEUTIC INDICATlONS: Local or!ocoregooalderrtal anaesthesia il patients ofatleast 4 years In caseof daSSiC Of
T'I'\(f:Xl gingrval (fIera!icrlS U dental SlTgical prCJCe(lures I'ot!ere bOne removal is necessary_ DOSAGE ANOADMIMSTAATION, For most common ~m, one inliltratloowith 1 7 ml issutf(leIlt. 00oot e~ theequivaieflt ot 7 mgarttaillt!
*
hydrod'ik::ri<1e oec kiloO! ~ghl . Dosage 11 c:hil&eo stnJl;j be coovnens<.rate with theirweign!. The recommended ClOSe In 20 kg ChildIsaOOUt cartridge ol1.7 ml Of Y, eartndgeOf 2.2 mI andsn 40 kgclllldIS atIout 15 ca~ot 1.7 ml
Of1 cartrillQe of2.2 ml.CQNTRAINOICATlONS Alf) PfliCAlJTIONS FOR USE' t+,,:lerseositMty 10 any teal anaesthel(tl!}e!1t oranyrompo:neot (j $EPTANEST. Do rot use SS'TANEST in patients IIi'JOna~ ~ tfOrI;hospasrns after
aOOlinislratiOO 01 DrOCIuetS containirg ~phlles. palierrt:s with delidency i1 plasma etdnestefaseactivily,palienl$ receMng MAOl or tri:ydic anti-delYessaols.patieols Jl 'IIo1'm1 general anaest!leSi3 mig:ll De reQl,Ilre(l to~Ill tOO ~re am
In children under 4 ye:am ofage. SfCtIlJ.. WAPtlINGS: SEPTANESTsIllUl be usedVlI1tl caub:r1 in pallt10lS with hepatic diSease. t!lyrotoQXlSlS. card:ova.so.Aat disease. alroonall!leS of cardiac cen::luctoo.epJepsy, andin diabel.c paf.oots tllra-
I'<lSC\W njection IsstrdIy COfltrlIlrdCated ResuscilalNe eqJ~efIl anli<on..usant meddnes a~ otherresustltalJl'e clrugs stnJj be availab!e torimmediate use The produ::l sInJd ooty be IJSe(j 11 pregoocy v.tIen !tiebenefits are considiired
tolIlItwEl91 \flensks. Bleast feeding should be alled lor48 hoIn alleruse of SEPTAtEST anv TO DRIVE AI'll LSE MAOtItS.1tl dem::llStra1ed e!tt'ets l.p)ll mooccmmation.tr:lw8Wr sooteets I'AIo ~er adI'erne eIlecls shooldnot
ltMl u usemaeooes uool ~ I\aI'eresolved. tITERACT1ONS: SEPWEST shOUld be attrtnsreredwilhcau\OllDany patentreceMng ltuqs wilfr~Imetic proper1leS Of 'flithagentswMsetherapetlOCac\Ols may be antatpIlsed
by ao-enalira Ar1icaile sIWll be giYef1 'Ioilh eauticWl il patlents receNilg an arnmtJyItmlC aoent l.KlESIRMlLE EFFECTS: ~IMly,lJI'l!lb;:age II' iltrlI1'iISCl.&1r ir'Qection may I'e$Jn il l:ClIaID'y U depressanl mardestations oIlhe0'5,
def)ress3lltcartfJO\'ilSC1Aar feac:lioos. r~ <V"(1 allfs9ic reac\trls.. Pa\iEm witfrperltIefallY tIyper1erlS1\'1! vasaAY lfISeaSe mayCleveloP ISChemic i1IWY II' necrosis f'KlIRtAACELITJC.6J.. PRECAUIlONS.Sttn nih:! orJ;JI'laI container.be!oW

25"'<:. Proteellror'n light.PtWlt,lACBJOCAl fORM ' Solution lor~ cmtained 11 11 aM 2.2 mIdenlaC3fW;leS. LEGAl CllTEGOR\'- POM_FOR RIffiHl fE(JRM4T1QN CONTACT Tl PRQCJl.CT I.C8'JCf HOLIlER:SEPTODONT LID. Units
R&S. Orettd &.zsioess Celtre, S1 Barnabas COse,AIn:Jtoo, Ma~ KerllMEl6QJZ.IKPI. 08313r0039 Available frem yQJ" ICensed oentaI ~esaler. Flrther ilItrmatm andSPCs availatlleonfBlJ,le$1.
SEPTANEST 1:200,(0)
COMPOSITION Arbeai'le ~ .I" , M'enaIIle (ti N:(lJlIlIeIY'rine}1artraIe eq:ressedas base1.200.000 THERN'ElIllC IMJCATJJNS' For rental anaesttEsia rffl- loc:aI OfItaHB\IiOfIaI CIefIlaI anaesl!lesIa 11 pa\B1IS01 al:least4 ye.r.;In
case 01 c:klssC (I' ll'lI.JCO-9i'1g ~lOOS DOSAGE NlJ Jol1WfSTRAT1ON: Fa- IOOSl carrnorJ ~ one i'filralionwitt1 1.7 mIissullbenl Do rot exceed \fleeIJJ"'2!enI 017mgartic::aile I)'IXlllOOJe PEr kllO 01 ~ lkJsa~ II chiktoo
m.*:l beCO'M'lef$SaleWttll\he( weJ;jhl TheRlCOfMJeI'kled close n 20 Kg chidis atoJt ~ ~cll1 mlor)'l ~ 01 2_2 fill .nl il 40 kg e:ti(l is atoJt 1,Sl3lI'O)e 01 1 7 mi D"1 ~ cl 2 2 mI c:omRA-fOCAOONSNlJ
PIH.AlJTJJNS FORUS; ~ 10 anykx:aI anaes~agenI Of al'J)' eatlXJ"leflI 01 SEPTAtf:ST.Do IYJt lJSeSEPW6T irl pateltSv.ro t-.t.e e:rverieoced OiCldospasi11S all9riOnRslralO'l 01 tJOOJcts tcJI\airlilg ~es, patb1ts
wittl detiaercy il plasma e:tdI'Ie:stetaseidMtt~ ra:eMl:'}I.V>D II' I7G<:it ~tie1lts il l'lto1l gema! iIlilesthesla ll'Wgttbe ~ed kl ~ ttIepr!Xl!(UeaM 1'1dlben l.flll!J 4)e<n 01 age SPE<:W. \'IAfWtMiS. Stlldrt Gunn 6Pfard loivery Nicola Cook LizPtmber SteveRothera Andre. WOrtfr l'efl ny Gage

"-
SCPTAIBT ~ beuseowiltl C8lbJlirl paDenls 'Mth ~li::~ , ~ ~ Iisease. al'.o"o'm1iltiesoIl3liacan1.cti.n epilepsy, <IlCI i'I <iareIic paliEWlts, trlra-vasaD r,ectb:l1S sIri:tIr~ ted _ !lesusdIalM; 07595211845 0;.i3(; 2iS H- ! 07913 222142 01921 089011 01913 2)7 064 01710661 036 01515 234 B69
~, ni~ meoidnes;n:lo1her resus:dlalMllItgs ~ be avaiIitJle b' imlediare use The prlW:t stWdrn, be used I'oten 1toe tlefIefits;ye CCfISidered kl ~ tte nslcs. Breast Ieeling stWd beaYOiOed k:r' 48 to.rs
af!g' use 01 SEPTAlIEST.am TO 00'1' AA\'J t.a MACHIJES: NocIoo1Of1SlTatt' effeQs l.p)ll ITlJlll" amlflataI, ~ Sltljects....m sutfer amerse effectr; stJOUkl not00ve II' IlSern.actn:s ~ Sl'IllOJI'llS IlMlresd>'ed M'ERACOONS
AS Atlerdttn
U. Cat1islt
N"""
1ltp 01 Ireland
88 Bladtium
00 ''''''''' "m
BA
Blml'InQham AI. St ,,-;cans
(8 Cambnd~
BN BMgnccn Special Mari::ets.
~~din Q lio,pitals.
SEPTAl'ST stlooldbe mwisTeJedwitflC8lJtiJl'IID ;y'JJ'patert.receM'9dnq; wittl ~ pqleftIeS Of witt1 agMlS wtnse \her.(leUtlC actms maybe ~ IJtacrenaIne_ArtICai'l! sIWd be 9i1oeo ~ eautiCfl i1 patioots OO ~ Bl "",00 B1'l Bourrremouth (M ChtlmslOltl covering tileUKand
( H (Ilestfr BS BriYot ( 0 ( 01l;tWtr "(T Canttrbul')'
<roy"""
receiWw;I al ~ ac;left. LKJESIRAaf EFFECTS t1ypefsmsitMty. 0'09'00sage (I' ifllravascwr~ may resu'l1l'I eUaby Of depressart maMeslaliOl1$ oI1tleQoS,depres:sanIc<wlIo-wscutar ru:llOOS.. re5P1'il1OY ard aI\<>..rrp:; DG " ' - " RepofIreL:tod
reaetO'lS. Patlenrs I'IIlf1IlEf11:'1era1 U Ilyper1'lJlswe vascular ooease may ~ ischemi: irJrY lY necrDSIS. PH/ftM,ACaffiCAL FflECAlITIlNS_Sttn i1 tte lri;JInal cootainer below25"C."'OleCt frcrn llghl. PtWf,\ACEUTICAL FORM: SOOtioo b
injeclicrl caItOOed 1I'l1 .7m1 om2 2 mI d91taI camlges. lEG'\l. CATEGOAV. POM. FOR RJRTlR tIFORMAJK)N CONTACT THE PIlIJlU:T u::mce H(lOO{: SEPTOOONT llD,lrlrts MS.()c:NId &lsA1ess Gentre.51 &m1bas Close. ~
& Galloway
0.. Owham
(W ( rtwE'
FY . _ CF Caldlll
DE Co'Rlltry
CJ _
DH Doncaster
liP HtmtI ,
0,1,. OdClfd
fast london

Maidslcne. KMtf.16OJZ,UK. Pl003131OO38 AvadabIe frOO! \WI"licensed dental ~ Flrther Oormata1andSPCs avaJ!ibe(JI relJll.!SI.
DL Darlington
Eli EdonbUf9fr
1'1 0 Huoo~
H(j li3ITOQille OT Oordlesler "-""
liU liuR
EC EaS( Londo" (CItyl
EN ( nfitk!

-
F( f..lkirk HR Ht<tford IP lpswictl
XYUlNORGEl '" 0"""
COMP<m1ON_1.iIocaire 5 %,GeIrinJlIe 0.15%. 1liEfW'EUTlC tlOCAID-lS: prlX!uctUl cllqXaI anaesthesiaII'l ltle bucCal cavityOOSAGE Atll AIJ.'I-ISlRATlON: AWi0 1 - O.SlI lQ(:a~ U5Ing conoo pellet. DoI"lllIlSein dliklrenunrer
3 ~ CONTRAIfDCATK:lNSANO PRECAUTKlNS FOR USE' XYL.Qt.OO GElis conlrairoc.aled ~ patJerl1S WtI/l history 01 hyper.;erl$llMly toIrXaI alaeSlhetlcs 01 tOO amade tJ1l6.1o celmlkleor to QIhefCOO1~ of!he gel. The kIwestrose
G
"'-
HS 5tomoway
1~rnt'Ss
HX Halifax
1M Isle 01 "Ian
l
EX [xeler
GL G!outtsfer
GY Guernsey
lH lincoln
LU lUlOfl
MK"!i kon ICtynts
GIl "''''''''
HA
~
Harrow

"'"
KT l:ingstcnIJpcn

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resultllg II'l etfectrve anaes1hesla should be used. Dosage stndd aMays be adaptecIlo tllephysical scate 01 the pabent SPECIAL WARNmS' m a Ul GEL should be lJSeIl lvitfr caJtioo it ttereissepsis or 6>:IIernety lr:uma1lSed II1lICtEI il tlle area KA lGImamod LA lancaster NG Noninghdm T"'"",
01 appIieatiooand.. persoos wilIllro.WllhJ:l sensitMtes. Patients should octlakeanyfr:wxl bekretheytra..e r~ sensitMti'- Trete isa [lOSSitjilyoIlX)Sili1'e reslAts on~ testspertormed onSI)(lrtSmen Caution should be ~cised when K\'! IOrkweII LO l~ndrmood wc ester NN Nontlamfllon M( M,);dstOfle
KY klr)l:caldy U llandudllO NP Nl"WjX)rl NR Norwicll N Nortfrl Olldon
the prOOucI is aclmlnlslered dlrtlg earlypregnarcy II' 10nursing I'J(IfJ)M. LtIOESlRABLE EFFECTS SWlemic ~ reac\JMS are 8l:lremelyrareWIth lklXaifiecintments. tt:lWeWr, tJypersensItMty. O'o'el'llosageor tilrini:shed to1erarll:tl may fesult il
l:CitatDj' ardIlYllep'BSSa1I C/IIS Ifmrteslati!.JlS, 00p'ess<rlt cardiova$OJ3f arwJ lespiratuy system moo~estations nIallefgic feacticll'ls.. PlWlIIW:EUT1CAL PRECAUTIONS' soaps arwJ amlOOlC surlactan1s arekr.oM1 to decrease ltIebactenoclal
M~ M01herwtl1 LS "", OX Oxford
,
PE I'@ terborough NWNWlOl'ldon
actMtyoi cetrrnrJe The !ltle S/lClJd be keptweBclm!d below25"C.~ FORM 9f!'I!tlbe' lSgl_lfGAL CATEGOflY: P. FOR FUImR rRlflI.V\TION CONTACT Tl PROOl..CT lICENCE HOL.Dl:R: SEPTODONT I t.lf TID. Lhts R&S.
N[ N~~lle
T",.
Upon
" Manchtsfer
Ol Oldham
Pl P!ymoulh
SA Swansea
5~lfltld
5G 5lel't'nage
PO Ponsmoulh
RG Reacling
Clfct'la'd !us,ness C8mre, St Barnabas Close, AftioJtoo, MaKlstOfle, Ken! ME16OJZ. UK. PI. (l8J13/OO'Zl. Available from)'OlJ' &::ensed oentat wholesal!!f. Ft.\tJer mloonat\ aooSPCsavaitable 00 r~.
XYlONOR SPRAY
Pal'>!ey
"IRPH ""'
PA Preston
5K 5lod:pM
Sf 5toke..()nTrent
5N Swindoll
SF Salisbury ,.,
55 50utl\enc).On. Rli Re<lhln
RM lIomlord
SUMl'I'I.Jnd TA Taunron W~ Wa kefitld IE 5Elolldon
COMPosmoN- per metere<l lklse: l(b:;aine10 00 mg. cetrimide 0 10 mgTHERAPEUTIC INDlCATlONS llI"iXllCton01foIj;;al arJaesthesia anddisinfectiO!l oflheITlLICOUS membrane illhe lloccat cal'it'( DlJS/IGE ANOADMI1tSTRATfQN' one metered TO Gal.lshe il~ SY Shrew,bury TQ TOf(~lJJy YO Yor'o:s~r e \l Slough
00se(10 mg)is usually suttiCienl. The maximum sillg~ dose is20mg. ~ 105sitesmay be treatecl Simultaneously, lhough 00morelhan 3 ineachquadrant. andonly coo quadrantShOuld be anaesthetiSed dt.J1nlloneSitting. Notto be usedin 1\ 5toc!(tonQn.Tee, TF TeMord Til Truro SM 5l1tlon
children aged tJI'(1er 3 years CONTRA-1NOlCATlONSANOPRECAUTIONS FDA USE XYLONOR SPRAYIs contraindl:atecl in pabsnlswith hislcryof hyperS6nSlt l'ity tolocal anaesthe~cs of theamidelype. 1o cetTImideor toother compooontsofthe II Shetland WAWarringlOn WR Worcesler SO Southampton
solution, Thelowest dOse resultingIn effecti'leanaesthesia should be used. Dosage ShOuld always beadaptedtothe physICal state of the patient. SPEClAlWARNINGS mONQfl SPRAYsnould be used withcall1lon rtthefe issepsis orextremely WNWigan INS Walsall SW SW london
traumatised mucosa in the area O! applicalion, andinpatientswith koown drugsensitivities A\'O:dspraying backof throat Of mouth. Beta adrenergil: blocking agents and clme!l(lrne may Slowthe metabolismof ~docaine ancl increaselIlerisk WVWolverha mplon TN Tonbrldge
TW Twtckenham
of to~iCity. Gaulion shOUld tie exercised when lIle product Is aclminisleredduringearly pregnancy Of tonursingwomen. UNDESiRABLE EFFECTS, systemIC adllersereaetons aTe ellremely lare With lidocaineointments However, hypersensitivily. UB Ux~ itlg e
overdosage oroiminiShed tOlerance may result in l:cilatoryand/or depressant CNSmanilesta ~ons, deprtlssant cardiovascLJlar and respiratory systemm3llitestations and allergic reactiOfls PHARMACEUTICAl. PRECAUTlONS store beklw 25G. W We~t lon don
PHARMACMICAl. FORM: metered aerosol (flask:36 g),l EGAl CATEGORY, PDM, FOR AJRTHER INFORMAnON CONTACT THE PRODUCTUCENCE HOLDERSEPTODONT UMITED,UnitSMS, OrchardBusinessGentre,5t Barnabas Close,Allinglon, we Wel t Wildon(City)
Maidstone,Kent MEl6QJZ. UK. PI. 0831310032 AI'Mabiefrom j'OIJI' licensed dental wholesaler. Fi.I1her informationandSf>C available onreQUest WD Watford

~
septodont

Units R & S, Orchard Business Centre, St Barnabas Close, Allington, Maidstone, Kent ME16 OJZ ~