1129: Patient Pain Reduction
This episode is being brought to you by front office academies upcoming virtual event building. Your black belt team all know that. The last twelve months has been extremely disruptive to the dental profession particularly when it comes to dental teams. Many of us have struggled with team turnover and many have also experienced mass exodus of their teams and most of us are discovering a frustrating lack of talent in the job when it comes to dental support staff for that reason we created front office academy which is a brand new community and has formal trainings to take your advanced level team members and improve their skill set and also trainings to take those who have zero dental experience and trading their up to be all star team members. So we're really excited about front office academy and what it can contribute to the profession during these unprecedented times to learn more. Just go to front office. Academy dot com also really exciting. Is that on april. Twenty third front office academy is hosting. Its very first virtual event as a launch party of sorts and there is an incredible speakers. Line up in store for you first. We have mike mccallum wits. Mike is one of my favorite business authors and he is author of the bestselling book profit. I now mike was actually slated to be one of our keynote speakers for two thousand twenty six summit in march and we all know what happens to live events in two thousand twenty sweet graciously agreed to take the keynote spot for this event. Front office academies i ever. Virtual event can't wait to hear mike present next up. We have dr sommer caz mel who is an extremely successful Dental practice owner. She owns multiple practices and colorado. Also decide blacktop coach. Next up. dr. Addison colleen also d'essai black belt coach and multiple practice owner next up we have dsl co founder. Mike loma town and erica aguilar. Who is our billing and coding expert inside the i and espn. We have the queen. Herself ashley evans and yours. Truly now the cost for this. Virtual event is only forty nine dollars and the cool thing about the way. We're working this. Is that a hundred percent of the ticket. Proceeds will be matched and donated to the national children's health foundation. So if you guys sign up yourself or your team members for this event every ticket gets matched to ninety eight dollars and that fall. Ninety dollars will get donated to our children's foundation. So we're doing this as a celebration to help launch front office academy to get you guys the very best content when it comes to team training and leadership within your team and we just can't wait so go to front office academy dot com for more information and to register. Can't wait to see you guys. At the virtual event on april twenty third up. So it's being brought to you by my homeys over at magento december one of my favorite new companies that i recently rolled out in all of my dental practices. They have a really cool feature called voicemail drops. That's an ingenious and fully automated way to stay connected with your patients to welcome new patients to the practice. Reach out about unscheduled treatment reactivate hygiene patients. Were send out end of day. Post op calls. I use this on a daily basis and it's been a huge value. Add to my group. The memento team also spends a lot of time making ultra efficient user-friendly and totally customizable paperless forms patients can receive these forms via text or email or they can update their forms right inside the mobile app. So your team isn't spending their valuable time with scanning or data entry and if that wasn't enough but then has several great tools to help offices with case acceptance we all know that delivering treatment plans in a way that makes sense to the patient greatly increases case acceptance. That's why magento has redesigned. Their treatment plans to be fully customizable so that providers and treatment coordinators can present treatment in a language that is less like a foreign language. So if you'd like to schedule a free demo just go to info dot magento is slash costas one more time. That's info dot modesto dot i o. ford slash costas. You'll be glad you did. The dental per noor podcast. Okay doctor. it's time to put down that hand piece. You're listening to the show dedicated to helping dentists. Get their lives back. It's time to decrease your stress increase your profitability and regain your passion now introducing your host. Dr mark kostas kelo. Everyone welcome to another episode of the dental podcast. I'm your host dr marcos guys. I'm super excited for our guest today. she is a very very prominent person in the world of pain management. Her name is. Dr amy baxter. She is a pediatric emergency physician. And the ceo of paintcare labs with a mission to eliminate unnecessary pain. Dr baxter has disrupted how vaccinations and shots are given and now is taking on the opioid crisis. She invented and patented vibrant cool vibrational cryotherapy to treat tend to napa 'this and decrease opioid use and disruptive buzzy device that has been used to control needle pain for over thirty five million needle procedures today. Eight there are fifty independent studies on pain balking frequency that she isolated technology now called industry leader in noninvasive. Patron lease by frost and sullivan paintcare. Labs new dual therm vibrating. Low back pain device just received a one point seven million dollar. Nih grant in is the first to kombi co to combat opioid use by combining six drugfree. Pain release modalities. She was named two thousand eighteen. Healthcare game changer. Healthcare transformer wall street journal idea person most innovative ceo of the year and top ten disruptors in medical tech as well as top women in tech to watch. Welcome to the podcast. Dr baxter wow. I'm in awe of you making it through that. I am great mark. Thanks so much for having me. Just tell us a little bit about where you are and about your history. If you don't mind sheryl in addition to everything you just ahead so i'm gonna atlanta georgia in high did pediatric emergency medicine. Amorim gail undergrad. Emory med school. Cincinnati children's for residency. And then i did a child abuse fellowship and then i did an emergency fellowship at king's daughters in virginia and then my husband told me to quit doing fellowship job and so i went to ut southwestern where i actually got a clinical research fellowship. While i was being attending and we didn't care as much for dallas as we did for atlanta and so that plus three small children in the fact that my parents weren't atlanta just brought us back like a magnet. So here we are. We've been here ever since fascinating. So i i did my research and i was fortunate enough to watch some of your presentations particularly your ted talk on youtube. Really really interesting stuff. Can you tell us how you got. Into the field of pain management and and kind of getting into. I guess the private and research fields when it comes to pain management et cetera. Yeah so. I'd always been interested in unnecessary. Suffering you know advocating attrition. you just wanna go. Aw and fix anything. That's going wrong with somebody. So it was very peculiar to me when there were colleagues or physicians who were pretty stoic. About their patient's pain. So i started my very first research project wanting to prove that topic on aesthetic called ex dividend improving spinal taps on neonates. We do a lot of rule out sepsis lumbar punctures and not using a topic on aesthetic. Seemed crazy to me so i. I had to do a piece of research to prove that. Most people didn't use numbing medicine at the time. And because my irbe you would do it. Wouldn't let me do a randomized trial with no novi medicine exterior. This is going to be better than what they're getting now. So did that. And then got interested in needle pain in general when my son was the right age to get his shots which actually happened to be nine. Eleven like the day of nine eleven. He was getting his royal back scenes and the nurse whether she was stressed about nine. Eleven I don't know even know that had happened yet. But she was. You better sit there and be still or this is really gonna hurt. And i was like well. No actually. there's some topical anesthetics in. I'm actually and she was like that stuff at work and gm did in there and made him afraid of needles and so that deviated my life trajectory because that point is like well forget worrying about doctors not caring about pain with good the patients and the parents something that they can use to address needle. Cain even if the system doesn't care so that kind of dramatic story was what started me on a journey through physics trying to understand the physiology of pain learning about a delta nerves and chilean corpuscles. And things you don't get in medical school or dental school but it turns out that you can actually cancel pain in the same way that you can use cancelling headphones to stop the sound getting through. Wow fascinating fascinating stuff. One of the that. I remember about your tedtalk. Presentation was the fact that the number of injections or in one day or previous to a certain point in somebody's life really had an effect on future needle phobia thought that was really interesting. And and the fact that. I guess if you had if you had a bunch of immunizations and one day or a really bad experience like your son had that could affect you for the rest of your life. Sure like most people who go into medicine. We aren't really bothered by needles. Because your self selecting if you go into a profession where you're doing a lot of injecting you probably ought be pretty cool with needles yourself. But i think we also assume that we are the center of the bell curve whether it's whether it's taste in food or whether appreciation of different lifestyle choices i think most people think that they're pretty close to average so when it comes to needle phobia zoom that. Our experiences are pretty similar to what our kids experiences were. And the reality as you noted is that in nineteen eighty two. We started giving boosters when children were old enough to remember but prior to that time anyone born nineteen two earlier got almost all of their vaccines if not all of them before they were age too. So that means that we don't remember. We only got six injections are total life and until we started adding the boosters and then flu shots every year and then we changed oral polio vaccine to an objective polio vaccine. So kids today. Early kids born in two thousand They got thirty six injections before they were six years old. So it's a really different landscape and we tend to judge. We tend to think these kids are caught on these kids week. These are weenies when in reality these kids gut six times more shots and got them when they were old enough to tell themselves a story about the trauma of going to the doctor and being held down and repeatedly stuck. And so that's where our research developing the buzzy device for needle pain but that's where the research took us was. We found so many more kids who are afraid of needles. Were supposed to be and discovered it was a new phenomenon. Wow excellent so this is really really pertinent to your audience today. Because we deliver injections every single day. And we see phobic patients every single day. And it's usually associated with some sort of previously bad experience or. It could be something as simple as you know a parent that that was phobic and they witnessed that or heard the stories of how terrible the shot is going to be or had been for them up. So we're dealing with this a lot. i was fortunate enough to have a mentor in dental school. One of my row instructors that that took the time for everybody in has row and nobody else in the school. Cut this this type of training. But he showed us how to really utilize topical anesthetic. And how if you know top glenn aesthetic is going to penetrate the oral mucosal by about one to two millimeters and if you just drop a couple of drops of local anesthetic less than two millimeters and let it sit for a bit. Then you're going to have a greater likelihood that the patient is going to have a painless injection. It just takes time and patience additionally he showed us this technique where you massage the gum tissue a little. Bit as you're as you're injecting an and then you're kind of Gently shaking tissue a little bit and it was. It's a technique that i've used every single day in private practice since he taught it to me and i'm consistently getting feedback from the patients that that that was the best injection that they've ever gotten so as it was a gift that somebody showed me that early on what is going on there when we are shaking or vibrating. An area to make painless. Sure i'm gonna give you a top layer and then going to give you a deeper layer of mysteries show. The top layer is that motion sense outweighs pain in importance to your brain. So if you bang you're under the hammer and you shake it. What you're doing is you're stimulating. The pacini corpuscles which do the motion sense. So this is the gate control or gate theory but really it's passed a theory. Now's nineteen sixty five miles. I can wall came up with this observation. And they sort of lego or teleological. Put it into this okay. Well we see this happening so probably what's going on. There's a a pain. And mechanical receptor sensations are all rushing to the same gate and if the mechanical receptors which are on big fat. A beta nerves and their wilma unaided. If they get to the gate. I than they slam the door on the really tiny wimpy delta a small fiber pain which is pretty close to what happens but the interesting thing that's been discovered in the last five years really. Is that these. Mechanical receptors are very specific to the amount of pain. They're able to block. And so you've got the messner light-touch corpuscles you've got the miracle discs which are long too long pressure. You've got the battalion's. I've noted which are the deepest ones and they do position sense. And then you got any. What your stretch ones. So all of this stuff is actually not the most important part of it. Though it's important is that the chilean's do most of the pain blocking and they respond to a specific frequency. So if you want to maximally block keen you wanna maximally stimulate virginia and it does about ninety percent of the pain blocking and it response to vibration and it responds to a really fast. Ration- like hundred eighty two hundred and fifty hertz. So all of that is new information in the last five ten years. About why jiggling jaw or taking the whip and an overriding the pain sensation by the motion sensation. Why that works now. The deeper level actually Is that that we karate in nineteen ninety-six who also noted oracle and tm. J. pain reduction with motion. He he says that there aren't any petitions in the face. So so what this means is. There's there's definitely hearts of the body know related to joint anything in that area. Where the champions. And that's why russians working and that's why it has to be very fast frequency but i do not believe that we actually know what is happening because if there aren't pretending corpuscles in the face then the reason that that motion is working is is some additional mechanism that we haven't defined yet interesting interesting because there is a device called the vibe reject and can put that on An aspiration syringe in that does vibrate. And i've heard that works well of a lot of colleagues that use it is that similar to what the buzzy devices that that you've patented. Yeah so there's actually a meta analysis by you wiki at all you e. k. I that looked at dental vibe. The blaine labs operation thing and buzzy and found that buzzy had a greater effect size in either of the other two. and probably. It's because we're in the right frequency for the beginning corpuscles even though again i don't know if they just haven't found the burundians and the jaw or whether we karate was wrong but other people have said their options in the face regardless buzzes using a two hundred hundred vibration but also an ice pack ice. Does something called descending. Inhibitory control and the other part is that while you might have a vibrating needle or a dental vibe. That sort of stretches a little tiny bit of skin and thus get some of the extra phoenix pencils with stretch as well as vibration What buzzy does is you put it on the next silla or the mandible and bone transmits vibration to a much much broader area. So at this means. Is that when the patient or win. The practitioner is holding buzzy on the next sola for an upper palate injection or for any kind of upper jaw or at. They're holding it on the mandible whether it's where the nerves come out or even lateral bit. Further down toward the and jay. You're getting a much broader spread of this two hundred hertz stimulation and you're also using this descending inhibitory control with the ice to do a feedback loop that decreases pain so the combination of the two are more effective and because often they have the patient holding it on. There's a bit of control to address the fear and there's a bit of positioning that can do a feedback loop to do better. Wow that sounds fascinating. That's amazing. how long did it take you to develop this technology. I started in well the day that my son had the the issue in two thousand one over the next couple of years. I tried to figure out a way to replicate this station of running water. Like you burn your fingers to get running water. Pain goes away. It was very messy. It didn't work. I thought about the idea of vibration causing the motion and running water. Since when i was coming home from an emergency shift in two thousand four and it by itself didn't work but when you put the ice together with it left marks on my kid stands and they couldn't feel anything so that was the the die was cast. I was not going to be mother of the year. 'cause i leave marks on my hands with a warden wheel but from two thousand four it was about two years of noodling and making prototypes in my basement. I mean literally. The kids and i would borrow would take people's old cell phones. It didn't work. And we will dissect them and find what made them vibrate and harvested whole bunch of little motors. Then i got an nih grant in two thousand eight nine and that was only discovered that needle fear was more than it should be and so did a couple studies on that for the next year's published. Something on that golly. Twenty seventeen and in twenty this teen one of my colleagues who turns was an opioid recovery asked whether or not buzzy would work for him to take a total knee. Replacement without any opioids and it did so. That was really when the the change in trajectory was complete. Because by that time we were. Selling some buzzes. I went on shark tank. Goes very exciting but it was still a doctor stole a researcher that was my my ego was tied into making a scientific contribution that would change behavior and change the way we vaccinated. Gpo and change how people perceive pain. It wasn't until my colleagues experience that i realized that all kinds of pain would respond to this and that the opioid crisis could be dealt with in a non pharmacologic way. So that was went. And my jew i was. I was a procedural sedation. As for the last ten years of my career so fall nell straight up. Morphine decks accommodating. Nitrous i was. I was really good at giving whatever the patient needed whether it was for of fracture reduction waza ketamine. I'm not opposed to pharmacology at all but when it comes to being able to block pain and when it comes to addiction knowing that there are better options that are non addictive really effective became a passion that caused me to quit practicing medicine. Go into researching this full-time that's fascinating to tell us. More about how this sort of device or any type of device or recipe could potentially decrease the necessity for opiates. Okay so first of all if you have pain and it is ongoing. One of the inherent problems with pharmacology is that you have a finite peak. And then the pharmacokinetics are gonna start dropping off and you're gonna lose a clinical efficacy before you lose enough of the drug in your system to to need more so for example. So so you take ibuprofen and it goes up in the first twenty thirty minutes and then it has a slow decline. Well if you take it before you get to the point where the the serum concentration has gone down the half-life then you're going to end up overdosing on ibuprofen same thing on. Opiates so inherent in pharmacology is that you're going to have a period of time where you're below the clinical efficacy of the drug for pain. But you're not yet able to take it again without risking having build up and taking it before the half life is done so it looks graph but the the point of this is that there. It is going to be a point of fear. Where if you are overwhelmed by pain. If you're concentrating on pain if you're combining fear and catastrophes and pain then you're inevitably going to have a period between the clinical scheme where efficacy wears off and when the half life is done so that you can take another dose and that little period of fear actually ramps up the perception of pame so one of the ways in which using a mechanical device for pain is better than pharmacological is that it gives the patient power over when they do something to to relieve the pain. If you bumped your elbow when you rub it immediately the pain goes away so having a device like i mean we call buzzy vehicle when it's for knees it's essentially the same thing we're working on a new one. That's a little bit bigger called by local pro which is a different device but what matters is the frequency so if you know that you put the frequency on in the pain immediately stops and you can put it with ice or not. What it with is. Put it with heat. Those choices give a patient control and decrease fear fear in the middle and the foulness increase the perception of pain. So part of the whole pain continuum is processed into place called the interesting gillet gyrus and that is evaluating whether something is dangerous to you so if you have control over the pain. The interesting hewlett gyrus says. We don't need to pay as much attention to this. It's not dangerous to us. Great example is say. You're playing a game that you like or you're doing something and you hurt part of your by your say. I actually broke my neck of years ago. And when my negatively hurting. And i'd be in front of the computer. It was annoying me and i would have gotten scared except that i knew i had a vehicle a heat back in the other room that i could go get and so just knowing that if i wanted to get up off the chair and stop what i was doing. I had something in the other room. That could help was enough to give me an extra half hour of ignoring it because it didn't scare me whereas if you're in that same situation and you know you've got an hour before you can take another pain pill that might start to get distracting to you because then you start focusing on the fact that you can't do anything about making time pass faster. Yeah that's that's really fascinating This this caught my eye. The low back pain device. Because i've personally had two back surgeries. And i know what back pain feels like real back pain when we're talking like an eight or nine out of ten for months at a time. It's extremely distracting like you say but it's very difficult to work. And because of the nature of our profession were sitting in the stool and and Posture is a big issue in the types of procedures. That were doing all day. Every day over decades really leads to a lot of people that have chronic back pain in our profession. Can you tell us about the device that you have created for for back pain. Sure so this is the one that we're currently studying with the nih. So national institute of drug abuse funded us to see if having a multimodal low vaccine device. So we're combining multiple different frequency and either heat or cold and pressure and a metal back plate. That's about Six by eight inches. So it's conformed to put the most treasure into the muscles adjacent to the spine. Because usually those are when you got posture back issues. It's because you stretch those muscles out in in a weird position and you've been using additional muscular energy to hold them together and so then when you try to stand up. They can't really elastic cord to for pulled out and so they can't go back together enough and so then they start aching. So it's a a plate. That has three different motors in it. I've been experimenting with different thicknesses of the plate and the shapes so that the propagation of the vibration gets the most nerve endings and we actually have my first feedback from someone last night that we sent our first device to. She's a doctor up in connecticut around yale and she had participated in indigo gopher. Do therm before we got it. Got it funded by the h. And so i actually burst out crying because i've been doing this for four years and i wasn't one hundred percent sure that this was going to make a difference for somebody who had really serious back pain and she said it was better than anything should ever used and said the constant stimulation of multiple different vibration patterns just interrupts the paying it will not be clinically consumer available for probably about a year and a half but But we're on the we're on the right calf with it. One thing. that's really fun is that there's a guy in sweden that was doing research with vibration in the early seventies and he found that when you left by ration- back plates on for about thirty minutes there was a dramatic change in the duration of time we find about three and a half to four hours consistently with the trouser done so far of low back pain relief so to use it for thirty minutes. Then you get like three and a half hours of pain relief and it's interesting something clearly going on because it's a very specific regardless of others acute or chronic. There's something going on. So what this guy had prophesized in the early seventies was that it might be that if you trigger these nerves enough that you invoke the The a one fibers that are wrapped around muscle spindles and so those are not traditionally thought of as being gate control nerves. But but you know you think about the the native peoples that would you know run for twenty four hours for people that were able to do really profound feats and do it for a long time. It makes sense that the body would have some kind of mechanism to override chronic pain that lasted for a long time. Or that if you had a sensation for long enough that the brain would have a way to say okay. This is not providing anything useful. I'm just gonna shut this down. So i don't know if that's what's happening or not but i'm really interested in the one after on some whether or not that is is part of what we're doing. Now wow show a cool dental for you totally red shout out dr patel. I mean. there's lots of dr patel's but Shoutouts dr patel who said so. He's been using buzzy on the mexico and the mandible four injections but he said that he's been putting it on people's temple to override the gag reflex with bite wings. And i think what might be happening is that it may transmit the vibration to the chemo tactic triggers zone and that ney. Stop the nausea gag reflex. I'm dying for someone to study this prospectively. I have no idea whether this works perspective or not. But it's an eight percent incidence of of Gag reflex right. So it should be a high enough percentage and people should have a history of it that you could do a randomized trial and get an answer with probably sixty people. Total that But i'm very interested. Do you have any theories about why that could work if it does. Do you know. It's very interesting because i've tried everything. We've we've tried to work with pressure points with with our gag irs. We've rubbed kind of clavicle. We've grabbed clavicle and kind of massage that we have people tighten up their apps and lift their heels up off the ground. Some we get we get mixed mixed results with that but it is a problem. I mean they say eight percent incidents but when it happens and it's keeping you from being able to get through a procedure or you've already completed a procedure and you need to get like an impression or something or you need a post op x ray or something. It's it can cause a problem we've had to have people come back sedated. In order to complete auto complete a basic exam because they couldn't tolerate it's funny because a lot of it is. I believe a lot of it a psychological because obviously they're able to chew food and put it in their mouth without without gagging but for some people you put it past their canines or their pre molars and touching anything else in. They start gagging so physiologically. It's actually really happening to them. But it doesn't seem like they'd be able to survive if that was the case with other things other than dental dental instruments and whatnot. Yeah have you i. I don't know. Because when i been i've i've had gags with Not often and and you can kind of overpower it. But there is a place. Just past the canines where sticking a little bit further out laterally than food would normally go. That's where it tends to almost like. We're the always been so long since i've not when you got when monks you got the was you can get a stone in to the saliva is stopped with What does that. A solver stone in the Done in the gland below the tongue. No no no. It's more it's right. It's like Right under the master. It's going to come to me. you know. We'll get a good inflame don good product gland or yes. Yes thank goodness i pulled out. How are being ridiculed. Every single dentist listening to spirit. I discussed the game so so so there's an area so it's kind of like it's just it's like exactly underwear the prada's there's just this little place where that that is is where i did a little gaggy and that's kind of where the bite wing is but no that you can use vibration with people that have That are unsteady on their feet. And so it's a semi. There is a semi circular condition. That vibration help straighten people up so it may be again. We know whether it's semi-circular whether it's the chemo tactic triggers zone by I actually was surprised that this guy said they haven't put it on their temple. Even though bonus conduct really well. I still would think that that more exceptional would make it be better or someplace just under the ear lobe. May you're on the on the angle of the jaw there but But regardless. I'm not sure but i do think that there is a chemo. Tactic trigger zone related thing. Because they're also is talk of vibration helping space sickness and men one point. I was talking to one of the chief. Medical officer of the iss about how rain could impact the the zero g nausea. Let's there's something there. There's definitely something interesting there. But not enough to put a five k. on it or make the claims. But i do think there's something worth studying there. Yes what is the process. I mean you're you're clearly an inventor you've invented lots of things. What's what's the process from when you actually get a patent which could which could be extremely long a long period of time when you actually get a patent to being able to release it out into. The world is a bona fide product. While there's so much unpack there so you don't actually need to have a patent It depends on what your goal is and when you have something bad is really easy to make and really easy to copy. That's one a patent may be valuable but if it's something that is going to be fast market and you gotta means a production or you've got away license it. Sometimes pending with little simple provisional thousand dollar filing is perfect. There's really no reason to go through the whole process of patenting. There's something the p. T. a. b. the patent trade analysis board. It's it is a way that a triumvirate of three different people can overrule the patent board So a lot of inventors have their patents overridden when a big company gets interested. Because we don't have enough money to fight some wine who is trying to invalidate our patent but the big companies can say. Oh you're just a troll. And this is our idea and then invalidate the patent easily so that makes the value of a patent lot less than it used to be. All of that. Said if you're going to come up with an idea that is worth patenting. You need to do it within a year of making any kind of public declaration of what you've done. So i filed my first patent as a provisional in two thousand six because i was presenting a vibrational pain device blocking pain for me injecting lighter kane in somebody who came into my office or while the emergency department and so since i was presenting it at a conference i filed the pat then to make sure that we were covered so it turns out i could have waited a full year but so long as you get it within a year after that. It's about what domain now. That's totally different from the process for fda one of the ironies in frustrations about medical devices is that it's just as rigorous to go through the fda for a drug as it is for a device in terms of how you do the trials what you claim. We're actually applying right now for additional coverage for dental injections because while we have regular injections and are five ten k. Controls pain from injections. Iv access needles. But we didn't specifically get dental because at the time we filed there. Were not explicit dental trials so now that there are five studies that were just done split now using fuzzy for dental injections now. We can get the specific indication for dental by. That's been i mean our first. Fda was issued in two thousand fourteen so allah later. Yeah yeah so So there's all of these different kind of byzantine things one thing. That's really interesting. As i figured when we first got the nih grant that that was gonna take care of the fda because it's all the same government right they talk to each other and it's like no no these. These guys are good. That's a huge assumption with the government. Yeah i really thought that. What i did was not only did our work with the nih. Have nothing to do with the fda but there was an fda auditor who came to us auditing whether we should be a class two device at the same time as we had already filed our class one fda application so fda auditor didn't know that we'd already applied for a class one device and so we had this horrible brutal nauseating post traumatic stress. Fda audit as a class two device and then as soon as we were granted. The cost one all the sudden. The woman just disappeared so just like oh well the nevermind. By though it was it was It was very stressful. A lot of stuff going on even if you had the fda clearance however that doesn't guarantee that centers for medicaid and medicare are going to pay for it so whereas with a drug when you pass through all of the studies and you prove efficacy then most pharmaceuticals are paid for once. They're proven effective. But with a device centers for medicaid medicare will not necessarily grandeur of coverage even if you're effective so there's There's work to be done to get people off drugs in this country and onto multiple different things at work and we're not there yet so let's go back to the buzzy device for dental professionals What exactly does it look like. Would we need one per room. Do you think or how exactly you know how much space does take. And how long does it take to administer etc. Sure so because a pediatrician. And i started doing this for kids. Vaccines are primary designed. Looks like a f buzzes. So get over it the eh grade plain black when now for adults but the irony is that even adults will tend to get a b once. They've committed to the fact that they don't like needles. They're like fun. Whatever bring on the. I don't care we also have a lady buzz because in south africa they have killer. Bees people have lost family members to be so. He's okay lady. Bug was the better part of our but It's about the size of a computer mouse. And the the action and of where the motorist that gives the frequency that does about seventy ninety percent of injection pain That is at where the stinger would be on a b. It's kind it's the opposite end of where the switches so it's about it's it's curbed so that it will go over the cheekbone or the jaw and it's really important to hit as much surface area as possible because the pain nerves. A delta pain nerves all over. The body are more of a fine web and even if you're just putting an injection in one spot. That is transmitting to the web. And its transmitting to the dorsal columnist. Final chord as multiple signals. So because of that you to get as much surface area as possible to override that signal. So the the surface area touching the Mandible are important and the patient chan press it to their jaw or the men will Or the jar a maximum of an and it works contact. I mean it's just like if you burn your finger as as you put it under cold water. The pain stops. So you don't have to wait but you do have to have it in place while you're using it. So the best way to do it is to have the patience hold themselves help them angle it so that the the bottom end of the device is toward their mouth or toward where the ejection is going to be. And then they can just press it to the bone and it's going to transmit down now if you have the ice pack it is gonna work better. It is not necessary so you're still going to get some bang for your buck. The just the vibration alone say you don't have to go back and forth to the freezer is worth is pat. Go and them. There's a little silicone strap on the bottom on behind the excel units extra large units and. There's a hook on the back of the mini units and so the ice pat just attached to the back so it looks like wings. I mean sticking with this be motif so the ice touches the skin but the way that we made the ice packs. It has a finite amount of thermal energy in it so they freeze solid but they will melt before they can cause frostbite. The freezing solid is important. Because again you want to make sure that that gration transmits unimpeded if you had a joke. Hack then you're not gonna be transmitting the vibration. It's better to just not use it at all if it's refrigerated but not frozen because you really the vibration is the is the the secret sauce in this. And the the ice pack is just an extra little bit of of seasoning. Gotcha gotcha end. These are currently available to dental. Professionals are not yet. Oh yeah no they definitely are okay we just. We can't explicit actually now. We can explicitly advertise that. They were credential injection so long as we cite one of the five papers that that has the data but yes so we went to him in a few years ago and we were in a couple dental catalogs the overwhelming interest that we had for vaccine connex travel clinics Women with ideas and then of course moving to the the vibrant coal for tendency plantar fasciitis that too. We kind of lost interest in dental a little bit. Just we don't there's there's eight of us were an all woman company. We have eight people. We don't have a whole lot of bandwidth for advertising. So you can get them with. Thermo fisher med line. Get him on amazon. It can get them at paintcare. Labs dot com or shopping care dot com and honestly The said the come with batteries. They last for about twenty hours. And then you just replace the batteries so what. We usually tell doctors offices. Because they're not getting injections in every office is that you probably need one for every three to four rooms and i would say i mean i think most most dental offices would need to their hundred bucks there so two hundred bucks get to them. You're done is definitely gonna look into that teaser. This is a fascinating fascinating device. That you've created here. Congratulations on on all of it. Oh thank you well you know. One of the thing is that's important. You guys do this better than almost anybody. Is that this distraction for the enters. And hewlett gyrus is complementary to using the pain control of buzzy. So whether you're jiggling jar whether you're putting buzzy on the the whether you're putting buzzy is on having a distraction also key and one of the cool things that we've discovered in our research is that the the way the injures viruses maximum distracted is if you give somebody an unfamiliar counting task. So i like is if somebody's really anxious i have them look across the room and count the number of letters that have holes in them. So i I'm looking actually at fear and dental right now because we're working our fda so E- has a whole a whole d- has whole he has a whole Yeah so once you dynastic okay. One two three. This shot has done so having look across the room at a task. is magnificent as an adjunct to mechanical stimulation pain release. I'm gonna have to put some posters on the ceiling then because they're usually looking straight up at the ceiling past my head exactly. Yeah we have. We not some kid posters with the yamaguchi monkeys or on the bed. Kind of things but Not any printed words so if your fear don't they'll an adult population maybe just print out. Everything is going to be fine. And could that on the ceilings. I love that love. Will dr baxter has been a true pleasure Getting to know you today and listening to all the advances. You're creating for the medical and dental professions. And and i would love it if you could just take a moment to maybe share your contact information absolutely and if anyone is interested in doing a randomized prospective trial i would be very happy to provide the the buddies for a kema tactic trigger zone or a dental bite wing. Study because i really think that that's got some exciting potential to it. How can i contact. Information is a baxter at pink your labs dot com and we are at paintcare dot com and the buzzes can be purchased at shop. Got pink your labs dot com very easy awesome awesome. Don't be surprised. I mean this is a pretty large audience. I wouldn't be surprised if you got somebody that might be interested in doing one of those studies for you but in the meantime thank you so much. I think i'm gonna go out and get a couple of those buses and try him out. Well please do give me your feedback and others anyway. We can improve it. Or if i can link to the meta analysis that is for dental products. It would be very happy to do so awesome awesome. Okay we'll have a wonderful day. Dr baxter thanks again for being here and hopefully we'll get to do this again someday soon. Mark it was a delight. All right ladies and gentlemen. Dr amy baxter. Ever dream about running a black belt level dental practice about becoming the kind of leader that inspires the team to create a systemized orderly and profitable practice. Free of unnecessary stress and drama. What if you could practice clinical dentistry on your terms or quit completely goes to do so without a decrease in your standard of living if this sounds like nothing more than a fantasy i assure you it's not and we've watched the scenario play out time and time again inside the elite practice mastermind group. But this isn't just any run of the mill coaching and consulting group. We have no desire to be the in fact. Growth beyond a certain point would decrease the effectiveness and value of our membership. So we only work with dentists that possess an abundance mindset and share similar values are hummel and coach and take one hundred percent ownership for the results that they're getting in their personal and professional lives. So if you feel like it's finally time to discover the limits of your potential and would like to apply for a spot inside of our special community just go to true dental success dot com and hit the connect with mark now icon. You put in the time and the effort. You made the sacrifices. Isn't it time you took control of your future true. Dental success dot com connect with mark now and that wraps it up for another episode of the dental poor. Podcast look for to reconnecting on the next episode. Thank you so much for joining us today. On the dental noor podcast check out true. Dental success dot com for full recap of every show a schedule of our live events free video tutorials and a whole host of practice building resources.