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Anesthesia Supporting Your Practice

Here’s A Novel Direct Injection Buffering Technique for Local Anesthetics

We are pleased to welcome once again Dr. Mark Donaldson to CDA Oasis. In a previous study that Drs. Mark Donaldson and Jason Goodchild conducted, two options available for buffering local anesthetics in dentistry were compared. One using the Onpharma® mixing system (Onpharma), and the other by hand mixing with 8.4% sodium bicarbonate using a "remove and replace" technique. The results of that study showed no statistically significant difference in buffering outcomes between the two methods.

The present follow-up in vitro study introduces and examines a less complex, direct injection, chairside hand-mixing approach, using four commercially available dental local anesthetic preparations.


  • The potential benefits of buffering local anesthetic solutions prior to injection, such as decreased injection pain, faster onset, and greater depth of anesthesia, may be particularly advantageous in patients who have difficulty achieving profound anesthesia for clinical dentistry, and for anesthetizing infected areas.
  • Dentists can effectively buffer local anesthetic preparations, using commercially available mixing systems or by utilizing a hand-mixing technique.
  • Rather than using a remove and replace technique, practitioners may consider a direct injection technique, adding 0.1 mL of 8.4% sodium bicarbonate directly into any local anesthetic cartridge regardless of local anesthetic concentration.

We hope you you find the  presentation informative. We always look forward to hearing your thoughts and receiving your questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.

Until next time!
Chiraz Guessaier, CDA Oasis Manager

Buffering Technique Demo

Oasis Moment (1.36")

Full Conversation (12.27")


  1. Elizabeth MacSween February 10, 2020

    I have understood this concept for years and was disappointed that the “systems” for buffering were not available in Canada. However I want to ask the question re: the mechanics of this technique. Obviously maintaining sterility is paramount, how does one mix the sodium bicarbonate or can an 8.4% solution be bought pre made? The downside of the “systems” are the expense of the product, this technique sounds like it would add minimal cost to the provision of anaesthetic.

  2. Gale Blischak DMD February 10, 2020

    Exciting advancement! How is the sodium bicarb supplied and how do I perform the technique?

  3. Dr. Paul DeMarco February 13, 2020

    Any consideration given to air embolism?

  4. Anonymous February 15, 2020

    I also looked into getting one of the systems a few years ago when I heard someone speak at our local meeting but could not find anything in Canada. Could CDA please consider making another video on the mixing technique? I think there is a lot of interest on this topic.

  5. Vasant Ramlaggan February 17, 2020

    Amazing! What a great idea! I’ll look forward to it’s development.

  6. Anonymous April 16, 2020

    Looking forward to trying this once we all get back to work. To cut down on cost, it is possible to use the same syringe to inject the sodium bicarb into multiple cartridges? Any issues with using the syringe more than once?

  7. Helena Daza June 11, 2020

    Congratulations Dr. Donaldson and Dr. Goodchild, your topic is really interesting, I’m a dental hygiene student and one of my assignments is to find a journal related with dentistry and I found your journal really interesting and very beneficial for dental practices reducing cost, time and less discomfort for patients.


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