It’s been said that Ronald Melzack is to pain research; what Einstein was to physics. Melzack is an emeritus professor of psychology. He is known to psychology and medical students worldwide because Ronald Mazak forever changed our understanding of how humans feel pain. When Ronald Melzack enrolled as a freshman at McGill university in 1946, he really didn’t know what he wanted to study, but his sense of curiosity and determination would certainly influence how he would study. 

Pick a tough problem. Don’t pick an easy one. Really the joy of research and science is the challenge of that.

And that’s exactly what Ronald Melzack did. It was an undergraduate psychology course that piqued his interest. The department chair was none other than the great Canadian psychologist. Donald Hebb Hebb would later become Mel Zach’s PhD, supervisor and mentor as a graduate student, Melzack studied emotional behavior in dogs. That’s when he made his first major discovery.

Right? Discovered it was part of my PhD thesis. It was with Scottish terriers that were raised in special ways so that they got very little sensory input. And I discovered that they feel pain quite differently from their, uh, brothers and sisters who were raised in homes. So obviously the background of the, of the animal had, uh, had an impact on the pain.

What Melzack observed was contrary to what medical science was teaching at the time, in terms of pain, since the mid 17th century prevailing medical wisdom held that pain was a very simple event. Nerve impulses. For example, after sustaining a burn were assumed to travel through a spinal pathway to the brain. And when those impulses arrive at the cerebral cortex, the person feels pain. The more damage done to the body, the greater, the pain simple cause and effect

With this idea of course, is that it’s too simple. People who have terrible kinds of pain, cancer, pain, or, uh, arthritic pain or Phantom limb pain. Um, what the neurosurgeon tries to do is to cut that pathway. That’s the logical thing to do

Right ? Wrong that had been done often, but patients still experienced pain. The concept of a pain pathway was first proposed by French philosopher, Rene Descartes in 1664 called the specificity theory. It remained unchallenged until World War II, Dr. Henry Beecher observed that a significant majority of soldiers seriously injured in battle didn’t feel the pain initially. Melzack was also intrigued by surgeon William Livingston’s, 1943 book pain mechanisms, which also questioned the specificity theory. Melzack had found his challenge, rethinking how humans really feel pain.

You have to start looking at a very much more complicated mechanism in the nervous system. And that is what I began to do. I, when I realized that it’s not a simple straight through pathway, but it’s gotta be a highly organized central nervous system. I, the organized brain that can take nerve impulses, which after all are simply electrical activity in a substance and turn it into what we feel as pain

After earning his PhD from McGill in 1954, Melzack joined pain, pioneer William Livingston in his lab at the University of Oregon medical school.

I think I was the first psychologist to work as a physiologist in a department of surgery .

There, he met Mrs. Hall, a patient who had had both legs amputated above the knee, but who was experiencing severe pain in her Phantom limbs.

And she had horrible pains in her feet. She felt like her ankles were in a vice and vice was crushing or her foot was in a flame burning. And, um, I began to write down these words and it’s a burning pain. It’s a crushing pain, a stabbing pain.

Melzack noticed that patients used a variety of words to describe their pain. He collected over 100 pain descriptors though. He was not yet sure what he do with them. In 1959, he joined the faculty at MIT where he met a kindred spirit neurophysiologist Patrick Wall, who also was fascinated by Phantom limb pain, both Melzack and wall believed that psychology and environment were key factors influencing how humans experience pain

And thinking about how that might work. I began to think of something that would sort of shut the input, going up to the brain or open it up.

Something like a gate in 1965 Melzack and wall introduced the gate control theory of pain in a landmark paper published in science, according to their theory, nerve impulses traveled to the spinal cord where they’re influenced by other nerve cells that act like neurological Gates, the Gates either block pain signals or allow them to continue onto the brain. The singles are processed according to a person’s mood, personal experience, environment and context from their signals are sent back down the spinal cord, determining the kind and quantity of pain that is, if any.

So, uh, you’re, you’re concerned with, it might sort of open up a gate as one thing. So it, once I think of it that let’s send information about what’s going on there, uh, or, and then you see that there’s really nothing wrong when you take a look. And so the gate closes and the bad pain you had is really not so bad anymore.

It changed the focus of pain from the spine to the brain. And that was a tough sell. We

Originally made a guess that the very tiny cells would sit around. The entry point might work good candidates for operating this control, but it was a real guest because we really couldn’t examine either the anatomy, pharmacology, or physiology of those little cells. Now it is possible. It’s a physical mechanism and it’s, we’ve found it. People, a hundred people have worked on it. There are thousands of pages written on it. We know what the electrophysiology is, what the chemistry is. And so on of that, of the game,

The gate control theory is today described as the most influential paper ever written in the field of pain. It validated the role of psychology in pain, research and management, and led to the discovery of the body’s own natural painkillers like endorphins and to treatments like transcutaneous electrical nerve stimulation.

Okay.

Having returned to McGill, Ronald Melzack continued collecting pain words from patients.

And I thought I’m going to start giving these words to people who are having a baby or who are, uh, having an operation or have some, some kind of pain, arthritic pain, rheumatoid arthritis, let’s say, and, uh, see what words they pick. They would pick the same kinds of words. There is a pattern to the words that were picked for a given

With the help of a statistician. He found a way to evaluate the kind and quantity of pain implied by each word in 1975, Melzack published the McGill pain questionnaire used to assess the type and intensity of pain a person is experiencing.

It’s very important to look at this sort of thing, because it gives you a clue as to how the neural mechanisms in your brain are working. What, where, where in the brain they are working

Now translated into over 50 languages. The McGill pain questionnaire is today considered one of the most powerful tools used in pain research and treatment. Worldwide patients were always central to Ronald Melzack research. And in 1974, he co-founded the first pain clinic in Canada at the McGill university health center. Today, it is recognized as one of the finest in the world. He had one

Pain that was to him most amazing. And that was a pain in which his legs with they would, this pain would happen most often at Melzack

Fascination with Phantom limb pain, in which a person feels pain in a limb that has been amputated or is missing inspired. His neuro matrix theory introduced in 1989. Melzack suggests that we are born with a genetically determined neural network in our brain. This body self neural matrix creates the perception we have of our body, our sense of self, and can generate chronic pain. Even in Phantom limbs.

I have the neuro matrix theory and what I don’t have is a model of the brain that would fit. And that is what I’m developing a new way of looking at the brain.

Melzack has devoted over six decades to solving the puzzle of pain while the puzzle is not yet solved. Ronald Melzack can be credited with having found many of the cornerstone pieces.

Very gratifying. It’s wonderful. Makes me want to continue because the job isn’t all done.

The DentalVibe. What’s neat about this is it has pulse electrical stim, which vibrates the tissues in the mouth. where an injection is being given.

Or you might remember your dentist wiggling your lip. And what they’re doing is trying to distract you, but also to stimulate some of those big propreceptive fibers that are real fast, and that limits those little tiny nerve fibers that cause call the carry pain, um, so that you don’t feel that that pain from the injection.

And that’s what the DentalVibe does.

It’s really interesting too. If we can find that it works in the dental field, maybe it can be applied to other medical disciplines where, where they have to have injections.

Hey guys, how’s everyone. I’m Dr. Tad. I’m a dentist here at the heart of Coral Springs. And I want to talk to you a little bit about the DentalVibe. This video is for my colleagues. I want to make sure that if you have DentalVibe that you’re using it properly, and if you’re thinking of getting a DentalVibe you want to make sure you use it the right way. Uh, I approached Vito who many of you know, Vito from the DentalVibe over at the dental conference. And I asked him, Hey, Vito, uh, the DentalVibe works. Sometimes. Sometimes it doesn’t. I mean, you know, yes. And so at that moment, he raises two fingers and he goes, where are you putting the needle? And I go, I’m putting it right down the middle, you know, which is what everybody says. You know, if you ask other colleagues, you know, where are you putting the needle on the DentalVibe?

You think there’s a prong here, there’s a problem. I just want to split it right down the middle. And it’s actually the wrong place, uh, to put the needle in. Because if you think about it, if you’ve got two prongs that are vibrating, where do you think you’re going to get the most vibration, you’re going to get it near nearest to those prongs. So in reality, when you’re numbing the patient, you don’t want to be placing the needle right in between. And it, the farthest away from the actual prongs, you want to be between a millimeter or two, no more than three away from the vibrating prong, because that’s, what’s actually numbing the area. Because if you’re down the middle, you’re going to be a little bit far from the area of action.

The other thing is, I don’t know if you’ve noticed this, uh, but the new tips. These are the Flexi tips. They allow you to actually change the shape. So if you change the shape that way, and you hold it for a few seconds, guess when it just happened, that just became taller. What can you do with something that’s a little bit taller like that you can give a mental block. So this is actually a great tool to give a mental block. And one of the things that you’re going to do when you place it, you’re going to leave that vibration on for about 10 seconds. No matter what, when you utilize a DentalVibe, you want to let it touch the area for at least 10 seconds, give it 15. You know, what are you going to do? You got to make some coffee or something. Now you’re there for your patient. Make sure you use it efficiently. Otherwise you’re just wasting your time and your money and your tip by just trying to rush through the numbing process.

So think about it this way. When you place the DentalVibe, and if you want to give it a little block, use the flexi tips to make it straighter. So you can access the area, apply it to the area where you’re giving the a, the mental block use the DentalVibe to reflect slightly, but light pressure the, lightest pressure you place, the more this is going to vibrate on the area. So if you just touch it slightly, try it on your fingers. If you touch it slightly, it’s going to translate and transfer a lot of that vibration over to the area that you’re trying to numb. Now, if I press hard, what’s going happen. Nobody’s going to stop, right? If I press hard, what’s going to happen. You get less vibration. And if you press even harder, it stops. So lightest pressure possible, 10 seconds. Then place your needle near the prong, lightest pressure possible 10 to 15 seconds.

Then place the needle near the actual two prongs. And you’re going to be efficient with giving comfortable injections to your patients. So here goes those tips. And you know what? Thanks for watching. If you have any questions also feel free to approach Vito at one of the dental conferences or feel free to master this. Thank you.

So let’s do a close up and let me show you how I’m going to numb this patient right now using the DentalVibe.

First thing you’re going to do is you’re going to shape the tip. You’re going to place it. And you’re going to turn the DentalVibe on. You’re going to wait for about 10 seconds. So the area numbs up slightly, as it numbs up slightly. You don’t want to put too much pressure. Cause if you put too much pressure, you’re going to lose some of that vibration. Okay? Now that the area is slightly numb, you’re going to place the needle near the prong. And then you inject slowly, as Vito says, the DentalVibe is not a miracle worker. So don’t inject fast as the acidity from the anesthetic is going to irritate the area, them backwards near the front and back a little bit. Don’t place it down the middle. Don’t put too much pressure. And once you’re done, be sure to leave the DentalVibe on for about five seconds.

So you gotta leave DentalVibe for about five seconds before you turn it off. And that’s it. So hopefully with these steps, you’ll be more efficient at numbing utilizing the DentalVibe. And if you don’t have the DentalVibe, you know, something you should consider getting because certainly very comfortable for your patients. Thanks. And thanks for watching.

The DentalVibe is tuned to a specific frequency and amplitude to close the pain gate. Try it on yourself first to see how it feels. Place a new comfort tip onto the DentalVibe and turn it on. Rest the vibrating tip above your upper lip, apply different pressure to the skin and you will notice that a light touch delivers the greatest amount of stimulation.

When placing the comfort tip onto the DentalVibe line up the arrow on the tip with the arrow on the device. It won’t go all the way down until both arrows are lined up, snap it in place. And it’s ready for use. To remove the comfort tip grip, the clear portion twist 180 degrees counter-clockwise and lift. The tip will tear for easy disposal preventing cross-contamination and remember twist 180 degrees counter-clockwise and lift. The tip will tear for easy disposal.

Hi, good morning. So a lot of people ask when you’re giving a posterior blocking injection or mandibular block, or you want to just get a little bit further back. How do you get there? Because the tip is so curved. So a simple solution is just grab the tip and hold it like this and bend, hold it for a few seconds that that’s the construct out. And now you have a straight tip. Take your DentalVibe, that’s now straightened, just placing here. So as I’m delivering anesthetic, I’m just making sure I’m going nice and even slow, keeping my vibration device right there.

If you have this tip and you want to get more anterior, we just grab it and roll it around your thumb, hold it for a few seconds. That’s the key. And now you have, now you can get in. So say I want to do more closer injection. Now I can use it like this. So flip this back on. So really you can give injections with a straight or bendable tip just depending what you want. You can custom modify these tips just by using that bend. So once again, if you want to take the tip and make it straight, just grab it and just use the weight that I might have to stretch it. Hold it for a few seconds. And you’ve got a straight tip. If you want it bent, take the tip, roll it down, hold it for a few seconds. And it, you’ve got a curve tip. Now when you’re going to dispose of it, just grab it, twist, pull off. That’s it. You don’t have to sterilize anything. Thanks.

Hello.

My name is Dr. David Ching and I’m DentalVibe clinical and education specialist. I’m here to show you how to use the DentalVibe for your pediatric patients. Being a pediatric dentist. I’ve always looking for ways to lower patients, fear and anxiety. The DentalVibe is a remarkable tool to help me achieve this. So let’s talk about some of the ways we can use DentalVibe with our pediatric patients. DentalVibe is safe to use on any age group. Number one, introduce the DentalVibe in the form of TELL, SHOW, DO. We want to explain to the patient about the vibration and attach meaning to tickling and buzzing, once that has been done, the child is now prime for the DentalVibe. Hi Tana. We’re going to show you Mr. Cracky duck. Okay. So just going to buzz on the side of your hand, like this , feel that? Is that cool. And then let’s try it on this side of your cheek. Doesn’t that tickle? Yeah.

Second point is to always use behavioral guidance while giving the injection. Make sure you positively reinforce good behavior. Good job. Good job. Very good. Third. Remember to direct their attention towards an external stimulus, the use of a TV or iPad above the patient’s head is remarkably effective. If you have no TV or iPad, redirect them towards your eyes and have them look at you. Okay, honey, we’re going to watch a movie now. Okay. So you’re just going to look right above you. Watch a movie. Good job. Fourth is technique. Remember to inject slowly and as close to the prong as possible. Okay.

Let’s see the DentalVibe in action.
Great job. Awesome. We are almost done then.

Okay. That’s it. Good job. Okay. Let’s see that again on another patient.

Retract , Inject as close to the problem as possible, slowly administer anesthetic.

Good job. Landon

DentalVibe works well in conjunction with nitrous oxide and other forms of sedation, DentalVibe uses vibration and won’t cause any increased form of anesthesia. So let me show you how to use nitrous oxide with the DentalVibe. First administered nitrous oxide, as you normally would. Second, introduce your DentalVibe. Okay. Landon, you’re going to feel a little buzzing. Little Quacky ducks.

Very good on the side of your cheek. A little tickling. Good job. Okay, now watch your movie. Okay. Very good.

So in closing, let’s review the key points first introduced DentalVibe second use behavioral guidance, third redirect patient’s attention. Fourth implement proper technique. Finally, keep in mind DentalVibe can be used in conjunction with nitrous oxide or other forms of sedation.

Hello. My name is Dr. David Ching, and I’m here to introduce to you a remarkable product called the DentalVibe. The DentalVibe is a tool that allows you to deliver painless local anesthetic injections, and patients don’t even realize they have just gotten the injection. The DentalVibe is very simple to use, and it doesn’t require you to change your approach to local anesthetic injections. This is the device. Simply turn it on. Notice that vibrational sounds and introduced it to your patient, maybe their hand or their lip, just so they know what’s coming next place. The DentalVibe in the site of injection. Also, notice there’s a light provided to illuminate that area. Think of the DentalVibe as a retractor, like a dental mirror, simply retract at the site of injection and vibrate for maximum infiltrations, turn the device on, retract the lip, vibrate for a range of five to 10 seconds to activate sensory receptors, while simultaneously vibrating slowly inject local anesthetic, remove the needle, vibrate for a few seconds to help dissipate the solution and remove the DentalVibe.

For Pallet injections, turn the device on, vibrate the tissue you plan to inject for a range of five to 10 seconds slowly administer local anesthetic. Once injection is completed vibrate for a few seconds. After I removed DentalVibe. For mandibular block injections. What I normally do is palpate the notch with my finger bisect, my finger, as I normally would for a mandibular block and locate where I wish to place the needle. I then placed the DentalVibe at the targeted site of injection vibrate the tissue push a little deeper to vibrate the mandible and insert the needle as close to the prong as possible, aspirate and slowly deliver injection. After injection is done, I remove the needle and the DentalVibe. Place here for long Bucko injection over here for mental nerve block injection for PDL injection, I placed the prong directly on the gum tissue and insert the needle. Now let’s go over the removal of the tip, simply twist, pull and dispose of the tip. So let’s review some key points. First introduce the DentalVibe to your patient. So they have an idea of what’s coming. Second vibrate, the tissue for a range of five to 10 seconds so that you stimulate sensory receptors. Third inject as close to the prong as possible and inject slowly and last once injections completed vibrate the tissue for a few seconds to help dissipate the solution.

Hello. My name is Dr. David Ching, and I’m here to introduce to you a remarkable product called the DentalVibe. The DentalVibe is a tool that allows you to deliver painless local anesthetic injections. During my residency at Tufts University, I conducted research to determine if there was significant pain reduction with the DentalVibe, the results were conclusive that the DentalVibe was able to reduce discomfort. And the study was published in the February, 2014, a PD journal. I use it every day in my practice and patients don’t even realize they have just gotten the injection. The DentalVibe is very simple to use, and it doesn’t require you to change your approach to local anesthetic injections. This is the device. Simply turn it on. Notice that vibrational sounds and introduced it to your patient, maybe their hand or their lip, just so they know what’s coming next place.

This is the device. Simply turn it on. Notice that vibrational sounds and introduced it to your patient, maybe their hand or their lip, just so they know what’s coming next place. The DentalVibe in the site of injection. Also, notice there’s a light provided to illuminate that area. Think of the DentalVibe as a retractor, like a dental mirror, simply retract at the site of injection and vibrate for maximum infiltrations, turn the device on, retract the lip, vibrate for a range of five to 10 seconds to activate sensory receptors, while simultaneously vibrating slowly inject local anesthetic, remove the needle, vibrate for a few seconds to help dissipate the solution and remove the DentalVibe.

For Pallet injections, turn the device on, vibrate the tissue you plan to inject for a range of five to 10 seconds slowly administer local anesthetic. Once injection is completed vibrate for a few seconds. After I removed DentalVibe. For mandibular block injections. What I normally do is palpate the notch with my finger bisect, my finger, as I normally would for a mandibular block and locate where I wish to place the needle. I then placed the DentalVibe at the targeted site of injection vibrate the tissue push a little deeper to vibrate the mandible and insert the needle as close to the prong as possible, aspirate and slowly deliver injection. After injection is done, I remove the needle and the DentalVibe. Place here for long Bucko injection over here for mental nerve block injection for PDL injection, I placed the prong directly on the gum tissue and insert the needle. Now let’s go over the removal of the tip, simply twist, pull and dispose of the tip. So let’s review some key points. First introduce the DentalVibe to your patient. So they have an idea of what’s coming. Second vibrate, the tissue for a range of five to 10 seconds so that you stimulate sensory receptors. Third inject as close to the prong as possible and inject slowly and last once injections completed vibrate the tissue for a few seconds to help dissipate the solution.