Periodontists can do amazing things for people. They are masters of the supporting structures of teeth. They rebuild gum and bone. They remedy disease states and can even replace teeth. But they cannot control how patients perceive and react to visiting the practice. Education and information are the foundations of building trust and guiding patients through a challenging experience. Considerable time and energy are devoted to developing a strong relationship with every single patient. Each patient has the baggage of their own set of experiences, medical histories, and sensibilities. Trust is critical, as are listening, understanding, and treating each patient individually. This experience is rewarding for all involved, but it is also exhausting and requires considerable effort.
Innovative technologies offer procedures that are proven to naturally relax the brain and body within minutes without drugs. NuCalm provides the appropriate neuroscience technology tools to completely neutralize patient anxiety, naturally relaxing them, and providing every single patient with a positive, relaxing dental experience.
Anecdotally, there is great awareness of the negative impact that stress has on overall health and well-being. Individuals under stress don’t sleep well, suffer diminished appetite and decreased nutrient uptake, don’t process information well, and report lowered energy levels; in short, satisfaction and happiness levels are compromised. Stress profoundly impacts cognition, vitality, effectiveness, and efficiency. On a cellular level, stress can wreak havoc on the autonomic nervous, immune, and our endocrine systems.
Breaking down the patient experience, the negative perception of dentistry may be traced to this simple equation: dental treatment = stress = negative experience. To reshape the dental experience from a negative experience to a positive experience, it is critical to try to alleviate and minimize stress for dental patients.
Clinical Protocol for Pre-Operative Patient Care
(Before NuCalm)
Typical pre-operative protocol began with spending a tremendous amount of time gaining a patient’s trust. Educating the patient about their specific condition and the explanation of treatment options were part of gaining their trust and understanding their emotional state. Most, if not all, patients present with a moderate amount of fear and anxiety which increases with a pending surgical experience. Pre-treatment discussion of fears, anxieties and day-to-day stressors help patients to understand how they may proceed with a needed surgery and to minimize any additional hardship while preparing, enduring, and healing. For many patients, a consultation appointment was followed by a second appointment, the pre-surgical review, to discuss pain management and post-surgery homecare. This review included medical consultation reports from the patient’s physician and the prescription of appropriate pre-operative, post-operative, and additional medications. The need for sedation is also discussed at this appointment. A typical protocol might include pre-operative steroids and antibiotics, and post-operative analgesics, such as non-steroidals (NSAIDs) and perhaps narcotic analgesics. Homecare is focused on minimizing damage to healing surgical site(s). Follow-up appointments are based on individual needs.
Clinical Protocol for Pre-Operative Patient Care (With NuCalm)
The pre-operative protocol still involves spending time with patients to gain their trust and to discuss their treatment options. NuCalm is utilized as a first-line relaxation modality. Patients can be virtually anxiety-free within 5-8 minutes, allowing modified treatment planning. Surgical times are shorter since lengthy set-up and post-surgical recovery times have been eliminated.
The surgical assistant administers NuCalm prior to surgery, freeing the practitioner for other patient treatment. Once NuCalm relaxation is established, anesthesia proceeds quickly and onset seems to be faster and more profound. Patients are more cooperative and surgery can begin sooner than without NuCalm. Since patients are very relaxed, they seem to be positively receptive to all aspects of the surgical experience, facilitating treatment and decreasing dentist stress. Post-surgically patients are reporting less pain and swelling for nearly all procedures. They indicate that they are either taking less post-operative medication or none at all. Post-operative complications have decreased. Post-treatment follow-up calls the evening after surgery reveal that patients feel fine and are not experiencing severe pain. Many patients reported that they were able to get a full night’s sleep and were only mildly irritated by the surgical experience the following day.
NuCalm
NuCalm is a revolutionary, patent-pending, technology proven to naturally relax the brain and body within minutes without drugs by mimicking the body’s natural experience of preparing for sleep. NuCalm is unique because it creates deep relaxation without narcotics or controlled substances, causes no side effects, and requires no recuperative time or supervision.
Unlike sedation techniques that chemically suppress the central nervous system, NuCalm brings alert beta brain wave function down to the alpha range (first stage of sleep, characterized by brain wave frequencies between 8-12Hz per second). Patients experience the same relaxation that they feel as their body “winds down” and readies for sleep. Alpha brain waves are associated with deep relaxation, meditation, and idleness. Patients in the alpha stage of sleep are physically unable to have an anxious response. NuCalm uses applied neuropsychobiology and neurobioinformatics to entrain brain wave frequency to the alpha range which is associated with deep relaxation, naturally creating homeostasis, neuromuscular release, and relaxation for the patient. NuCalm provides a safe, non-intrusive solution to eliminating anxiety in the dental chair.
Prior to NuCalm, the two healthcare procedure anxiolytics were chemical sedation or treatment avoidance. With NuCalm, clinicians can create a relaxed experience without the risks associated with conventional sedation techniques.
The NuCalm Protocol
NuCalm creates a profound anxiolytic experience by combining four sensory applications: chewable tablets (natural anxiolytic neurotransmitters), CES (FDA-cleared Cranial Electrotherapy Stimulation), neuroacoustic binaural beat software, and black-out glasses. The NuCalm system is simple to administer. The four steps take less than 3 minutes and most patients experience deep relaxation within 5 minutes (Figs. 1-4).
Orthomolecular Chewable Tablets
The NuCalm orthomolecular formula was developed to maximize the body’s natural relaxation response (Fig. 5). This proprietary formula includes structured nutrient-sourced building blocks that counteract adrenaline by rapidly entering the brain where they suppress anxiety and create relaxation. The primary ingredients in NuCalm’s orthomolecular formula are GABA and L-Theanine. Like benzodiazepines, NuCalm influences behavior at the GABA receptor site; NuCalm provides GABA to the brain while benzodiazepines promote the production of GABA. L-Theanine supports the formation of GABA and has been shown to induce a general calming effect.
Cranial Electrotherapy Stimulation (CES)
NuCalm’s CES device catalyzes the effect of the orthomolecular tablets on the neurotransmitters (Fig. 6). The CES device produces low levels of electrical current that interact with cell membranes to modify information transduction associated with classical second messenger pathways. Research over the past 50 years indicates an increase in the metabolism of neurotransmitters. The CES has been cleared by the FDA for the treatment of anxiety, depression, and insomnia. Combining CES with precursor neurotransmitters, such as those found in the NuCalm chewabl
e tablets, causes a profound state of relaxation and anxiolysis.
Neuroacoustic Software
NuCalm’s proprietary neuro-acoustic software uses Frequency-Following-Response (FFR) that initiates a change in brain wave frequencies through entrainment (Fig. 7). Research has demonstrated that a scientifically validated neurophysiologic response is initiated when an auditory pacing signal is presented to the brain. NuCalm’s binaural beat, FFR neuroacoustic software is overlaid with classical music and administered to patients using an MP3 player and noise-dampening headphones. The neuro-acoustic software slows the patient’s brain wave function from the high beta frequencies associated with anxiety (23-40 Hz per second) to patterns consistent with the alpha stage of sleep (8-12 Hz per second). These alpha brain waves are associated with deep relaxation and calmness and are maintained throughout the NuCalm experience.
Black-Out Glasses
NuCalm’s black-out glasses (dark sunglasses) are used to block light from the optic nerve to the visual cortex of the brain (Fig. 8). This helps maintain deep relaxation.
Impact of NuCalm on
Pre-Operative Patient Stress
NuCalm addresses the midbrain activities responsible for producing stress and anxiety by naturally mimicking the communication pathways used to prepare the body for sleep. It works on the GABAergic system to create a biomimetic negative feedback loop that reduces the action of the HPA axis (Hypothalamus – Anterior Pituitary Gland – Adrenal Gland). The NuCalm entrainment to the first stage of sleep encourages parasympathetic nervous system dominance. Once in a relaxed state, patients do not experience the ‘fight-or-flight’ response and do not produce cortisol (the ‘stress hormone’).
Research indicates the patient’s physiology on NuCalm is consistent with a ‘relaxation response’ where the muscles relax as oxygenated red blood cells are pumped throughout the body including the frontal cortex. The physical manifestations of the ‘relaxation response’ include relaxed head, neck, and jaw muscle tension, decreased startle response and hand clenching, decreased gag reflex, decreased salivary flow, and decreased resistance to treatment. A still, relaxed patient is a better candidate for surgery and more likely to have uneventful post-operative healing.
NuCalm Case Studies
Case Report One: Extraction, grafting, and implant placement with NuCalm
A 66-year-old female was referred for extraction of the lower right first molar, which had a vertical mesial root fracture and a buccal fistula (Figs. 9 & 10). Her medical history was unremarkable, but there was an elevated pretreatment systolic blood pressure (149/72 mm Hg). The clinician suspected “white coat” anxiety causing an elevated systolic blood pressure. After NuCalm relaxation therapy, the molar was extracted with immediate implant placement and bone grafting. There was less bleeding than normally expected for this procedure. (Fig. 11) At the conclusion of the surgery, the blood pressure was 124/70. NuCalm effectively reduced her dental anxiety, in turn lowering her blood pressure. At one week when her sutures were removed, she demonstrated significant soft tissue healing and a resolution of the fistula (Fig. 12).
Case Report Two: Implant exposure for the compromised patient with NuCalm
A 43-year-old male presented for the exposure of a previously placed maxillary right central dental implant. He had experienced extraction of the tooth and immediate implant placement with buccal ridge preservation (xenographic bone graft and fixation tacked resorbable membrane) (Fig. 13). Four months post-operatively he required exposure for a customizable healing abutment. He has smoked 2-3 packs of cigarettes for 20 years and has hypertension. On the day of exposure surgery he had extreme anxiety and began to hyperventilate. He was calmed and provided with oxygen via nasal canula. His pre-operative blood pressure was 156/92. The NuCalm relaxation protocol was instituted. There was less bleeding than normally expected during this procedure (Fig. 14). Post-operatively his blood pressure dropped to 137/90. It can be concluded that NuCalm had a significant impact on his anxiety and lowered his blood pressure. While his healing progress was slowed due to continued tobacco use, it was better than expected (Fig. 15).
Case Report Three: Patient with NuCalm
A 47-year-old female required implants to replace the endodontically-compromised maxillary centrals and the left lateral after orthodontic extrusion was completed (Fig. 16). Numerous traumatic dental experiences have left her with a tremendous amount of anxiety. Complications include a 30-year, pack-a-day smoking history and decreased pulmonary function. Her anxiety about intravenous sedation led to the selection of the NuCalm relaxation protocol. Extraction of the teeth was performed with immediate implant placement (xenographic bone grafting with stainless steel fixation tacked resorbable barrier membranes) (Fig. 17). Her tissue condition at 18 days post-operatively demonstrates the impressive healing response that may be due to the effects of NuCalm (Fig. 18).
Conclusions
The use of the NuCalm relaxation protocol makes patients more comfortable leading up to the surgery, more relaxed during the procedure, and they seem to heal better and more rapidly. The decreased anxiety during the surgical phase of treatment helps to reduce operative bleeding and improves initial healing, extending post-operatively to pain reduction and decreased swelling. The need for “stronger” post-operative pain medications has lessened. Since NuCalm’s induced relaxation state has such a rapid onset, treatment time is decreased for the patient, diminishing the stress of surgery and improving the surgical experience. NuCalm relaxes patients before and during surgery, providing a better overall experience for patients, the dental team, and the practitioner.OH
Paul J. Denemark, DDS, MSD, is a Diplomate of the American Board of Periodontology and a practicing clinician. He serves on several advisory boards, providing guidance on product development. His practice is limited to periodontics and dental implants in Burr Ridge, IL. He earned a Bachelor’s degree from Loyola University at Chicago, his DDS at the University of Illinois, College of Dentistry in Chicago. He attended Indiana University School of Dentistry for his Masters of Science in Dentistry in Periodontics and minored in Oral Pathology. Oral Health welcomes this original article.
