We as dentists have taken local anesthetics for granted for decades. Pop the anesthetic carpule out of the package, load it up in the syringe, slap the harpoon into the rubber stopper and then inject away. Simple. And the cost of a single carpule of anesthetic is rock bottom due to the intense competition between manufactures. Yes, it seems like the field of local anesthetics has been figured out completely. That was until Onpharma Onset entered the picture. Recently my son, Phillip, attended a laser course with Dr. Mark Colonna in Las Vegas to learn more about WPT and PIPS. Phillip introduced himself as my son and Dr. Colonna responded something like..." Oh, your dad is the blogger. You know your father was a little unfair in his post on Onpharma Onset causing tissue toxicity because it was only FDA approved for lidocaine, not articaine." In the post he was referring to I wrote about using the Onset mixing pen dialed to 18 (the recommended dose for use with 2% lidocaine) with 4% articaine, which was certainly causing some tissue necrosis. Shout out to Dr. Colonna, "Thanks for helping my son learn more about lasers. You're great!" Meanwhile, back at the office I receive a call from John Huley, Vice President of Sales for Onpharma Onset out of Philadelphia and he wanted to talk to me. I called him back with a little trepidation and to my delight he actually liked my posts on his product. We had a great conversation that ended with him scheduling a flight down to my Cape Coral dental office to visit me and my son in person. My son called Dr. Mic Falkel who is the co-inventor of Onset and had an informative conversation about the product. Dr. Falkel is a general dentist and chemist who practices part time and spends the rest of his time working on local anesthetics. Great guy who is very down to earth and easy to talk to. When asked about why dentists cannot use a medical grade bicarb solution to mix it together for ourselves Dr. Falkel said that medical grade bicarbonate is usually labeled as having a wide range of possible pH's (~7-8), which means that you cannot control the pH of your cartridge of anesthetic. At a pH of 7 the solution is carbonic acid; at pH 7.5 it is sodium bicarbonate; and at a pH of 8 it is sodium carbonate. The solution that is inside the Onset mixing pen is precisely controlled to be a pH of 7.5 so that only sodium bicarbonate is present. Furthermore, he suggested that it wasn't just the pH of local anesthetics that dentists should worry about, its also the osmolarity. If the solution is not isotonic (containing the same amount of solute as the tissues) then pain and tissue necrosis can result. The problem with a 4%articaine is that it already contains a lot of solute, and adding more bicarb to the solution can make it potentially caustic to the tissues. To see my recommendations for using Onpharma Onset with 4% Articaine please visit my post. What is in the future for Onpharma Onset? It's a very young company and as more dentists start seeing the benefits of the product they should certainly start to develop bigger and better ways to help with our anesthetics.