When 58% of patients say the injection is the worst part of the dental experience, it's time someone did something about it, and that's exactly what is happening right now in our industry.
This year brought two new products (and the promise of a third), enabling pH-balanced ("buffered") and highly improved local anesthetics. Essential for nearly every procedure, anesthetic changes affect dentistry at the same scale as gloves and masks.
Game-changing innovations
Premier’s new BufferPro and Onpharma’s (second-generation and much improved) Onset EZ both offer convenient, simple-step buffering, and it’s fair to say both are major improvements to the clunky and expensive devices of the past.
Meanwhile, Balanced Pharma reports continued progress toward an already-buffered drug in a standard dental cartridge. With all significant barriers to buffered anesthetics removed, a new standard of care has arrived.
New standard of care
Clinical studies have long shown that buffered injections are less painful, faster acting, and for infected teeth, twice as likely to work.
Dr. Stanley Malamed, in his authoritative textbook the Handbook of Local Anesthesia (now in its seventh edition), concluded long ago that dentists should buffer all injections. Contacted by DrBicuspid for this article, Malamed remained unequivocal in his belief on the subject.
"It is my strong belief that buffering of dental local anesthetics should become a routine part of all dental injections," Malamed said.
Dr. Arthur DiMarco, co-author of Local Anesthesia for Dental Professionals, also shared Malamed's perspective, saying, "Buffering improves patient comfort, enhances time management, decreases doses, and improves safety and efficacy. Ultimately, it leads to more efficient and pleasant dental experiences.
"In view of these new products, a threshold has been crossed, and in 2025, buffering should be the standard of care. I wouldn't give an unbuffered anesthetic to my family or my patients, and no informed patient would consent to an unbuffered injection," DiMarco told DrBicuspid.
Best anesthetic competition
While competition between the three smaller companies heats up, larger players are showing interest. Last year, Balanced Pharma received a multimillion-dollar investment from Septodont, by far the dominant company in the global dental anesthetic business.
Septodont followed up this spring with a deal to distribute the BufferPro product for Premier. Acteon, a major dental brand and manufacturer, took a large stake in dental anesthetic company Inibsa last year, but it remains to be seen whether they intend to enter the buffered category.
At stake may be a significant share of the nearly 2 billion dental anesthetic cartridges that are sold annually around the world, including an estimated 750 million cartridges in high-end markets in the U.S., Western Europe, and Asia.
Best practice competition
As patient awareness and demand for less painful injections grow, expect a similar race among white-glove dental practices and dental service organizations to let their patients know they are doing all they can to mitigate dentistry’s biggest complaint.
Dr. Jose Auñon, owner of a thriving private group dental practice in North Carolina, shared his experience with DrBicuspid introducing buffering into his business.
"After my first week of incorporating buffering, here are my findings: I’m shocked as to how many patients did not know that I had already given them an injection for the procedure," Dr. Auñon said. "Those who did feel something said it was about a 1 or 2 out of a 10 pain scale for a mandibular nerve block.”
So did the experience convert Dr. Auñon into a customer?
"Today is Thursday. I started this week with just one order to test it out. I just ordered a three-month supply," he said. "This is a game changer for sure."
Retired dentist and Balanced Pharma CEO Scott Keadle shared his thoughts on how providers view the situation, saying, "We speak with dental providers (our customers) on a daily basis, and they are eager to get the better products, for their patients and for themselves. We also speak with a lot of patients (their customers), and I can just tell you that once they find out about these products, a nonbuffered anesthetic is a nonstarter. I can't say I blame them."
A win for patients
Patients of early adopter dental practices are already reaping the buffered benefits, but questions remain for 2026 and beyond. Will Premier, Onpharma, or Balanced Pharma emerge victorious and dominate the buffered anesthetic market and perhaps the anesthetic market in general? Will Septodont, Pierrel, Acteon, Inibsa, or another dental industry giant get further involved?
No matter which company leads the way, dental patients will most certainly be the big winners.
Editor's note: References available upon request.
The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.
