Sir, the experiences summarised in the paper by Versloot et al. (BDJ 2008; 205: E2) do not reflect our experience in NHS Highland.

I have been using The Wand for over two years in my practice as senior dentist with special interest in children's dentistry. I see a large number of patients referred into the anxious child service whose own dentists have been unable to provide treatment under local anaesthetic despite best efforts. Previously, a mixture of behaviour management, nitrous oxide sedation and general anaesthesia (GA) has been used. Many of these children can be acclimatised very quickly with The Wand to tolerate treatment with local anaesthesia. It has made treating the very anxious children who are referred to us a much quicker and simpler process, reducing the reliance on sedation and GA.

The Wand allows the administration of very comfortable infiltrations (buccal, palatal and intra-ligamental) and ID blocks with a much less threatening appearance than a traditional dental syringe. Lieberman1 expressed the importance of the change in patient perception: 'Since The Wand is so unique in appearance, the patients do not relate it to their previous experiences or preconceived ideas. It has been our experience that an overwhelming percentage of patients who verbally express fear of the “shot”, seem greatly reassured that we will use The Wand instead.'

Held in a pen grip, the approach to the patient is much more relaxed, particularly when it is reduced in size by snapping the handle to its shorter length and it is also significantly less strain for the operator than giving a slow, controlled injection with a conventional syringe. The shape of the needle allows very easy introduction into tissue and the use of a pre-puncture technique to ensure comfortable penetration. The reliability of inferior dental blocks is improved due to the ease of rotation of the wand using the bi-rotational injection technique, reducing needle deflection as it passes through tissue.2

Performing pain free palatal infiltrations quickly and easily using a pre-puncture technique enables orthodontic extractions with much less anxiety and comfortable PASA and AMSA techniques produce reliable anaesthesia in the maxilla with a greatly reduced dose and minimal labial anaesthesia.

A significant advantage of The Wand is the very positive, reliable, simple aspiration facility. The cross infection control is simple and the re-sheathing is very effective, reducing the possibility of needlestick injury. It has proved very cost effective in reducing reliance on sedation and GA.

We use two Wands which are in daily use for a large number of procedures. After two years we have suffered no reliability problems with little maintenance beyond periodic lubrication. There is a learning curve and a shift in perception when first using the instrument and appropriate behaviour and anxiety management are still the cornerstone of treating children. However, my colleague in the department is a vocational trainer and we have trained a number of FY2 dentists in its use. Their feedback has been very positive.

In the words of one (formerly anxious) young patient: 'It's great now you don't need to get the jag'!