• Restorative Dentistry and Endodontics
• /
• v.46 no.3
• /
• pp.41.1-41.23
• /
• 2021

Objectives: This study aimed to evaluate the efficacy of various local anesthesia (LA) in vital asymptomatic teeth. Materials and Methods: Randomized controlled trials comparing pulpal anesthesia of various LA on vital asymptomatic teeth were included in this review. Searches were conducted in the Cochrane CENTRAL, MEDLINE (via PubMed), EMBASE, ClinicalTrials.gov, Google Scholar and 3 field-specific journals from inception to May 3, 2019. Study selection, data extraction, and risk of bias assessment using Cochrane Risk of Bias Tool were done by 2 independent reviewers in duplicate. Network meta-analysis (NMA) was performed within the frequentist setting using STATA 15.0. The LA was ranked, and the surface under the cumulative ranking (SUCRA) line was plotted. The confidence of the NMA estimates was assessed using the CINeMA web application. Results: The literature search yielded 1,678 potentially eligible reports, but only 42 were included in this review. For maxillary buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than lidocaine 2% with epinephrine 1:100,000 (odds ratio, 2.11; 95% confidence interval, 1.14-3.89). For mandibular buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than various lidocaine solutions. The SUCRA ranking was highest for articaine 4% with epinephrine when used as maxillary and mandibular buccal infiltrations, and lidocaine 2% with epinephrine 1:80,000 when used as inferior alveolar nerve block. Inconsistency and imprecision were detected in some of the NMA estimates. Conclusions: Articaine 4% with epinephrine is superior when maxillary or mandibular infiltration is required in vital asymptomatic teeth.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.23 no.6
• /
• pp.293-302
• /
• 2023

This review paper delves into the comparative study of epinephrine and phenylephrine as vasoconstrictors in dental anesthesia, exploring their histories, pharmacological properties, and clinical applications. The study involved a comprehensive literature search, focusing on articles that directly compared the two agents in terms of efficacy, safety, and prevalence in dental anesthesia. Epinephrine, with its broad receptor profile, has been a predominant choice, slightly outperforming in the context of prolonging dental anesthesia and providing superior hemostasis, which is crucial for various dental procedures. However, the stimulation of beta-adrenergic receptors caused by epinephrine poses risks, especially to patients with cardiovascular conditions. Phenylephrine, a selective alpha-1 adrenergic agonist, emerges as a safer alternative for such patients, avoiding the cardiovascular risks associated with epinephrine. Moreover, its vasoconstrictive effect may not be as deleterious as that of epinephrine, due to its selective action. This review reveals that despite the potential benefits of phenylephrine, epinephrine continues to dominate in clinical settings, due to its historical familiarity, availability, and cost-effectiveness. The lack of commercially available pre-made phenylephrine dental carpules in most countries, except Brazil, and a knowledge gap within dental academia regarding phenylephrine, contribute to its limited use. This review concludes that while both agents are effective, the choice between them should be based on individual patient conditions, availability, and the practitioner's knowledge and familiarity with the agents. The underuse of other vasoconstrictors like levonordefrin and the unavailability of phenylephrine in pre-mixed dental cartridges in many countries highlights the need for further exploration and research in this field. Furthermore, we also delve into the role of levonordefrin and examine the rationale behind the exclusion of phenylephrine from commercially available pre-mixed local anesthetic carpules, suggesting a need for a responsive approach from pharmaceutical manufacturers to the distinct needs of the dental community.

• Korean Journal of Veterinary Research
• /
• v.63 no.3
• /
• pp.21.1-21.6
• /
• 2023

The increasing prevalence of toxic substance-exposure in pets in South Korea endangers the health and safety of numerous companion animals, and has become a cause for concern. Notably, the annual incidence of forensic analysis in pets has increased by more than 150% in South Korea, mainly in populous regions such as Seoul, Incheon, and Gyeonggi. In response to this growing issue, veterinary forensic examinations were conducted on 549 dogs and cats from 2019 to 2022. This study revealed the presence of various toxic substances, including pesticides, insecticides, and drugs such as analgesics, anesthetics, antidepressants, and muscle relaxants, in pets. Among the 38 different toxins identified in pets, coumatetralyl, methomyl, terbufos, and buprofezin were the most frequently detected. In this study, toxic substances for pets were identified based on the "toxic agent list for humans," developed by the National Forensic Services, because no list of toxic agents for animals currently exists and data regarding potentially toxic substances for dogs and cats is limited. This is one of the limitations of this study, and necessitates the establishment of a toxic agent list for animals. Continued monitoring and research is also recommended to reveal the incidence, causes, and solutions of toxicity in animals.

• Archives of Craniofacial Surgery
• /
• v.25 no.1
• /
• pp.17-21
• /
• 2024

Background: The pain caused by local anesthetic injection can lead to patient anxiety prior to surgery, potentially necessitating sedation or general anesthesia during the excision procedure. In this study, we aim to compare the pain relief efficacy and safety of using a digital automatic anesthetic injector for local anesthesia. Methods: Thirty-three patients undergoing excision of a benign soft tissue tumor under local anesthesia were prospectively enrolled from September 2021 to February 2022. A single-blind, randomized controlled study was conducted. Patients were divided into two groups by randomization: the experimental group with digital automatic anesthetic injector method (I-JECT group) and the control group with conventional injection method. Before surgery, the Amsterdam preoperative anxiety information scale was used to measure the patients' anxiety. After local anesthetic was administered, the Numeric Pain Rating Scale was used to measure the pain. The amount of anesthetic used was divided by the surface area of the lesion was recorded. Results: Seventeen were assigned to the conventional group and 16 to the I-JECT group. The mean Numeric Pain Rating Scale was 1.75 in the I-JECT group and 3.82 in conventional group. The injection pain was lower in the I-JECT group (p< 0.01). The mean Amsterdam preoperative anxiety information scale was 11.00 in the I-JECT group and 9.65 in conventional group. Patient's anxiety did not correlate to injection pain regardless of the method of injection (p= 0.47). The amount of local anesthetic used per 1 cm² of tumor surface area was 0.74 mL/cm² in the I-JECT group and 2.31 mL/cm² in the conventional group. The normalization amount of local anesthetic was less in the I-JECT group (p< 0.01). There was no difference in the incidence of complications. Conclusion: The use of a digital automatic anesthetic injector has shown to reduce pain and the amount of local anesthetics without complication.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.24 no.3
• /
• pp.161-171
• /
• 2024

The efficient management of pain and discomfort is essential for successful dental treatment and patient compliance. Dental professionals are commonly evaluated for their ability to perform treatment with minimal patient discomfort. Despite advancements in traditional local dental anesthesia techniques, the pain and discomfort associated with injections remain a concern. This scoping review aims to provide a comprehensive overview of the literature on novel dental anesthetics and associated devices designed to alleviate pain and discomfort during dental procedures. The Joanna Briggs Institute and the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews guidelines were used to prepare the review. Six databases and two sources of gray literature were searched. This review analyzed 107 sources from 1994 to 2023. Local anesthesia devices were grouped into computer-controlled local anesthetic delivery (CCLAD) systems, intraosseous anesthesia (IOA), vibratory stimulation devices, and electronic dental anesthesia (EDA). CCLAD systems, particularly the Wand and Single-Tooth Anesthesia, have been the most researched, with mixed results regarding their effectiveness in reducing pain during needle insertion compared to traditional syringes. However, CCLAD systems often demonstrated efficacy in reducing pain during anesthetic deposition, especially during palatal injections. Limited studies on IOA devices have reported effective pain alleviation. Vibrating devices have shown inconsistent results in terms of pain reduction, with some studies suggesting their primary benefit is during needle insertion rather than during the administration phase. EDA devices are effective in reducing discomfort but have found limited applicability. These findings suggest that the CCLAD systems reduce injection pain and discomfort. However, the evidence for other devices is limited and inconsistent. The development and research of innovative technologies for reducing dental pain and anxiety provides opportunities for interdisciplinary collaboration and improved patient care in dental practice.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.24 no.2
• /
• pp.91-99
• /
• 2024

Background: Palatal injections are often painful. We aimed to compare topical ice and 20% benzocaine gel for pre-injection anesthesia before greater palatine nerve block (GPNB) injections. Methods: A randomized split-mouth clinical trial was conducted among patients aged 15-60-years needing bilateral GPNB injections. A total of 120 palatal sites from 60 patients were randomly allocated to Group A (topical ice) or Group B (20% benzocaine gel). Pain was evaluated using sound, eye, motor (SEM), and the visual analog scale (VAS) in both groups. Inferential analysis was performed using the Mann-Whitney U test. Results: The mean age of the participants was 20.5 ± 3.9 years. The median VAS score for group A was 11 (Q1 - Q3: 5.25 - 21.75), which was slightly higher than the 10 (Q1 - Q3: 4.0 - 26.75) reported in group B. However, the difference was not statistically significant (P = 0.955). The median SEM score for group A and group B was 3.5 (Q1 - Q3: 3.0 - 4.0) and 4.0 (Q1 - Q3: 3.0 - 4.0), respectively, which was statistically insignificant (P = 0.869). Conclusion: Using ice as a form of topical anesthetic for achieving pre-injection anesthesia before GPNB was as effective as 20% benzocaine gel.

• Journal of Korean Ophthalmic Optics Society
• /
• v.17 no.2
• /
• pp.215-222
• /
• 2012

Purpose: This study was performed to investigate the influence of indoor air qualities of an office environment on dry eye syndrome for wearing contact lens and non-wearing contact lens. Methods: To study the effects of indoor air qualities on dry eye syndrome for seventy-one subjects, $CO_2$, temperature, humidity, TSP, PM10, HCHO were measured. Each subject was tested by a McMonnie's dry eye syndrome questionnaire, a Schirmer Tear Test-I (S.T.T-I), a Schirmer Tear Test-II with anesthetics (S.T.T-II), and Tear film break-up time (T.B.U.T) in the their offices. Results: There was significant relation between the indoor air quality and dry eye syndrome for wearing contact lens and non-wearing when TSP was over $200{\mu}g/m^3$, PM10 was higher than $86.7{\mu}g/m^3$ and Formaldehyde was over $0.4{\sim}1.0{\mu}g/m^3$. However, there was no significant effect on dry eye syndrome with $CO_2$ (p=.0146), temperature (p=0.074) and humidity (p=0.053). Conclusions: It was indicated that $CO_2$, temperature and humidity were no effect on dry eye syndrome in the office environment. However TSP, PM10, formaldehyde, and wearing contact lens were effect on dry eye syndrome. Therefore, the entire management of wearing contact lens and the individual evaluation of the indoor air quality are required.

• Journal of Yeungnam Medical Science
• /
• v.11 no.2
• /
• pp.270-276
• /
• 1994

To evaluate the effect of a new topical anesthetic cream (EMLA: Eutectic mixture of local anesthetics) on reducing pain associated with DPT vaccination, we conducted a clinical observation on eighty infants who were brought to well baby clinic of Yeungnam University Hospital for DPT vaccination. 80 Infants, who were between 2 months and 8 months in age, were divided into two groups. EMLA treated group and control group. Male to femle sex ratio was 1.4 to 1. EMLA cream was applied 60 minutes before DPT vaccination, the effect of reducing pain was assessed by using McGrath's face scale, Oucher pain scale and modified behavioral pain scale (MBPS) and also evaluated by measuring the duration and time of crying (the time of the first crying after injection, duration of the first crying, total duration of crying). The scores of those scales were lower in EMLA treated group than in control group significantly (P(0.01 in McGrath's face scale, MBPS and p<0.05 in Oucher pain scale). There was no difference in the time of the first crying after vaccination in both groups. The duration of the first crying was shorter in EMLA treated group than control group of crying was also shorter in EMLA treated group (EMLA treated group $9.0{\pm}6.0$ sec, control group $21.9{\pm}12.5$ sec, p<0.05). Transient skin erythema was noted in 5 infants after EMLA application, but no other adverse effects were observed. We conclude that the application of EMLA cream before vaccination seems to be an effective and safe way to reduce the pain from vaccination, but it takes usually 60 minutes to get the anesthetic effect of EMLA and it is expensive, so EMLA cream can not be recommended in routine vaccination in infants now.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.43 no.1
• /
• pp.17-26
• /
• 2016

The use of a rubber dam is a useful technique for protecting patients and operators, producing good results when treating children and adolescent patients. Despite its many advantages, some children and adolescent patients have negative feelings and sometimes express its discomfort. The purpose of this study was to evaluate the patients' preferences for rubber dam use and the associated factors that may affect it. A survey was conducted targeting patients aged 4-18 years old who visited the pediatric dental clinic, the restorative dental clinic, or the student treatment dental clinic of ${\bigcirc}{\bigcirc}$ University Dental Hospital, and were treated using a rubber dam without sedation. We collected questionnaires through electronic medical records. Most children and adolescent patients showed positive attitudes towards using rubber dams. The group with a short treatment time and the group with past knowledge or experience of rubber dam use showed more positive attitudes towards rubber dams (p < 0.05), while no significant difference was found among factors such as gender, age, procedure, anesthetics, treatment site, and operator (p > 0.05).

• The Korean Journal of Pain
• /
• v.33 no.4
• /
• pp.378-385
• /
• 2020

Background: The thoracic paravertebral block is an effective analgesic technique for postoperative pain management after breast surgery. The ultrasound-guided retrolaminar block (RLB) is a safer alternative to conventional paravertebral block. Thus, we assessed the analgesic efficacy of ultrasound-guided RLB for postoperative pain management after breast surgery. Methods: Patients requiring breast surgery were randomly allocated to group C (retrolaminar injection with saline) and group R (RLB with local anesthetic mixture). The RLB was performed at the level of T3 with local anesthetic mixture (0.75% ropivacaine 20 mL + 2% lidocaine 10 mL) under general anesthesia before the skin incision. The primary outcome was cumulative morphine consumption using intravenous patient-controlled analgesia (IV-PCA) at 24 hour postoperatively. The secondary outcomes were the visual analogue scale (VAS) scores at 1, 6, 24, and 48 hour postoperatively and the occurrence of adverse events and patient satisfaction after the surgery. Results: Forty-six patients were included, 24 in group C and 22 in group R. The cumulative morphine consumption using IV-PCA did not differ between the two groups (P = 0.631). The intraoperative use of remifentanil was higher in group C than in group R (P = 0.025). The resting and coughing VAS scores at 1 hour postoperatively were higher in group R than in group C (P = 0.011, P = 0.004). The incidence of adverse events and patient satisfaction was not significantly different between the two groups. Conclusions: A single injection of ultrasound-guided RLB did not reduce postoperative analgesic requirements following breast surgery.