• Journal of Dental Anesthesia and Pain Medicine
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• 제17권1호
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• pp.29-35
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• 2017

Background: No study has compared lidocaine with articaine, each at a concentration of 4% and combined with epinephrine. The purpose of this study was to compare the effectiveness of 4% lidocaine with that of 4% articaine, with a concentration of 1:100,000 epinephrine added to each, in an inferior alveolar nerve block for surgery on impacted lower third molars. Method: This study was conducted at the Faculty of Dentistry, Mahidol University in Bangkok, Thailand. The randomized, single-blind, comparative split-mouth study was carried out in patients with symmetrically impacted lower third molars, as identified on panoramic radiographs. Each patient underwent surgery for the removal of the lower third molars by the same surgeon under local anesthesia at two separate visits, 3 weeks apart. The onset and duration of local anesthesia, intra-operative pain, surgical duration, and number of additional anesthetics administered were recorded. Results: The subjective and objective onset of action for the local anesthetics showed statistically significant differences (P < 0.05). However, the intra-operative pain, surgical duration, duration of local anesthesia, and number of additional anesthetics administered did not show statistically significant differences. Conclusion: The use of 4% articaine for the inferior alveolar nerve block was clinically more effective in the onset of subjective and objective anesthesia as compared with the use of 4% lidocaine. Based on the pain scores from the visual analogue scale, 4% lidocaine provided more analgesia during the procedure, and patients noted less intra-operative pain than with 4% articaine; however, the difference was not clinically significant.

• Journal of Dental Anesthesia and Pain Medicine
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• 제20권1호
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• pp.29-37
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• 2020

Background: This study evaluated the efficacy of three intraoral topical anesthetics in reducing the injection needle prick pain from local anesthetic among children aged 7-11 years old. Methods: It is a prospective, Interventional, parallel design, single-blind, randomized clinical trial in which subjects (n=90) aged 7-11 years were included in the study based on an inclusion criteria. Subjects were divided into three groups based on computer-generated randomization with an allocation ratio of 1:1:1. Groups A, B, and C received benzocaine 20% jelly (Mucopain gel, ICPA health products Ltd, Ankleshwar, India), cetacaine anesthetic liquid (Cetylite Industries, Inc, Pennsauken, NJ), and EMLA cream (2% AstraZeneca UK Ltd, Luton, UK), respectively, according to manufacturer's instructions, for 1 minute prior to local anesthetic injection. After application of topical anesthetic agent, for all the groups, baseline pre-operative (prior to topical anesthetic administration) and post-operative scores (after local anesthetic administration) of pulse rate was recorded using Pulse oximeter (Gibson, Fingertip Pulse Oximeter, MD300C29, Beijing Choice Electronic). Peri-operative (i.e., during the administration of local anesthesia) scores were recorded using Face, Legs, Activity, Cry, Consolability (FLACC) Scale, Modified Children hospital of Eastern Ontario Pain Scale (CPS) behavior rating scale, and Faces Pain Scale (FPS-R) - Revised (For self-reported pain). Direct self-reported and physiological measures were ascertained using FPS-R - Revised and Pulse oximeter, respectively, whereas CPS and FLACC scales assessed behavioral measures. To test the mean difference between the three groups, a one way ANOVA with post hoc tests was used. For statistical significance, a two-tailed probability value of P < 0.05 was considered as significant. Results: The Cetacaine group had significantly lower pain scores for self-report (P < 0.001), behavioral, and physiological measures (P < 0.001) than the other two groups. However, there was no significant difference between the Benzocaine group and EMLA group during palatal injection prick. Conclusion: Cetacaine can be considered as an effective topical anesthetic agent compared to benzocaine 20% jelly (Mucopain gel) and EMLA cream.

• Journal of Dental Anesthesia and Pain Medicine
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• 제21권1호
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• pp.49-59
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• 2021

Background: To evaluate changes in the effectiveness of phentolamine mesylate in combination with different local anesthetics (LAs) and vasoconstrictors. A prospective randomized double-blind study was conducted with 90 patients divided into three groups, with each group being administered one of three different LAs: lidocaine 2% 1/80,000, articaine 4% 1/200,000, and bupivacaine 0.5% 1/200,000. Methods: We compared treatments administered to the mandible involving a LA blockade of the inferior alveolar nerve. Results were assessed by evaluating reduction in total duration of anesthesia, self-reported patient comfort using the visual analog pain scale, incidence rates of the most common adverse effects, overall patient satisfaction, and patient feedback. Results: The differences among the three groups were highly significant (P < 0.001); time under anesthesia was especially reduced for both the lip and tongue with bupivacaine. The following adverse effects were reported: pain at the site of the anesthetic injection (11.1%), headaches (6.7%), tachycardia (1.1%), and heavy bleeding after treatment (3.3%). The patients' feedback and satisfaction ratings were 100% and 98.9%, respectively. Conclusions: Efficient reversal of LAs is useful in dentistry as it allows patients to return to normal life more readily and avoid common self-injuries sometimes caused by anesthesia. Phentolamine mesylate reduced the duration of anesthesia in the three studied groups, with the highest reduction reported in the bupivacaine group (from 460 min to 230 min for the lip and 270 min for the tongue [P < 0.001]).

• 대한치과마취과학회지
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• 제5권1호
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• pp.15-21
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• 2005

Autism is characterized with an abnormality of reciprocal social relatedness and of communication development. Also, autistic children show repetitive and stereotypical behavior pattern and deficiency of endurance against change. Dental problems related to autism are self-injury and trauma from accidents. Sometimes self-injury is due to discomfort resulting from restoration and local anesthesia. Also, gingivitis and multiple caries are common because of poor oral hygiene. Autistic children are anxious about visual and auditory stimuli because they don't understand the dental procedure. If the face of any changes in their daily life, their behavior becomes uncontrollable. In a setting such as the outpatient office, an autistic child's uncontrollable behavior makes it difficult to carry out proper treatment. If they need treatment under general anesthesia, it is very difficult to manage them in a ward as they are severly anxious about being admitted to a hospital. Therefore it is necessary to treat these children according to a specific management program under general anesthesia in an outpatient office. This case study reports of a 14 year old autistic teenager who although became uncontrollable because of the pain from multiple caries and from anxiety of the dental treatment eventually received treatment under general anesthesia and under conscious sedation in an outpatient office.

• Journal of Dental Anesthesia and Pain Medicine
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• 제19권3호
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• pp.175-180
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• 2019

Although allergic reactions are not rare complications in drug use, anaphylaxis or anaphylactoid reactions to some widely used drugs can embarrass clinicians because anaphylaxis is not easily diagnosed at the time of the event and treatment is unfamiliar to many. Lidocaine is a very popular drug in dental procedures and anaphylactoid reaction to it has been rarely reported. Clinicians who use lidocaine daily should, however, be aware of the possibility of anaphylaxis after its use. Once it occurs, anaphylaxis can be fatal, but if it is quickly diagnosed or suspected, treatment is simpler than most clinicians believe. An 86-year-old woman experienced an anaphylactic reaction 30 min after local infiltration of lidocaine for retraction of retained teeth. The dentist called an anesthesiologist for assistance. Fortunately, an anaphylactic reaction was quickly suspected and after subsequent rapid treatment with the administration of fluid and drug therapy, the patient recovered completely.

• Journal of Dental Anesthesia and Pain Medicine
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• 제22권1호
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• pp.1-10
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• 2022

Background: Inferior alveolar nerve block (IANB) is known to have a lower success rate for anesthesia in patients with irreversible pulpitis. This calls for supplementary techniques to effectively anesthetize such patients. This systematic review aimed to evaluate the published literature for determining the success rate of anesthesia induction using post-IANB intraligamentary (IL) injection in the mandibular teeth of patients with symptomatic irreversible pulpitis. The review question was, "What is the success rate of IL injection in the mandibular teeth of patients with irreversible pulpitis as a supplementary technique for endodontic treatment?" Methods: A thorough search of electronic databases and manual searches were performed. The protocol of the review was framed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and was registered in the International Prospective Register of Ongoing Systematic Reviews (PROSPERO) with a proper criterion for inclusion and exclusion of studies. The included studies were analyzed using the Cochrane Collaboration "Risk of Bias" tool. A meta-analysis that included a comparison of primary nerve block and supplemental IL injection was performed. The success rate was evaluated using the combined risk ratio (RR) with a random risk model. A funnel plot was created to measure publication bias. Results: After all analyses, four studies were included. In the forest plot representation, RRs were 3.56 (95% CI: 2.86, 4.44), which were in favor of the supplemental IL injections. Statistical heterogeneity was found to be 0%. These values suggest that supplemental IL injections provide better success rates for anesthesia. Conclusion: According to the pooled qualitative and quantitative analyses, supplemental IL injections increased anesthetic efficacy.

• 대한치과마취과학회지
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• 제11권1호
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• pp.45-50
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• 2011

Bell's palsy is an isolated facial paralysis of sudden onset caused by a neuritis of the seventh nerve within the facial canal. It occurs often in the adult man with a history of recent exposure to local cold, such as sleeping next to an open window, or in some cases it occurs after infections of the nasopharynx or masticator spaces. Especially, this neuropathy have linked with the major collagen disorders (diabetes mellitus). A segmental demyelination develops rapidly, with vascultitis in microinfarcts and ischemia to the nerve segment. The authors experienced about the bizarre neurological symptom of Bell's palsy after inferior alveolar nerve block anesthesia and TMJ dislocation in diabetic mellitus. The early and correct consultation with the multiple medical and dental departments was important to prevent the inadequate care & medicolegal problems.

• Journal of Dental Anesthesia and Pain Medicine
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• 제23권2호
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• pp.83-89
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• 2023

Background: With advances in safety measures for anesthesia, conscious sedation has gained popularity in the field of dentistry and has become essential in dental practice worldwide. However, in Tanzania, intravenous (IV) sedation is rarely practiced in the dental field. Therefore, we report the establishment of sustainable IV conscious sedation in dental practices and subsequently train local OMS residents in Tanzania. Methods: In 2019, intravenous conscious sedation was initiated at the University Dental Clinic of the Muhimbili University of Health and Allied Science (MUHAS), Tanzania. During the preparatory phase of the program, local oral and maxillofacial surgeons (OMSs) were given a series of lecture notes that concentrated on different aspects of IV conscious sedation in dentistry. During the on-site training phase, an oral surgeon from the United States joined the OMSs for case selection, IV-conscious sedation procedures, and patient follow-up. Patients were recruited from existing patient records at the MUHAS Dental Clinic. Results: The first conscious IV sedation program in dentistry was successfully launched at the University Dental Clinic in Tanzania. The local team of OMSs was trained on the safe administration of sedative agents (midazolam or ketamine) to perform various minor surgical procedures in a dental office. Nine patients with different ages, body masses, and medical conditions benefited from the training. No complications were associated with IV conscious sedation in the dental office. Conclusion: This was the first successful "hands-on" training on IV conscious sedation provided to OMSs in Tanzania. It laid the foundation for the sustainable care of patients with special needs requiring oral health-related care in the country.

• Journal of Dental Anesthesia and Pain Medicine
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• 제23권3호
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• pp.173-177
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• 2023

Local anesthetics are an essential part of pain control during dental treatment. Despite its effectiveness and safety, patients should constantly be aware of potential adverse effects, including allergic reactions. Allergic reactions to amide-type local anesthetics (LAs), such as lidocaine and mepivacaine, are rare compared to those to ester-type LAs. Herein, we report the case of a patient with a history of allergy to lidocaine and mepivacaine, with symptoms of itching, diffuse erythema of the wrists and hands, dizziness, and pectoralgia. This case report emphasizes the importance of collecting medical and dental histories of patients is necessary, and how an allergy test in the allergy and clinical immunology department helps select safe LAs for patients.

• Journal of Dental Anesthesia and Pain Medicine
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• 제23권2호
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• pp.121-121
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• 2023