• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.6
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• pp.419-426
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• 2022

Topical anesthetics are routinely used in dental practice for various purposes. They are usually available at higher dosages and have serious potential adverse reactions, such as seizures, anaphylaxis, and acquired methemoglobinemia. To date, the scope of application of herbal plants and their extracts, which have medicinal properties, has been elaborated in the field of dentistry. The growing interest in herbal medication can be attributed to the increased safety profile of herbal agents, in contrast to synthetic preparations that have a higher risk of systemic complications. Herbal preparations can induce topical anesthesia with minimal side effects. Recently, many studies have reported the use of topical herbal preparations. The current review aimed to evaluate data from various articles comparing the capacity of herbal topical anesthetic formulations and conventional synthetic anesthetics in reducing pain perception when used as local anesthesia before dental procedures.

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

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.3
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• pp.251-255
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• 2010

A local anesthetic agent which is most commonly used for outpatients is lidocaine hydrochloride that contains epinephrine, which is for vasoconstriction in 1:100,000 concentration. This agent is known as a safe local anesthetic agent and has been used widely for topical use or injections. However, the allergic reaction that we will report in this case occurred when common local anesthesia was done intraorally, and the patient complained of hyperventilation, tachycardia, abdominal pain and unintentional tears. We experienced an allergic reaction after injecting the lidocaine hydrochloride and therefore report the case to suggest that local anesthesia should be always carried out very carefully.

• Restorative Dentistry and Endodontics
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• v.47 no.3
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• pp.25.1-25.11
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• 2022

Objectives: This study aimed to evaluate the effects of 5% lidocaine and 2.5% lidocaine/2.5% prilocaine topical anesthetic on pain during needle insertion and infiltration injection in the labial mucosa of anterior maxillary teeth, and to assess the relationship between patients' anxiety and pain scores. Materials and Methods: The Modified Dental Anxiety Scale questionnaire was applied and recorded. Patients were randomly divided into 4 groups (n = 30), as follows: G1 group: 5% lidocaine and placebo for 1 minute, G2 group: 2.5% lidocaine/2.5% prilocaine and placebo for 1 minute, G3 group: 5% lidocaine and placebo for 3 minutes, and G4 group: 2.5% lidocaine/2.5% prilocaine and placebo for 3 minutes. Before the application of topical anesthesia, one side was randomly selected as the topical anesthesia and the contralateral side as the placebo. The pain levels were measured with Visual Analog Scale (VAS) immediately after needle insertion and injection and were compared. The correlation between anxiety and pain scores was analyzed. Results: Administration of 5% lidocaine for 1 minute had significantly higher pain scores for both insertion and infiltration injection than the other groups (p < 0.05). There was a significant moderate positive correlation between dental anxiety and the injection-induced VAS pain score in the placebo side in all groups (p < 0.05). Conclusions: Topical anesthetics significantly reduced the pain caused by both needle insertion and injection pain in comparison to the placebo side. The pain scores of patients with dental anxiety were lower on the topical anesthesia compared to the placebo side.

• Child Health Nursing Research
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• v.20 no.3
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• pp.142-148
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• 2014

Purpose: This study was done to evaluate the effectiveness of EMLA cream on pain related to venipuncture among children. Methods: In this study, 48 children were evaluated using a sequential measurement for level of pain by Skin Conductance Level (SCL) based on Galvanic Skin Response (GSR), heart rate, and the Visual Analogue Scale (VAS) at four times. Results: The maximum and mean of the SCL were each significantly different between the experimental and control groups and furthermore, the two were also significantly different among observed times. In addition there was a significant interaction between group and time. The children's perceived pain using VAS was not significantly different between the experimental and control groups. There was no significant difference in the heart rate between the experimental and control groups; however, the interaction between group and time was significant. Conclusion: In conclusion, applying topical anesthetic cream to the venipuncture site to reduce pain was effective among the children and therefore it is highly recommended that topical anesthetic cream be applied at the venipuncture site as a nursing intervention to reduce pain when a child has to undergo a venipuncture.

• Journal of the korean academy of Pediatric Dentistry
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• v.38 no.1
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• pp.1-8
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• 2011

The objective of this study was to determine the effectiveness of topical 5% EMLA cream versus 20% Benzocaine gel in reducing pain from intra oral needle insertion alone as well as injection of anesthetic. The 2 topical anesthetics were tested against each other bilaterally using a randomized, controlled, single blinded, split mouth design. Phase I was conducted to find out the rapidity of onset action of the two agents on anterior/posterior vestibules and anterior/posterior palatal mucosa. Phase II was conducted to evaluate the efficacy of the two topical anaesthetic agents in reducing the pain of intraoral injections. The agents were left in anterior/posterior vestibules and anterior/posterior palatal mucosa for the amount of time recorded in phase I. Subjects recorded pain on a 100-mm modified visual analog scale(VAS). A pulse oximeter was used to recorded the preoperative and postoperative pulse rates. In phase I of the study, two topical agents showed the longer onset of action at anterior part and vestibules than posterior part and palatal mucosa. EMLA cream showed the rapidest onset of action compared to benzocaine gel except on anterior palatal mucosa. In phase II of the study, the VAS grading of the pain for anesthetic administration showed EMLA cream was significantly(P<.05) better in elimination or reducing the pain on the anterior/posterior palatal mucosa. In conclusion, EMLA cream showed the rapidest onset of action compared to benzocaine gel except on anterior palatal mucosa. EMLA cream was found to be superior to Benzocaine gel with regards to pain reduction for anesthetic administration especially on anterior and posterior palatal mucosa.

• Journal of the Korean Academy of Clinical Electrophysiology
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• v.4 no.1
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• pp.63-83
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• 2006

This study conducted the following experiment to examine anesthetic effects of 500 kHz ultrasound with lidocaine. Clinical experiment was conducted to compare local anesthetic effects by ultrasound frequencies and drugs with 40 normal adults and it divided subjects into experimental group (I) applying only ultrasound, ointment group (II) applying only lidocaine, phonophoresis group of 1 MHz (III), phonophoresis group of 500 kHz lidocaine (IV) for pain threshold and nerve conduct experiments. Mechanical threshold was measured with von Frey monofilament, thermal pain threshold with halogen lamp and digital thermometer, action potential in median nerve with diagnostic electromyography before and after treatment, and at 30 min., 60 min., 90 min., and 120 min. after treatment. Results of this study can be summarized as follows. Topical anesthesia experiment showed that pain threshold of phonophoresis groups was significantly increased, but there were little differences in ultrasound frequency and drugs among phonophoresis groups. Conduction anesthesia experiment showed that phonophoresis group of 500 kHz using lidocaine had significant difference in pain threshold and sensory nerve conduction compared to ointment group and ultrasound group, but there was no great difference from other phonophresis groups and light nerve block effect was found. It was considered that application of 500 kHz ultrasound using lidocaine will be more effective in deep anesthesia or nerve block than 1 MHz ultrasound. However, researches considering various frequencies, intensities and application hours in low frequency areas including kHz ultrasound are needed to increase deep permeation of drugs.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.6
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• pp.397-402
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• 2020

Background: Inferior alveolar nerve block (IANB) is the most common, painful, and anxiety-provoking procedure involving needle insertion for anesthetic solution deposition. DentalVibeⓇ (DV) delivers vibration at a sustained frequency as a counter-stimulation to the site of injection, thereby alleviating pain. The aim of this study was to evaluate and compare the effectiveness of DV and lignocaine hydrochloride 2% gel (Lox 2% jelly) in pain reduction during IANB in children. Methods: A split-mouth randomized clinical trial was designed with a sample of 60 children (age, 6 to 12 years) requiring bilateral IANB for various dental procedures; DV was used while administering IANB and Lox 2% jelly was used as the topical anesthetic before administering IANB at subsequent appointments. During both appointments, pain perception was measured using the sound, eye, motor (SEM) scale and Wong-Baker faces pain rating scale (WBFPRS); oxygen saturation (SpO2) and pulse rate were measured using a pulse oximeter before, during, and after the IANB procedure. The obtained values were tabulated and subjected to statistical analysis. Wilcoxon test was used for intergroup comparison, and Friedman test, for intragroup comparison of measured variables at different treatment phases. Results: The medians and interquartile ranges of the WBFPRS scores recorded during the IANB procedure for DV and Lox 2% jelly were 2 (2-4) and 2 (0-2), respectively (P < 0.05). The SEM scale scores, mean SpO2, and pulse rate did not show any significant differences during the IANB procedure between both treatments. Conclusion: Both DV and Lox 2% jelly were found to be effective in pain reduction during IANB in children.

• Journal of the korean academy of Pediatric Dentistry
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• v.29 no.1
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• pp.69-75
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• 2002

A number of techniques may be employed to reduce the discomfort of syringe or needle for dental care. The use of topical anesthesia is one such method. Topical anesthetics are applied to alleviate pain during many clinical procedures, such as injection of local infiltration anesthetics, primary tooth extraction, X-ray taking of sensitive patients, reducing gag reflex prior to impression taking. In children, placement of a rubber dam clamp, however, may cause significant discomfort for purpose of pit and fissure sealant and preventive resin restoration(PRR). A topical anesthetic would be beneficial to aid in rubber dam placement for this purpose. It has been suggested that all intra-oral topical anesthetics are equally effective on reflected mucosa, however EMLA(an acronym for eutectic mixture of local anesthetics), which was developed in the 1980s and produces surface anesthesia of skin, has been shown to be more effective than conventional topical anesthetics when used on attached gingivae. This report is topical anesthesized 4 case by EMLA cream, who showed better effect in reducing the pain of infiltration anesthesia, extraction of deciduous teeth, rubber dam clamp placement and reducing the pain of preformed crown adaptation.

• Journal of Dental Anesthesia and Pain Medicine
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• v.23 no.6
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• pp.317-325
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• 2023

Background: Local anesthetic injections may induce pain in children, leading to fear and anxiety during subsequent visits. Among the various approaches recommended to reduce pain, one is the use of a Buzzy Bee^TM device that operates on the concept of gate control theory and distraction. The literature regarding its effectiveness during the deposition of local anesthesia remains limited; hence, the aim of the present study was to determine the efficacy of extraoral cold and vibrating devices in reducing pain perception during the deposition of local anesthesia. Methods: A split-mouth crossover study in which 40 children aged 3-12 years requiring maxillary infiltration or inferior alveolar nerve block for extractions or pulp therapy in the maxillary or mandibular posterior teeth were included. The control intervention involved the application of topical anesthetic gel for one minute (5% lignocaine gel), followed by the administration of local anesthetic (2% lignocaine with 1:80,000 adrenaline) at a rate of 1 ml/ minute. Along with the control protocol, the test intervention involved using the Buzzy Bee^TM device for 2 minutes before and during the deposition of the local anesthetic injection. The heart rate and face, legs, arms, cry, and consolability revised (FLACC-R) scale scores were recorded by the dentist to assess the child's pain perception. Results: The mean age of the participants in Group A and Group B was 7.050 ± 3.12 years and 7.9 ± 2.65 years respectively. A reduction in the mean heart rate and FLACC-R score was observed during the deposition of local anesthetic solution in the tissues when the Buzzy Bee^TM was used in both groups at different visits in the same subjects (P < 0.05) The Buzzy Bee^TM device was effective in reducing the heart rate and FLACC-R scores when used during maxillary infiltration and inferior alveolar nerve block local anesthesia techniques (P < 0.05). Conclusion: The use of extraoral cold and vibrating devices significantly reduces pain perception during local anesthetic deposition in pediatric patients. Considering the results of this study, the device may be incorporated as an adjunct in routine dental practice while administering local anesthesia in children.