Local anaesthesia in dentistry: a review

Evaluation of diagnostic tests for immediate-type allergic reactions to amide group local anesthetics in children

BACKGROUND

Local anesthetics (LAs) are widely utilized to provide analgesia in minor surgical interventions. Although patients are frequently referred for suspected LA allergies in clinical practice, confirmed cases of immediate-type hypersensitivity remain rare. This study aims to establish an optimal diagnostic protocol for immediate-type LA allergy in children and to assess the practicality and reliability of an alternative diagnostic approach for hypersensitivity testing of amide-type local anesthetics.

METHODS

The medical records of patients diagnosed with suspected immediate-type reactions to LAs administered by pediatric dentists between January 2019 and August 2024 were retrospectively reviewed. All children underwent a skin prick test (SPT), followed if negative by an intradermal test (IDT) at a 1:10 dilution. If intradermal testing was also negative, a subcutaneous provocation test was subsequently performed.

RESULTS

A total of 88 patients (47 boys, 41 girls), with a mean age of 8.5 ± 3.5 years, were included. In most cases (n = 59, 67%), the suspected LA was unidentified. Among the known agents, articaine (n = 18, 20.5%) and lidocaine (n = 11, 12.5%) were the most frequently reported. IDT results were positive in 11 patients (12.5%), with articaine in 8 cases (61.5%), prilocaine in 3 cases (23%), and lidocaine in 2 cases (15.5%). Intradermal testing at a 1:10 dilution demonstrated a high negative predictive value (99%) for immediate-type reactions.

CONCLUSION

For the diagnosis of immediate-type LA allergy, including cases with a history of anaphylaxis, an IDT at a 1:10 dilution following a negative SPT, followed by subcutaneous provocation, may serve as a time-efficient and reliable diagnostic strategy.

Evaluation of Cold and Electric Pulp Tests for Assessing the Success of Inferior Alveolar Nerve Block for Mandibular First Molars Diagnosed with Symptomatic Irreversible Pulpitis

INTRODUCTION

Fear of dentistry, often due to past painful experiences, is a significant barrier preventing patients from visiting dentists. Achieving effective pain control, especially during root canal treatments, is crucial. However, inferior alveolar nerve blocks (IANBs) have a low success rate, influenced by factors such as anxiety, anatomical variations, and technique limitations, leading to anesthesia failure. Although numerous studies have examined the cold test and electric pulp test (EPT) in assessing the success of local anesthesia, no standardized method has been established. This study evaluated the effectiveness of EPT and cold tests in assessing the depth of anesthesia in patients with symptomatic irreversible pulpitis in the mandibular first molar teeth.

METHODS

A cross-sectional study was conducted on 50 patients with symptomatic irreversible pulpitis who met the inclusion criteria and exhibited lip numbness. Following the administration of the IANBs and confirmation of lip numbness, cold tests and EPT were performed on all patients. Subsequently, the preparation of the access cavity (gold standard test) was initiated, and patients' responses during cavity preparation were recorded as either "presence of pain or discomfort" or "absence of pain or discomfort," indicating IANB failure and success, respectively. Sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratios, and accuracy (AC) with 95% confidence intervals were calculated for each test separately as well as for sequential testing.

RESULTS

IANB failure was determined in 56% of the patients. A comparative analysis of diagnostic tests (cold test and EPT) showed no significant difference in SN, NPV, and AC; however, the cold test had higher SP, PPV, and positive likelihood ratio. Combining cold test and EPT evaluations improved SN, NPV, PPV, and negative likelihood ratio, but SP and AC were similar to EPT alone. No correlation was found between IANB success and patient age, sex, or initial pain.

CONCLUSIONS

Despite evidence of lip numbness, a significant number of IANBs failed in cases of painful pulpitis. A positive result from the cold test strongly indicated anesthesia failure. The findings of the current study suggested that when the cold test yielded a negative result, further evaluation with EPT was necessary to confirm anesthetic success and ensure complete pain control.

Liposomal Bupivacaine in Dentistry and Oral and Maxillofacial Surgery. A Review of Human and Veterinary Literature

This article reviews the human and veterinary literature regarding liposome encapsulated bupivacaine use in dentistry and oral and maxillofacial surgery. The purpose of this review is to present available information on this local anesthetic in a manner that will allow veterinary dentists and oral and maxillofacial surgeons to use evidence-based information when considering incorporating liposomal bupivacaine into their practice. The twelve human clinical studies and three veterinary reports that met the literature search criteria do not support the use of liposomal bupivacaine in veterinary dentistry and oral and maxillofacial surgery.

Adrenaline dilution in dental local anesthetic: a preliminary study to prevent coring in cartridges

Many patients with underlying medical conditions are treated with local anesthetics in dental clinics. Dental local anesthetic cartridges contain the vasoconstrictor adrenaline, which can affect the cardiovascular system. For this reason, the adrenaline in the cartridge (2% lidocaine + 1:80,000 adrenaline) is sometimes diluted in order to avoid hemodynamic changes in these patients. However, at the same time, considerations have to be made for coring. Coring is a process in which a piece of rubber is scraped off when a needle is inserted into a rubber stopper, and the rubber is mixed with the drug solution. Particles generated during the coring process contaminate local anesthetic solutions. In this study, we closely observed the puncture site of a 33G dental needle inside a cartridge to investigate a safe dilution method that considers coring. The puncture site was located within 1.50 ± 0.08 mm (mean ± SD) of the diameter from the center of the rubber stopper of the cartridge head. Punctures were made with a 0.75-mm outer diameter metal needle outside the 1.50-mm diameter range from the center of the rubber stopper to reduce the overlap between puncture sites and minimize the risk of coring. After discarding half of the cartridge, 2% lidocaine without adrenaline was injected by piercing the end of the rubber stopper at the cartridge head with a 22-27G metal needle (outer diameter approximately 0.4-0.7 mm). This method minimizes the risk of rubber displacement and coring while ensuring a safe and effective dilution process. Providing a safer method for adrenaline dilution reduces the risk of coring and contamination in dental anesthetic cartridges.

Manan WNH. Dataset on characterisation and stability of gingival retraction cord lignocaine-adrenaline nanogel optimised using central composite design

This study aims to characterise and assess the stability of an optimised lignocaine-adrenaline nanogel using central composite design (CCD). Compatibility studies were conducted using Attenuated Total Reflectance-Fourier Transform Infrared (ATR-FTIR) and Ultraviolet-visible (UV-vis) spectroscopy. Eighteen lignocaine-adrenaline Nanoemulsion (LANE) formulations derived using CCD were characterised for particle size, polydispersity index (PDI), zeta potential and pH. All LANE formulations were transformed into lignocaine-adrenaline Nanoemulsion-based Gel (NBG) by adding 0.1 % Carbopol 940. Stability studies for LANE and NBG were conducted for 12 months storage at 25 °C. The results of long-term stability assessment of LANEs and NBGs were integrated with CCD predictions to produce the optimised NBG, lignocaine-adrenaline Nanogel. The optimised NBG model was validated in triplicates. The optimised NBG was subjected to 5000 rpm centrifugation for 30 min, repeated heating-cooling cycles (40 °C and 4 °C), and a freeze-thaw cycle (-5 °C and 25 °C). ATR-FTIR and UV-vis results indicated compatibility between lignocaine, adrenaline and the excipients. The viscosity of the nanogel corresponded to that of ferric sulphate solution (24 ± 1 mPa·s at 20 °C). The LANE and NBG formulations showed no drug precipitation or phase separation after the stability study. The optimised NBG had particle size (61.76 ± 0.25 nm), PDI (0.36 ± 0.01), zeta potential (-26.47 ± 0.02 mV) and pH (6.28 ± 0.02). The optimised NBG remained stable in stress-induced environments. CCD enabled optimisation of a stable NBG formulation.

Efficacy of Articaine versus Lignocaine as Local Anesthetic Agents Using Buccal Infiltration Technique for Extraction of Mandibular Premolars

Introduction

Lignocaine, commonly used for local anesthesia, often results in discomfort during mandibular premolar extractions due to limited tissue diffusion with the buccal infiltration technique. Articaine, with better lipid solubility, promises improved diffusion and patient comfort. This study compares the efficacy of 2% Lignocaine and 4% Articaine in reducing pain during mandibular premolar extractions.

Methodology

A split-mouth, randomized, controlled trial included 40 patients, aged between 18 and 40 years, undergoing bilateral mandibular premolar extractions. Each patient received 4% Articaine with adrenaline and 2% Lignocaine with adrenaline on opposite sides at separate appointments. Pain was assessed using the Visual Analog Scale (VAS) and Faces Pain Scale (FPS).

Results

Patients in the Articaine group reported significantly lower pain levels (mean FPS: 0.2) compared to the Lignocaine group (mean FPS: 3.6) (P < 0.001). In the Articaine group, 34 out of 40 patients experienced no pain, whereas all patients in the Lignocaine group reported mild to severe pain. Mild pain was reported by 23 patients in the Lignocaine group, and moderate pain by 12 (P < 0.05). No severe pain was recorded in the Articaine group.

Conclusion

Articaine demonstrated superior pain control, making it a more effective choice over Lignocaine for mandibular premolar extractions using the buccal infiltration technique.

Adrenaline Dilution in Dental Local Anesthetic Cartridges: A Practical Method Using the Inner Needle of Intravenous Catheter

Local anesthesia is a routine medical procedure for dentists. To achieve the desired anesthetic effect of lidocaine and favorable hemostatic effects by adrenaline, the combination of 2% lidocaine + 1:80,000 adrenaline is commonly used, including in dental patients with underlying diseases for whom adrenaline in local anesthetics is problematic due to its vasoconstrictive effects, as the adrenaline concentration in dental local anesthetic cartridges in Japan is commercially set at 1:80,000. To reduce the effect of adrenaline on the cardiovascular system, adrenaline is sometimes diluted in dental local anesthetic cartridges. We have previously introduced a simple dilution method. However, this method requires the additional purchase of thin metal needles, which may be inconvenient for dentists who do not specialize in dental anesthesia. Here, we present a more practical dilution method that uses the inner needle of an intravenous catheter (22- or 24-G). Given that intravenous catheters are often kept in dental clinics for sedation or emergency use, we thought that this method would be more versatile. In this method, the inner needle of the intravenous catheter is attached to the syringe and 2% lidocaine without adrenaline is aspirated; then, the half-discarded cartridge is filled with it. A unique feature of this method is the use of an intravenous catheter, which many dental clinics keep on hand for intravenous sedation or emergencies during dental treatments. To safely administer local anesthesia during dental procedures, we propose a more practical and convenient method of diluting the adrenaline concentration in local anesthetic cartridges.

How do dental practices respond to changes in scope of practice regulations?

Regulations that restrict the tasks that credentialed workers are allowed to perform may affect a firm's input choices, output, and which part of the market the firm serves. Using dental practice survey data from 1989 to 2014 and a stacked difference-in-differences design, this paper examines the effects of state-level scope of practice regulations on the behavior of dental practices. Results suggest that scope of practice deregulation in regards to dental hygienists' ability to administer nitrous oxide or local anesthesia is associated with fewer dentist visits per week in the short-term, lower patient wait times, and an increased likelihood of treating lower revenue generating publicly insured patients. There is weak evidence that scope of practice deregulation alters a practice's labor inputs.

Effect of Dental Local Anesthetics on Reactive Oxygen Species: An In Vitro Study

Introduction Oxidative stress, an imbalance between reactive oxygen species (ROS) production and antioxidant defenses, plays an important role in various dental diseases. Local anesthetics are frequently used in dentistry. The potential antioxidant activity of dental local anesthetics can contribute to dental practice. Therefore, this study aimed to investigate the ROS-scavenging activities of three commonly used dental local anesthetics, lidocaine, prilocaine, and articaine, focusing on their effects on hydroxyl radicals (HO•) and superoxide anions (O2 •-). Materials and methods The electron spin resonance (ESR) spin-trapping technique was employed to specifically measure the ROS-scavenging activities of these local anesthetics at varying concentrations. Results Lidocaine, prilocaine, and articaine exhibited concentration-dependent HO•-scavenging activities, with IC50 values of 0.029%, 0.019%, and 0.014%, respectively. Lidocaine and prilocaine showed concentration-dependent O2 •--scavenging activity, with IC50 values of 0.033% and 0.057%, respectively. However, articaine did not scavenge O2 •-. Conclusions The proactive use of dental local anesthetics may mitigate oxidative injury and inflammatory damage through direct ROS scavenging. However, further research is needed to elucidate the specific mechanisms underlying the antioxidant effects of these dental local anesthetics and their potential impact on the dental diseases associated with oxidative stress.

Knowledge and attitudes toward anaphylaxis to local anesthetics in dental practice

OBJECTIVE/AIM

The absence of a comprehensive understanding of potential anaphylactic reactions to local anesthetics (LAs) and management can result in grave consequences. For this reason we aim to assess Latin American dentists' knowledge, preparedness, and competency in managing anaphylactic reactions to LAs.

MATERIALS AND METHODS

Design: A cross-sectional study was conducted from November 2021 to February 2022. Board-certified dentists answered a survey comprising 26 structured questions. Chi-square tests and logistic regression models were performed in Stata 17.0.

SETTING

Argentina, Brazil, Colombia, Costa Rica, Ecuador, Honduras, Mexico, Peru, Venezuela, and other Latin American countries.

RESULTS

Of 507 respondents, lidocaine was the most frequently used LA (88.1%). While 85.2% could identify dyspnea as a symptom of anaphylaxis, only 50.1% knew the correct route for epinephrine administration, and just 43.5% had epinephrine in their emergency kits. Confidence in managing anaphylactic reactions was low (9.6%). Older age was inversely related to both knowledge of anaphylaxis management and the possession of epinephrine (P = 0.003 and P = 0.0001, respectively).

DISCUSSION

Our study highlights a concerning discrepancy between the practical readiness of Latin American dentists in handling anaphylaxis.

CONCLUSION

The study's findings underscore the need for educational interventions to improve the readiness to identify and handle anaphylactic emergencies in dental practice.

Local anesthetics allergy in children: Evaluation of diagnostic tests with Real-Life data

BACKGROUND

Local anesthetic (LA) drugs are commonly used in clinical practice to provide effective analgesia, including in dentistry and minor surgical procedures. The perception of a high risk of allergy in daily applications leads to the referral of atopic patients and those with other drug allergies to allergy clinics for the evaluation of allergic reactions to LA. The aim of this study was to determine who should be referred to the allergy clinic for LA allergy testing, assess the frequency of LA allergy in pediatric patients, and identify the negative predictive value of skin tests in diagnosis.

METHODS

January 2017-July 2023, the clinical and laboratory data, as well as the results of drug allergy tests, of patients referred to our pediatric allergy clinic by dentists and physicians performing minor surgical procedures with suspected LA allergy were retrospectively evaluated.

RESULTS

Our study included a total of 153 patients, comprising 84 girls (54.9%) and 69 boys (45.1%), with a mean age of 8.9 (±3.3) years. The most common reason for referral was a history of non-LA drug allergies (n = 66, 43.2%), followed by asthma (n = 25, 16.3%). Hypersensitivity reactions (HRs) with LA were most commonly associated with articaine (n = 7, 4.8%), followed by lidocaine (n = 6, 4.1%). When intradermal tests were evaluated, 17 patients (11.1%) had a positive test result. The positivity for lidocaine was 70.6% (n = 12), and prilocaine was 29.4% (n = 5). Subcutaneous provocation was administered to 109 patients (71.2%), and one patient exhibited local erythema and swelling with prilocaine.

CONCLUSION

Although LA allergy is a rare occurrence, consultations of this nature are frequently requested from allergy clinics in real life. Considering the negative predictive value of skin tests performed with LA drugs, the reaction rate appears to be low in patients with atopy or other drug allergies. It is crucial for all relevant healthcare professionals to be knowledgeable about the appropriate approach to suspected LA allergies to avoid unnecessary tests. To the best of our knowledge, our study is the most comprehensive work in the literature that evaluates the results of diagnostic tests in children referred with a suspicion of LA allergy.

Swiss paediatric dentists' preferences and experience on the use of articaine and other local/topical anaesthetics

PURPOSE

This study was conducted to explore the preference and experience of paediatric dentists based in Switzerland regarding the use of articaine and other local and topical anaesthesia.

METHODS

An 18-question survey was developed, piloted, and distributed to the members of the Swiss association of paediatric dentistry (n = 460). The following information were collected: most used local anaesthetic in different age groups, time needed to inject a full ampule, frequency of observed local and systemic side effects, application of topical anaesthetic prior to injection, time waited between application and the injection, and perceived effectiveness of topical anaesthetic. The dentists' responses were analysed with logistic regressions reporting odds ratios (OR) and 95% confidence intervals (CI) at 5%.

RESULTS

The response rate was 37% (n = 168) out of the 460 questionnaires sent, with the responders being predominantly female (67%) and 47-year-old on average. More than 80% of the dentists used articaine in all age groups. 45% of responders took longer than 60 s to inject a full ampule. Local and systemic side-effects were observed by 82% and 28% of respondents respectively, although the nature and the significance of those were not detailed due to the anonymous nature of the questionnaire. Significantly less local adverse effects were seen for older children (p = 0.04) and among dentists with more years of experience (p = 0.01). Most responders applied topical anaesthetic and half of them waited longer than 60 s before injection.

CONCLUSIONS

Articaine is a widely used local anaesthetic by the studied group of Swiss paediatric dentists regardless of patient's age. The use of topical anaesthetic before injection is a common practice with good perceived effectiveness.

Neurological Complications of Local Anesthesia in Dentistry: A Review

Local anesthesia is a technique that temporarily desensitizes a specific body area, typically for a surgical procedure, dental work, or pain management. It is described as a sensation loss in a specific area of the body due to depression of excitation in the nerve endings or due to the inhibition of the conduction process within the peripheral nerves. It allows for safer and more comfortable medical procedures, reducing the need for general anesthesia and facilitating faster recovery. Local anesthesia is generally safe, but like any medical intervention, it carries potential risks and side effects. The complications related to local anesthetics can be assessed in terms of neurological, vascular, local, systemic, and neurological. In this review article, we discussed the neurological complications of local anesthesia related to the ophthalmic nerve, maxillary nerve, mandibular nerve, branches of the trigeminal nerve, and facial nerve. These include diplopia, ptosis, paralysis of the eye, blindness, paresthesia, trismus, soft tissue lesions, edema, hematoma, facial blanching, infection, allergy, overdose, neuralgia, facial palsy, etc.

Effect of local anesthetics on renal function: An animal study in Iran

Background

Although most of the metabolism of local anesthetics (LAs) takes place in the liver, no study has investigated the effect of these anesthetics on the kidney function of single-kidney humans or animals. The present study was conducted to examine the effect of LAs on renal function in single-kidney rats.

Materials and Methods

The present experimental animal study with two control groups was done in an animal laboratory. Forty-two rats were randomly assigned to seven groups of six rats, including two control groups and five experimental groups. The experimental groups underwent intraperitoneal anesthesia with 2% lidocaine, 2% lidocaine with 1:80,000 epinephrine, 4% articaine, 3% prilocaine with 0.03 IU Felypressin, and 3% mepivacaine, respectively. Unilateral nephrectomy was done. After 24 h, the rats' blood urea nitrogen (BUN), serum creatinine (Cr), and blood specific gravity (BSG) were measured. A standard dose of anesthetics was injected into the peritoneum for 4 days afterward. Then, these indices were measured again 24 h after the last injection. Data were analyzed using IBM SPSS (version 21.0). One-way analysis of variance, Tukey's honestly significant difference post hoc, and paired t-tests were used for statistical analysis. P < 0.05 was considered statistically significant.

Results

The results indicated significant differences among groups in the rats' BUN and serum Cr 24 h after nephrectomy (P < 0.05). However, there were no significant differences in BUN, BSG, and Cr among groups after the interventions.

Conclusion

LAs did not affect renal function in single-kidney rats. Therefore, dentists can use the anesthetics in single-kidney people.

Beyond Tradition: Non-surgical Endodontics and Vital Pulp Therapy as a Dynamic Combination

Symptomatic irreversible pulpitis and apical periodontitis in mature permanent teeth present challenges in their management. Traditional treatment approaches, such as root canal therapy or tooth extraction, may compromise tooth structure and oral function. This review article explores the combination of non-surgical endodontic treatment and vital pulp therapy as an alternative approach for these conditions. The purpose is to examine this combined approach's effectiveness, benefits, challenges, and limitations. The objectives include reviewing the literature, evaluating clinical outcomes, discussing potential benefits, and providing recommendations for clinical practice. The combination approach aims to preserve tooth structure, promote healing, and reduce postoperative complications. The article discusses the rationale for combining the two techniques, presents evidence supporting their efficacy, and outlines the techniques and protocols involved. Clinical outcomes, case studies, potential challenges, and comparative analysis with traditional approaches are also explored. Future directions and research recommendations highlight areas for further investigation, innovations, and the development of clinical guidelines. In conclusion, the combination of non-surgical endodontic treatment and vital pulp therapy offers a valuable strategy for managing mature permanent mandibular molars with symptomatic irreversible pulpitis and apical periodontitis. Further research and advancements are needed to refine the treatment protocol and expand the evidence base, and clinicians should stay updated to provide optimal care and improve patient outcomes.

Knowledge, Practice and Self-Reported Confidence Level of Croatian Dentists in the Use of Local Anesthesia: A Cross-Sectional Study

Objectives: To provide safe and effective local anesthesia, dentists must have knowledge of neuroanatomy, anesthesia agents, techniques, equipment, and proper use of local anesthetics. This study aims to explore the knowledge, practices, and confidence regarding local anesthetics and anesthetic techniques in dentistry. Material and Methods: The online cross-sectional questionnaire was conducted via social media, and yielded 441 responses from across the country (69.8% women and 30.2% men; 70.7% general dentists; and 29.3 specialists). The data collected included sociodemographic characteristics, knowledge, and practices pertaining to the usage of local anesthesia. The questionnaire also documents their self-assessed confidence level in applying different local anesthetic techniques and experiences with adverse reactions. The obtained data were processed by description and using a generalized linear model for regression. Results: The respondents had a median knowledge score of 6 out of a possible 14 points regarding local anesthetics in dental medicine, and their median self-confidence level in the successful application of various techniques of local anesthesia was 54 out of a maximum of 85 points. The results showed that a higher knowledge level was associated with the female gender (OR 1.83, CI 1.13-2.98, p = 0.014) and specialization in oral surgery (OR 7.04, CI 1.71-29.07, p = 0.007). In contrast, a lack of confidence in using various local anesthetic techniques was also associated with the female gender (OR 0.63, CI 0.41-0.99, p = 0.047) and specialization in orthodontics (OR 0.16, CI 0.03-0.88, p = 0.035). Of the respondents, 81.4% (n = 371) experienced a local complication, and 42.2% (n = 186) experienced a systemic complication during local anesthesia. The complications experienced cannot be associated with a lack of knowledge or self-confidence (p > 0.05). The majority of respondents (364 of the 441 total-82.5%) expressed interest in receiving further education on the topic of local anesthesia. Conclusions: The research results show that the dentists involved in the study have poor knowledge of local anesthetics and moderate self-reported confidence levels in using various local anesthetic techniques. Moreover, dentists' self-confidence in applying different techniques of local anesthesia is not related to their knowledge. Therefore, it would be necessary for dentists to undergo a continuing dental education program that enables them to enhance their skills and knowledge in local anesthesia.

A Novel Scale to Assess Parental Satisfaction of Dental Local Anesthetic Techniques in Children: A Cross-Sectional Study

Background

Pain control is one of the most important aspects that can affect parental satisfaction of the dental care provided for children. Dental local anesthesia has the highest impact on pain sensation of the children. However, there is no scale in the literature to assess parental satisfaction of dental local anesthetic techniques.

Objectives

This study was aimed to assess the parental satisfaction with dental local anesthetic techniques for their children through designing a scale that reflects satisfaction and to study the validity and reliability of this scale.

Methods

A cross-sectional observational study was conducted on 150 parents (102 mothers and 48 fathers). Two techniques of local anesthesia were used for each child participated in this study (inferior alveolar nerve block and computerized intraosseous anesthesia). The developed scale consisted of 20 items in a 5-point Likert scale. Half of the items were written in a negative format. Internal consistency, validity, and factor analysis were performed in this study. Independent t-test was used to compare between the two techniques of anesthesia, between boys and girls and among fathers and mothers.

Results

Parental satisfaction mean values were higher in the computerized intraosseous anesthesia group in comparison to inferior alveolar nerve block (P value <0.05). The T-test showed that there was no difference between boys and girls regarding parental satisfaction (P value >0.05). Furthermore, fathers show lower satisfaction in the computerized interosseous anesthesia group (P value <0.05). Excellent internal consistency of this scale was resulted as Cronbach's alpha reliability coefficient was 0.985. After factor analysis, seven factor components were retained by using varimax rotation.

Conclusions

Findings of this study reported that the designed parental satisfaction of dental local anesthetic techniques scale (PSLAS) is a valid and reliable scale to be used. Moreover, this study showed that parental satisfaction was higher when computerized intraosseous anesthesia was used in comparison to inferior alveolar nerve block.

Factors associated with knowledge about pharmacological management of pregnant women in Peruvian dental students: a logistic regression analysis

BACKGROUND

Clinical management to maintain or restore oral health through the use of drugs during pregnancy is crucial, since at this stage physiological changes significantly influence the absorption, distribution and elimination of the drug, considering also that excessive administration of drugs during this period may have adverse effects on the mother and/or fetus. Therefore, the aim of the present study was to evaluate the factors associated with knowledge of pharmacological management of pregnant women in dental students of a Peruvian university located in the capital and province.

METHODS

This analytical, cross-sectional, prospective and observational study assessed 312 Peruvian dental students from third to fifth year of study between February and April 2022. A validated questionnaire of 10 closed questions was used to measure knowledge about pharmacological management in pregnant women. A logit model was used to assess the influence of the variables: gender, age, year of study, marital status, place of origin and area of residence. A significance of p < 0.05 was considered.

RESULTS

The 25.96, 55.13 and 18.91% of the dental students showed poor, fair and good knowledge about pharmacological management in pregnant women; respectively. In addition, it was observed that students under 24 years of age and those from the capital were significantly (p < 0.05) 44% less likely to have poor knowledge of pharmacological management in pregnant women compared to those aged 24 years or older (OR = 0.56; CI: 0.34-0.92) and those from the province (OR = 0.56; CI: 0.32-0.98); respectively. Finally, those in their third and fourth year of study were significantly three times more likely to have poor knowledge (OR = 3.17; CI: 1.68-5.97 and OR = 3.88; CI: 2.07-7.31; respectively) compared to fifth year dental students.

CONCLUSION

The knowledge of dental students about pharmacological management in pregnant women was predominantly of fair level. In addition, it was observed that being under 24 years of age and being from the capital city were protective factors against poor knowledge, while being a third- and fourth-year student was a risk factor. Finally, gender, marital status and area of residence were not influential factors in the level of knowledge.

BUCCAL INFILTRATION WITH 4% ARTICAINE MAY BE AN ALTERNATIVE OPTION TO INFERIOR ALVEOLAR NERVE BLOCK WITH 2% LIDOCAINE FOR PULP THERAPY IN PRIMARY MANDIBULAR MOLARS

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Can 4% Articaine Buccal Infiltration Replace Inferior Alveolar Nerve Block (IANB) with 2% Xylocaine for Pulp Therapy in Primary Mandibular Molars? A Systematic Review. Sunny P Tirupathi, Srinitya Rajasekhar, Mayuri Ganesh, Abhishek Vamshi, David Tyro, Int J Clin Pediatr Dent. 2021;14(3):420-425.

SOURCE OF FUNDING

The authors did not state any funding support.

TYPE OF STUDY/DESIGN

Systematic review.

Lidocaine: A Local Anesthetic, Its Adverse Effects and Management

The most widely used medications in dentistry are local anesthetics (LA), especially lidocaine, and the number of recorded adverse allergic responses, particularly of hazardous responses, is quite low. However, allergic reactions can range from moderate to life-threatening, requiring rapid diagnosis and treatment. This article serves as a review to provide information on LA, their adverse reactions, causes, and management.