1
|
Rai S, Jaisani MR, Dongol A, Acharya P, Yadav AK. Effectiveness of pre-injection use of cryoanesthesia as compared to topical anesthetic gel in reducing pain perception during palatal injections: a randomized controlled trial. J Dent Anesth Pain Med 2024; 24:91-99. [PMID: 38584760 PMCID: PMC10995535 DOI: 10.17245/jdapm.2024.24.2.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 02/13/2024] [Accepted: 03/04/2024] [Indexed: 04/09/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Siddhartha Rai
- Department of Oral and Maxillofacial Surgery, B.P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Mehul Rajesh Jaisani
- Department of Oral and Maxillofacial Surgery, B.P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Ashok Dongol
- Department of Oral and Maxillofacial Surgery, B.P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Pradeep Acharya
- Department of Oral and Maxillofacial Surgery, B.P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Anjani Kumar Yadav
- Department of Oral and Maxillofacial Surgery, B.P Koirala Institute of Health Sciences, Dharan, Nepal
| |
Collapse
|
2
|
Patel BJ, Surana P, Patel KJ. Recent Advances in Local Anesthesia: A Review of Literature. Cureus 2023; 15:e36291. [PMID: 37065303 PMCID: PMC10103831 DOI: 10.7759/cureus.36291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 03/19/2023] Open
Abstract
Even if local anesthetic is still the mainstay of pain management in dentistry, research will keep striving for novel and effective pain management techniques. The majority of research efforts are focused on improving anesthetic medications, delivery systems, and related methods. There are more recent technologies available that can assist the dentist in providing better pain relief with fewer unpleasant injections and fewer negative adverse effects. The purpose of the current review of the literature is to compile evidence that will convince dentists to employ modern local anesthetics, as well as other methods and techniques to reduce patient discomfort while administering anesthesia.
Collapse
|
3
|
Abbasi H, Saqib M, Maqsood A, Jouhar R, Lal A, Ahmed N, Heboyan A. Effectiveness of precooling with ethyl chloride versus honey in alleviating intra-oral injection pain in adult patients: A randomized controlled trial. SAGE Open Med 2023; 11:20503121231162342. [PMID: 37008683 PMCID: PMC10064462 DOI: 10.1177/20503121231162342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/18/2023] [Indexed: 03/31/2023] Open
Abstract
Objective: The objective of the study was to assess and compare the effectiveness of precooling with ethyl chloride versus honey in alleviating the pain of dental injection. Methods: About 90 patients were recruited for this randomized controlled trial. In each of the following three groups, 30 patients were allocated: Group 1, precooling with ethyl chloride; Group 2, honey; and Group 3, control. The pain score of patients in each group was measured after injecting the dental local anesthesia using a visual analog scale. Paired t-test and multiple linear regression tests were used for statistical analysis. A p value of ⩽0.05 was considered to be as significant. Results: The mean pain scores of participants residing in different groups were as follows: Group 1: 2.83 ± 1.46, Group 2: 4.33 ± 1.62, and Group 3: 7.80. After administrating ethyl chloride, the majority of the 18 (60%) patients reported to suffer from “mild pain.” Furthermore, in patients who were given honey in Group 2, most of the 21 (70%) patients reported suffering from “moderate pain.” In Group 3 (control) where no anesthetic modality was used, the majority of the 25 (83.33%) patients experienced “severe pain.” A significant difference was noted among the pain scores of three groups ( p = 0.001). Conclusion: The administration of local anesthetic is part of almost all dental procedures. Precooling with ethyl chloride resulted in a greater reduction in pain scores than honey upon administration of local anesthesia injection.
Collapse
Affiliation(s)
- Hira Abbasi
- Department of Operative Dentistry and Endodontics, Altamash Institute of Dental Medicine, Karachi, Pakistan
| | - Muhammad Saqib
- Department of Operative Dentistry and Endodontics, Altamash Institute of Dental Medicine, Karachi, Pakistan
| | - Afsheen Maqsood
- Department of Oral Pathology, Bahria University Dental College, Karachi, Pakistan
| | - Rizwan Jouhar
- Department of Restorative Dental Sciences, College of Dentistry, King Faisal University, Al Ahsa, Saudi Arabia
| | - Abhishek Lal
- Department of Prosthodontics, Altamash Institute of Dental Medicine, Karachi, Pakistan
| | - Naseer Ahmed
- Department of Prosthodontics, Altamash Institute of Dental Medicine, Karachi, Pakistan
| | - Artak Heboyan
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
- Artak Heboyan, Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Koryun str. 2, Yerevan, 0025, Armenia. Emails: ;
| |
Collapse
|
4
|
Tirupathi SP, Nanda N, Pallepagu S, Malothu S, Rathi N, Chauhan RS, Priyanka V, Basireddy R. The combined effect of extraoral vibratory stimulus and external cooling on pain perception during intra-oral local anesthesia administration in children: a systematic review and meta-analysis. J Dent Anesth Pain Med 2022; 22:87-96. [PMID: 35449783 PMCID: PMC8995677 DOI: 10.17245/jdapm.2022.22.2.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 12/03/2022] Open
Abstract
This study aimed to assess the combined use of extraoral vibratory stimulation and extraoral cooling in reducing the pain (subjective and objective) of dental local anesthesia administration in children. PubMed, Cochrane Central Register of Controlled Trials, and Ovid SP databases were searched up to July 2021. Article titles were screened and full-text evaluations of the selected articles were performed. Finally, seven studies (391 children, aged 4 – 12 years) were included in this qualitative and quantitative analysis. The pooled data determined the combined effect of extraoral vibration and extraoral cooling as a single measure. Extraoral vibration or cooling alone were not compared. The measured primary and secondary outcomes were pain perception and subjective and objective pain, respectively. When compared with the control, extraoral vibration and cooling resulted in significant differences in the mean combined data for the variables, pain perception, and pain reaction. Children’s subjective pain as measured by pain scores were reduced when extraoral vibration and cooling was used during local anesthesia administration (mean difference -3.52; 95% confidence interval [-5.06 - 1.98]) and objective pain (mean difference -1.46; 95% confidence interval [-2.95 - 0.02] ; mean difference -1.93; 95% confidence interval [-3.72 - 0.14]). Within the confines of this systematic review, there is low-quality evidence to support the use of combined extraoral vibration and cooling for reducing pain (subjective and objective) during intraoral local anesthesia administration in children.
Collapse
Affiliation(s)
- Sunny Priyatham Tirupathi
- Department of Pediatric & Preventive Dentistry, Dr. D. Y. Patil Dental College & Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharasthra, India
| | - Neethu Nanda
- Department of conservative dentistry & endodontics, Govt dental college, Hyderabad, India
| | - Sneha Pallepagu
- Department of conservative dentistry & endodontics, Govt dental college, Hyderabad, India
| | - Sardhar Malothu
- Department of Periodontics, Mamata Dental College, Khammam, Telangana, India
| | - Nilesh Rathi
- Department of Pediatric & Preventive Dentistry, Dr. D. Y. Patil Dental College & Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharasthra, India
| | - Rashmi Singh Chauhan
- Department of Pediatric & Preventive Dentistry, Dr. D. Y. Patil Dental College & Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharasthra, India
| | | | | |
Collapse
|
5
|
Bahrololoomi Z, Maghsoudi N. Articaine use does not routinely eliminate the need for palatal injections for primary maxillary molar extractions: a randomized cross-over clinical trial. Oral Maxillofac Surg 2021; 26:603-611. [PMID: 34853915 PMCID: PMC8635313 DOI: 10.1007/s10006-021-01021-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/15/2021] [Indexed: 11/30/2022]
Abstract
Purpose The aim of this study was to compare single buccal infiltration of 4% articaine versus routine buccal and palatal injections of 2% lidocaine during bilateral extraction of maxillary primary molars. Methods Thirty healthy children aged 6–9 years old requiring bilateral extraction of maxillary primary molars were enrolled into the trial. Randomization was performed in two steps. Routine buccal and palatal infiltrations were administered using 2% lidocaine in the control side. Four percent articaine was used for single buccal infiltration in the intervention side. WBFP scale (Wong-Baker FACES Pain scale) was employed for subjective assessment of pain. For objective evaluation of pain, FLACC scale (Face, Legs, Activity, Cry, Consolability) and physiological parameters of blood pressure and pulse rate were recorded. Results Analyses did not show any significant differences in blood pressure, pulse rate, and FLACC scale between groups (P value > 0.05). However, statistically lower WBFP scores were observed in articaine group as compared to lidocaine group (P value < 0.05); the difference was less than one unit which is not clinically considerable. Conclusion Single buccal infiltration of 4% articaine can be administered as an alternative for conventional infiltration of 2% lidocaine to avoid fear or uncooperative behavior of the child patient. However, the assessment of palatal tissue anesthesia is quite necessary before the procedure is initiated. In case of failure in achieving palatal anesthesia, a palatal injection should be given.
Collapse
Affiliation(s)
- Zahra Bahrololoomi
- Department of Pediatric Dentistry, Social Determinants of Oral Health Research Center, Dentistry Faculty, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nahid Maghsoudi
- Department of Pediatric Dentistry, Social Determinants of Oral Health Research Center, Dentistry Faculty, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| |
Collapse
|
6
|
Tirupathi SP, Rajasekhar S. The effect of vibratory stimulus on pain perception during intraoral local anesthesia administration in children: a systematic review and meta-analysis. J Dent Anesth Pain Med 2021; 20:357-365. [PMID: 33409364 PMCID: PMC7783378 DOI: 10.17245/jdapm.2020.20.6.357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/04/2020] [Accepted: 10/25/2020] [Indexed: 01/19/2023] Open
Abstract
Background To evaluate the effectiveness of vibration as a counter-stimulatory measure in reducing subjective pain due to local anesthesia administration in children. Methods Electronic databases (PubMed, Ovid SP, Cochrane Central Register of Controlled Trials) were searched until April 2020. Studies were screened by titles and abstracts, followed by full text evaluation of the included studies. Results A total of seven studies involving 376 children aged 5-17 years were included in the systematic review and meta-analysis. The meta-analysis compared vibration as a counter-stimulatory measure with no vibration as a comparator. The primary outcome evaluated was pain perception or subjective pain reported by the child. The secondary outcome evaluated was objective pain evaluated in each study. The pooled mean difference favored vibration to be effective for the first outcome. Conclusion Within the limits of this systematic review, low quality evidence suggests that vibration as a counter-stimulatory measure is effective in reducing the subjective pain reported by children during local anesthesia administration.
Collapse
Affiliation(s)
- Sunny Priyatham Tirupathi
- Department of Pedodontics & Preventive Dentistry, Malla Reddy Institute of Dental Sciences, Hyderabad Telangana, India
| | - Srinitya Rajasekhar
- Department of Pedodontics & Preventive Dentistry, Malla Reddy Dental College for Women, Hyderabad, Telangana, India
| |
Collapse
|
7
|
Computer-Controlled Local Anesthesia Complication: Surgical Retrieval of a Broken Dental Needle in Noncooperative Autistic Paediatric Patient. Case Rep Dent 2020; 2020:6686736. [PMID: 33224533 PMCID: PMC7673923 DOI: 10.1155/2020/6686736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 11/22/2022] Open
Abstract
The article describes an unusual case of retrieval of 8 mm fragment of a broken 30-gauge 21 mm dental needle in a 6 y.o. noncooperative autistic male patient. The needle of a computer-controlled local anesthesia device was broken during an attempt to administer local anesthetic, in order to perform conservative treatment of teeth 55 and 54 by a pedodontist. Despite the fact that the patient was under nitrous oxide sedation, an unexpected movement of the patient occurred and resulted in needle breakage. Due to the lack of patient cooperation, the surgical retrieval of a broken needle was performed under general anesthesia as part of one-day surgery procedures. The purpose of the article is to emphasize careful decision-making in proper choice of dental instruments during treatment of noncooperative paediatric patients even under sedation and to suggest dentists to carry out treatment of such patients under general anesthesia.
Collapse
|