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Ergün O, Öztürk SA, Aydemir S. A Randomized Controlled Trial Comparing Two Different Local Intraurethral Anesthetics in Optical Internal Urethrotomy at the Outpatient Clinic. Urology 2022; 170:21-26. [PMID: 36195164 DOI: 10.1016/j.urology.2022.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess feasibility and efficacy of local topical urethral anesthesia at optical internal urethrotomy (OIU) in patients with anterior and posterior urethral strictures at outpatient clinic. METHODS One hundred and twenty eight patients were prospectively randomized to perform OIU with intraurethral prilocaine solution (group 1 = 64 patients) or intraurethral lidocaine gel (group 2 = 64 patients). Visual analog scale was used for procedure related pain evaluation at the beginning, during, and one hour after the procedure. All patients had follow-ups for a minimum of 12 months. Treatment failure was defined as Qmax < 12ml/sec at uroflowmetry and observed urethral stricture on cystoscopy. RESULTS The overall success rate of the OIU was 75.8%. The intraoperative mean visual analogue score in group 2 (5,1 ± 1,77) was significantly higher than the group 1 (3.7 ± 1.9) (P = 0.0001). The median time to stricture recurrence was 9.2 months (range 1-13 months). Stricture recurrences were noted in 15 patients in Group 1 and 16 patients in Group 2 during the follow-up period. CONCLUSION Prilocaine solution as a local anesthetic is a better option than intraurethral lidocaine gel in the OIU procedure and allows successful OIU to be performed in outpatient clinic. It can be preferred as a local anesthetic for OIU, particularly in unfit patients for general/regional anesthesia. Although it provides successful pain relief, it still cannot prevent experiencing moderate or severe pain in a group of patients. More studies about more effective local anesthetics for pain relief during OIU at the outpatient clinic are required.
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Affiliation(s)
- Osman Ergün
- Süleyman Demirel University, Medical Faculty, Department of Urology, Isparta, Isparta, Turkey.
| | - Sefa Alperen Öztürk
- Süleyman Demirel University, Medical Faculty, Department of Urology, Isparta, Isparta, Turkey
| | - Sabri Aydemir
- Süleyman Demirel University, Medical Faculty, Department of Urology, Isparta, Isparta, Turkey
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Gangawane AA, Shah SB, Malankar TE, Mathur A, Ginde SS, Lakshmi Priyanka M. Comparative evaluation of pain perception during conventional greater palatine injections versus the use of a novel barovibrotactile device - In vivo study. J Oral Biol Craniofac Res 2022; 12:542-546. [PMID: 35866146 DOI: 10.1016/j.jobcr.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 03/18/2022] [Accepted: 06/26/2022] [Indexed: 10/17/2022] Open
Abstract
Background Pain control by means of local anesthesia is an intrinsic part of clinical practice in dentistry. It is an irony that the modality used for pain free procedure itself is a source of fear & anxiety to the patient. Several modifications have been made to the injecting devices, local anesthetic solutions and techniques to render their administration comfortably. The objective of this study was thus designed to evaluate and compare anxiety and pain perception during conventional greater palatine injections versus use of a novel barovibrotactile device named Accupal to give painless anesthesia. This device has an additional attachment which works on Vibra-pulse technology thus minimizing pain during injection technique. Materials and methods A prospective, split mouth, open label, randomized, crossover clinical study was conducted on 50 patients coming to our institute whereby on one side Accupal was used during administration of local anesthesia. And on other side, traditional local anesthetic injection technique was used with one week of time interval. Results A statistically significant difference was found as in the pain perception between the two techniques as per Visual Analogue Scale whereas no difference was seen in the anxiety levels as per the physiological parameters recorded by noninvasive blood pressure machine at various intervals. Conclusion The use of Accupal has thus proved to show better pain control as compared to traditional injection techniques of local anesthesia.
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Affiliation(s)
- Aishwarya Avinash Gangawane
- Dept. of Oral and Maxillofacial Surgery, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Sonal Bhavesh Shah
- Dept. of Oral and Maxillofacial Surgery, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Tanvi Eknath Malankar
- Dept. of Oral and Maxillofacial Surgery, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Anmol Mathur
- Dept. of Public Health Dentistry, Dr. D.Y Patil Dental College and Hospital, Dr. D.Y Patil Vidyapeeth, Pimpri, Pune, India
| | - Shriya Shrirang Ginde
- Dept. of Oral and Maxillofacial Surgery, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Manne Lakshmi Priyanka
- Dept. of Oral and Maxillofacial Surgery, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, India
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Areenoo P, Manmontri C, Chaipattanawan N, Chompu-inwai P, Khanijou M, Kumchai T, Wongsirichat N. Anesthetic efficacies of buccal with palatal injection versus buccal with intra-septal injection in permanent maxillary first molars of pediatric patients. J Dent Anesth Pain Med 2022; 22:239-254. [PMID: 35991357 PMCID: PMC9358269 DOI: 10.17245/jdapm.2022.22.4.239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/15/2022] [Accepted: 07/17/2022] [Indexed: 11/27/2022] Open
Abstract
The high success rate of dental treatment is dependent on the cooperation of pediatric patients during procedures. Dental treatment often causes pain, particularly in children. The factors in providing treatment to pediatric patients include the characteristics and location of the tooth, profoundness of the anesthesia including the type of local anesthetic, and cooperation of the patient. Previous studies have examined several techniques to successfully achieve profound pulpal anesthesia in maxillary permanent teeth. The dentist should select the injection technique to be used based on patient needs. In children, either buccal with palatal injections or buccal with intra-septal injections may be used to anesthetize the permanent maxillary first molar. Buccal with palatal injections are commonly used prior to routine maxillary dental procedures. Currently, there are only a few studies on the employment of buccal with intra-septal injections to anesthetize permanent maxillary first molars in pediatric patients. This review will focus on efficacy of buccal with palatal versus buccal with intra-septal pulpal anesthesia of the permanent maxillary first molars in pediatric patients and aim to determine which technique should be used during routine dental procedures.
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Affiliation(s)
- Peecharat Areenoo
- Division of Pediatric Dentistry, Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Chanika Manmontri
- Division of Pediatric Dentistry, Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Nattakan Chaipattanawan
- Division of Pediatric Dentistry, Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Papimon Chompu-inwai
- Division of Pediatric Dentistry, Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Manop Khanijou
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bangkokthonburi University, Bangkok, Thailand
| | - Thongnard Kumchai
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bangkokthonburi University, Bangkok, Thailand
| | - Natthamet Wongsirichat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bangkokthonburi University, Bangkok, Thailand
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Gazal G. Does articaine, rather than prilocaine, increase the success rate of anaesthesia for extraction of maxillary teeth. Saudi J Anaesth 2020; 14:297-301. [PMID: 32934619 PMCID: PMC7458028 DOI: 10.4103/sja.sja_94_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/03/2020] [Accepted: 03/17/2020] [Indexed: 12/04/2022] Open
Abstract
Objective: To compare the anesthetic performances of 3% prilocaine and 4% articaine when used for the extraction of the maxillary teeth. Materials and Methods: Ninety-five patients, aged between 16 and 70 years, were included in this study. Patients were divided into two groups. Group one received articaine 4% with 1:00.000 adrenaline. Group two received prilocaine with 3% felypressin (0.03 I.U. per ml). Onset time of anesthesia was objectively evaluated by using electronic pulp testing. Results: Eighty-five patients in this study had a successful local anesthetic followed by extraction within the study duration time (10 minutes). However, there were six patients with failure anesthesia (5 in prilocaine group and 1 in articaine group). By applying Person's Chi-square test (x2), there were no significant differences in the number of episodes of the anesthetic success between articaine and prilocaine groups at time intervals (P = 0.5). T-test showed that there have been no important variations within the mean onset time of anesthesia for articaine and prilocaine buccal infiltrations (P = 0.1). Conclusions: 3% Prilocaine with felypressin is as effective as 4% articaine with adrenaline when used for the extraction of maxillary teeth. Recommendations would be given to the dental practitioners to use prilocaine more frequently than articaine because of its low toxicity. Trial registration number: NCT04236115.
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Affiliation(s)
- Giath Gazal
- Department of Oral and Maxillofacial Surgery, Taibah University, College of Dentistry, Madinah Al- Munawwarah, Saudi Arabia
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Blinova EV, Semeleva EV, Shilova AM, Vediaeva AP, Blinov DS, Skachilova SY, Vasil'ev YL, Vasilkina OV, Samishina EA, Meylanova RD. [Experimental study of the effectiveness of local anesthetic activity of a new dimethylphenylacetamide-containing pharmaceutical composition in chronic periodontitis]. STOMATOLOGII︠A︡ 2020; 99:11-16. [PMID: 32441069 DOI: 10.17116/stomat20209902111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Novel anaesthetic formulation LHT-15-32 was studied. The experimental study involved 66 white mice, 15 Rana radibunda frogs and 50 male Sprague Dawley rats. Its acute intravenous and subcutaneous toxicity was determined in mice. Pain sensitivity threshold of upper second molar was determined in rats with experimental periodontitis. Oxidative stress activity and total antioxidant capacity were determined in rats' gingival mucosa by induced chemiluminescence. Tissue IL-1β, IL-10 and TNF-a concentration was quantitatively assessed by ELISA. LHT-15-32 Na-blocking activity was studied on isolated neurons of Limnea stagnalis para-pharyngeal ganglion. Rana radibunda isolated sciatic nerve was perfused with LHT-15-32 to assess its conductivity. LHT-15-32 acute intravenous and subcutaneous toxicity was lower then that of its active substance LHT-4-00. The formulation infraorbital administration induced deep dental anaesthesia lasted longer than 70 min, activated local antioxidant defence system and decreased IL-1β level in gingival tissue. At 10-6 to 10-3 M LHT-15-32 inhibited sciatic nerve conductivity and blocked Na+-channels of isolated neurons in dose-dependent manner. LHT-15-32 proved to be less toxic than active substance and lidocaine. The agent provides deep and prolonged anesthesia of the upper molar of rats in chronic apical periodontitis, lowers tissue concentration of pain cascade cytokines and oxidative stress activity and suppresses the action potential amplitude of a sensory nerve due to Na-blocking activity.
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Affiliation(s)
- E V Blinova
- First Moscow State Medical University named after I.M. Sechenov (Sechenov University), Moscow, Russia
| | - E V Semeleva
- National Research Mordovian State University named after N.P. Ogarev, Saransk, Russia
| | - A M Shilova
- Federal Research Center for Safety of Biologically Active Substances, Staraya Kupavna, Russia
| | - A P Vediaeva
- First Moscow State Medical University named after I.M. Sechenov (Sechenov University), Moscow, Russia
| | - D S Blinov
- Federal Research Center for Safety of Biologically Active Substances, Staraya Kupavna, Russia
| | - S Ya Skachilova
- Federal Research Center for Safety of Biologically Active Substances, Staraya Kupavna, Russia
| | - Yu L Vasil'ev
- First Moscow State Medical University named after I.M. Sechenov (Sechenov University), Moscow, Russia
| | - O V Vasilkina
- National Research Mordovian State University named after N.P. Ogarev, Saransk, Russia
| | - E A Samishina
- Federal Research Center for Safety of Biologically Active Substances, Staraya Kupavna, Russia
| | - R D Meylanova
- First Moscow State Medical University named after I.M. Sechenov (Sechenov University), Moscow, Russia
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Novel Dimethylacetamide-Containing Formulation Improves Infraorbital Anaesthesia Efficacy in Rats with Periodontitis. Adv Pharmacol Pharm Sci 2020; 2020:3058735. [PMID: 32355910 PMCID: PMC7178499 DOI: 10.1155/2020/3058735] [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: 10/16/2019] [Revised: 12/23/2019] [Accepted: 02/20/2020] [Indexed: 11/18/2022] Open
Abstract
Background To evaluate acute toxicity and local anaesthetic activity of a formulation containing a novel dimethylacetamide derivative, antioxidant, and vasoconstrictor in rats with chronic periodontitis. Methods Novel anaesthetic dimethylacetamide-containing formulation LHT-15-32 was studied as 2% water solution. Its acute intravenous and subcutaneous toxicity was determined in mice. Pain sensitivity threshold of the upper second molar was determined in rats with experimental periodontitis. Oxidative stress activity and total antioxidant capacity were determined in rats' gingival mucosa by induced chemiluminescence. Local changes were evaluated in periodontal tissue by morphological examination. Tissue IL-1β, IL-10, and TNF-α concentration was quantitatively assessed by an enzyme-linked immunosorbent assay. LHT-15-31 Na-blocking activity was studied on isolated neurons of Limnaea stagnalis' parapharyngeal ganglion. Isolated sciatic nerve of Rana radibunda was perfused with different concentrations of LHT-15-32 to assess its conductivity. Statistical analysis was used, and continuous variables were presented as mean ± square deviation. The normality of distribution was determined using ANOVA. Newman–Keuls parametric criterion was used for intergroup comparison. LD50 indexes were calculated by probit analysis. Results LHT-15-32 acute intravenous and subcutaneous toxicity was lower than that of its active substance. The formulation by infraorbital administration induced deep dental anaesthesia which lasted over 70 min and activated the local antioxidant defense system and decreased IL-1β level in gingival tissue. LHT-15-32 triggered tissue reparation around the impacted upper molar in rats assessed five days after administration. At 10−6 to 10−3 M concentration, LHT-15-32 inhibited sciatic nerve conductivity and blocked Na+ channels of isolated neurons in a dose-dependent manner. Conclusions The formulation may be considered as an effective and safe approach to anaesthetize upper molars with periodontitis.
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Gazal G, Omar E, Fareed WM, Alsharif A, Bahabri R. Impact of maxillary teeth morphology on the failure rate of local anesthesia. Saudi J Anaesth 2020; 14:57-62. [PMID: 31998021 PMCID: PMC6970379 DOI: 10.4103/sja.sja_542_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 09/02/2019] [Indexed: 12/12/2022] Open
Abstract
Objective: To investigate the effect of maxillary single and multiple rooted teeth on the success rate of buccal infiltration anesthesia. Subjects and Methods: This clinical study was performed by dividing the participants into three groups. Group one included 30 patients with upper anterior teeth, group two 23 patients with upper premolars teeth and group three 39 patients with upper molars for extraction. Onset time of anesthtic action was evaluted by using electronic pulp tester. Pulp testing assessments were carried out immediately before the injection and at the intervals of 2 mins following the injection until the anesthetic success obtains. Results: Seventy-nine patients in this study secured anesthetic success within study duration time (10 min). However, there were 13 patients with dental anesthesia failures (3 patients with single rooted teeth and 10 patients with multiple rooted teeth). There were no significant differences in the mean onset time of pulpal anesthesia between the anterior, middle and posterior teeth (P value = 0.449). Clinically, patients with single rooted teeth reported faster dental anesthesia and earlier teeth extraction than patients with multiple rooted teeth. Conclusion: This study showed that the single rooted teeth have faster pulpal anesthesia and early extraction than teeth with multiple roots but not statistically significant. Administration of extra local anesthetic cartridge or using intraseptal injection technique can be a solution to overcome the failure of anesthesia in the maxillary posterior teeth.
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Affiliation(s)
- Giath Gazal
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Taibah University, Madinah Al-Munawwarah, Kingdom of Saudi Arabia
| | - Esam Omar
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Taibah University, Madinah Al-Munawwarah, Kingdom of Saudi Arabia
| | - Wamiq M Fareed
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Taibah University, Madinah Al-Munawwarah, Kingdom of Saudi Arabia
| | - Ali Alsharif
- Department of Prosthodontics, College of Dentistry, Taibah University, Madinah Al-Munawwarah, Kingdom of Saudi Arabia
| | - Rayan Bahabri
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Madinah Al-Munawwarah, Kingdom of Saudi Arabia
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Abstract
Objectives: To investigate the potency and speed of action of 2% lidocaine and 3% prilocaine for upper teeth extractions. Methods: This prospective clinical study was conducted from November 2016 to May 2017. Ninety-six patients, aged between 16 to 70 years old were recruited in this study. Two regimens were randomly administered over one visit. Patients, treatment group I, received 2% lidocaine with 1:00.000 adrenaline. Patients treatment group II received prilocaine 3% and felypressin 0.03 I.U. per ml. The efficacy of pulp anesthesia was determined by electronic pulp testing. At any point of trial (10 minutes), the anesthetized tooth becomes unresponsive for maximal pulp stimulation (64 reading), the extraction was carried out. Results: There were no significant differences in the mean onset time of pulpal anesthesia and extraction between the prilocaine and lidocaine buccal infiltration groups (p=0.28). However, clinically, the patients in prilocaine group recorded faster onset time of anesthesia and teeth extraction than those in lidocaine group. Conclusion: Prilocaine has a better clinical performance in terms of providing rapid dental anesthesia and earlier teeth extraction than lidocaine but the differences were not significant. Prilocaine with felypressin could be a good choice for patients who have contraindication to the use of lidocaine with adrenaline.
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Affiliation(s)
- Giath Gazal
- Department of Oral and Maxillofacial, Taibah University, Al Madinah Al Munawwarah, Kingdom of Saudi Arabia. E-mail.
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Gazal G. Is prilocaine safe and potent enough for use in the oral surgery of medically compromised patients. Saudi Med J 2019; 40:97-100. [PMID: 30617388 PMCID: PMC6452603 DOI: 10.15537/smj.2019.01.23475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To investigate the potency and speed of action of 2% lidocaine and 3% prilocaine for upper teeth extractions. METHODS This prospective clinical study was conducted from November 2016 to May 2017. Ninety-six patients, aged between 16 to 70 years old were recruited in this study. Two regimens were randomly administered over one visit. Patients, treatment group I, received 2% lidocaine with 1:00.000 adrenaline. Patients treatment group II received prilocaine 3% and felypressin 0.03 I.U. per ml. The efficacy of pulp anesthesia was determined by electronic pulp testing. At any point of trial (10 minutes), the anesthetized tooth becomes unresponsive for maximal pulp stimulation (64 reading), the extraction was carried out. Results: There were no significant differences in the mean onset time of pulpal anesthesia and extraction between the prilocaine and lidocaine buccal infiltration groups (p=0.28). However, clinically, the patients in prilocaine group recorded faster onset time of anesthesia and teeth extraction than those in lidocaine group. Conclusion: Prilocaine has a better clinical performance in terms of providing rapid dental anesthesia and earlier teeth extraction than lidocaine but the differences were not significant. Prilocaine with felypressin could be a good choice for patients who have contraindication to the use of lidocaine with adrenaline.
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Affiliation(s)
- Giath Gazal
- Department of Oral and Maxillofacial, Taibah University, Al Madinah Al Munawwarah, Kingdom of Saudi Arabia. E-mail.
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Alsharif A, Omar E, Alolayan ABB, Bahabri R, Gazal G. 2% lidocaine versus 3% prilocaine for oral and maxillofacial surgery. Saudi J Anaesth 2018; 12:571-577. [PMID: 30429739 PMCID: PMC6180686 DOI: 10.4103/sja.sja_259_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective To investigate the speed of action and injection discomfort of 2% lidocaine and 3% prilocaine for upper teeth extractions. Materials and Methods Forty-six patients were included in the prilocaine 3% group, and 46 in the lidocaine 2% control group. After all injections, soft and hard tissue numbness was objectively gauged by dental probe at intervals of 15 s. Moreover, the pain of the injections was recorded by the patients after each treatment on standard 100 mm visual analog scales, tagged at the endpoints with "no pain" (0 mm) and "unbearable pain" (100 mm). Results There were no significant differences in the meantime of first numbness to associated buccal, palatal mucosa, and tooth of patients in the lidocaine and prilocaine buccal infiltration groups (P = 0.56, 0.37, and 0.33). However, clinically, the patients in prilocaine group recorded earlier buccal, palatal mucosa, and teeth numbness than those in lidocaine group. With regards to the discomfort of the needle injections, there was a significant difference for lidocaine and prilocaine groups when comparing the post buccal scores with the post palatal injection scores (t-test: P < 0.001). Lidocaine and prilocaine buccal injections were significantly more comfortable than palatal injections. Conclusions Using 2% lidocaine and 3% prilocaine for extractions of upper maxillary teeth produces similarly successful anesthesia. Clinically, prilocaine has slightly rapid onset of action, earlier buccal mucosa, hard palate, and teeth numbness. Prilocaine and lidocaine buccal injection was significantly more comfortable than palatal injection.
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Affiliation(s)
- Ali Alsharif
- Department of Oral and Maxillofacial, College of Dentistry, Taibah University, Medina, Kingdom of Saudi Arabia
| | - Esam Omar
- Department of Oral and Maxillofacial, College of Dentistry, Taibah University, Medina, Kingdom of Saudi Arabia
| | - Al-Braa Badr Alolayan
- Department of Oral and Maxillofacial, College of Dentistry, Taibah University, Medina, Kingdom of Saudi Arabia
| | - Rayan Bahabri
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Medina, Kingdom of Saudi Arabia
| | - Giath Gazal
- Department of Oral and Maxillofacial, College of Dentistry, Taibah University, Medina, Kingdom of Saudi Arabia
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St George G, Morgan A, Meechan J, Moles DR, Needleman I, Ng Y, Petrie A. Injectable local anaesthetic agents for dental anaesthesia. Cochrane Database Syst Rev 2018; 7:CD006487. [PMID: 29990391 PMCID: PMC6513572 DOI: 10.1002/14651858.cd006487.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pain during dental treatment, which is a common fear of patients, can be controlled successfully by local anaesthetic. Several different local anaesthetic formulations and techniques are available to dentists. OBJECTIVES Our primary objectives were to compare the success of anaesthesia, the speed of onset and duration of anaesthesia, and systemic and local adverse effects amongst different local anaesthetic formulations for dental anaesthesia. We define success of anaesthesia as absence of pain during a dental procedure, or a negative response to electric pulp testing or other simulated scenario tests. We define dental anaesthesia as anaesthesia given at the time of any dental intervention.Our secondary objective was to report on patients' experience of the procedures carried out. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library; 2018, Issue 1), MEDLINE (OVID SP), Embase, CINAHL PLUS, WEB OF SCIENCE, and other resources up to 31 January 2018. Other resources included trial registries, handsearched journals, conference proceedings, bibliographies/reference lists, and unpublished research. SELECTION CRITERIA We included randomized controlled trials (RCTs) testing different formulations of local anaesthetic used for clinical procedures or simulated scenarios. Studies could apply a parallel or cross-over design. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological approaches for data collection and analysis. MAIN RESULTS We included 123 studies (19,223 participants) in the review. We pooled data from 68 studies (6615 participants) for meta-analysis, yielding 23 comparisons of local anaesthetic and 57 outcomes with 14 different formulations. Only 10 outcomes from eight comparisons involved clinical testing.We assessed the included studies as having low risk of bias in most domains. Seventy-three studies had at least one domain with unclear risk of bias. Fifteen studies had at least one domain with high risk of bias due to inadequate sequence generation, allocation concealment, masking of local anaesthetic cartridges for administrators or outcome assessors, or participant dropout or exclusion.We reported results for the eight most important comparisons.Success of anaesthesiaWhen the success of anaesthesia in posterior teeth with irreversible pulpitis requiring root canal treatment is tested, 4% articaine, 1:100,000 epinephrine, may be superior to 2% lidocaine, 1:100,000 epinephrine (31% with 2% lidocaine vs 49% with 4% articaine; risk ratio (RR) 1.60, 95% confidence interval (CI) 1.10 to 2.32; 4 parallel studies; 203 participants; low-quality evidence).When the success of anaesthesia for teeth/dental tissues requiring surgical procedures and surgical procedures/periodontal treatment, respectively, was tested, 3% prilocaine, 0.03 IU felypressin (66% with 3% prilocaine vs 76% with 2% lidocaine; RR 0.86, 95% CI 0.79 to 0.95; 2 parallel studies; 907 participants; moderate-quality evidence), and 4% prilocaine plain (71% with 4% prilocaine vs 83% with 2% lidocaine; RR 0.86, 95% CI 0.75 to 0.99; 2 parallel studies; 228 participants; low-quality evidence) were inferior to 2% lidocaine, 1:100,000 epinephrine.Comparative effects of 4% articaine, 1:100,000 epinephrine and 4% articaine, 1:200,000 epinephrine on success of anaesthesia for teeth/dental tissues requiring surgical procedures are uncertain (RR 0.85, 95% CI 0.71 to 1.02; 3 parallel studies; 930 participants; very low-quality evidence).Comparative effects of 0.5% bupivacaine, 1:200,000 epinephrine and both 4% articaine, 1:200,000 epinephrine (odds ratio (OR) 0.87, 95% CI 0.27 to 2.83; 2 cross-over studies; 37 participants; low-quality evidence) and 2% lidocaine, 1:100,000 epinephrine (OR 0.58, 95% CI 0.07 to 5.12; 2 cross-over studies; 31 participants; low-quality evidence) on success of anaesthesia for teeth requiring extraction are uncertain.Comparative effects of 2% mepivacaine, 1:100,000 epinephrine and both 4% articaine, 1:100,000 epinephrine (OR 3.82, 95% CI 0.61 to 23.82; 1 parallel and 1 cross-over study; 110 participants; low-quality evidence) and 2% lidocaine, 1:100,000 epinephrine (RR 1.16, 95% CI 0.25 to 5.45; 2 parallel studies; 68 participants; low-quality evidence) on success of anaesthesia for teeth requiring extraction and teeth with irreversible pulpitis requiring endodontic access and instrumentation, respectively, are uncertain.For remaining outcomes, assessing success of dental local anaesthesia via meta-analyses was not possible.Onset and duration of anaesthesiaFor comparisons assessing onset and duration, no clinical studies met our outcome definitions.Adverse effects (continuous pain measured on 170-mm Heft-Parker visual analogue scale (VAS))Differences in post-injection pain between 4% articaine, 1:100,000 epinephrine and 2% lidocaine, 1:100,000 epinephrine are small, as measured on a VAS (mean difference (MD) 4.74 mm, 95% CI -1.98 to 11.46 mm; 3 cross-over studies; 314 interventions; moderate-quality evidence). Lidocaine probably resulted in slightly less post-injection pain than articaine (MD 6.41 mm, 95% CI 1.01 to 11.80 mm; 3 cross-over studies; 309 interventions; moderate-quality evidence) on the same VAS.For remaining comparisons assessing local and systemic adverse effects, meta-analyses were not possible. Other adverse effects were rare and minor.Patients' experiencePatients' experience of procedures was not assessed owing to lack of data. AUTHORS' CONCLUSIONS For success (absence of pain), low-quality evidence suggests that 4% articaine, 1:100,000 epinephrine was superior to 2% lidocaine, 1:100,000 epinephrine for root treating of posterior teeth with irreversible pulpitis, and 2% lidocaine, 1:100,000 epinephrine was superior to 4% prilocaine plain when surgical procedures/periodontal treatment was provided. Moderate-quality evidence shows that 2% lidocaine, 1:100,000 epinephrine was superior to 3% prilocaine, 0.03 IU felypressin when surgical procedures were performed.Adverse events were rare. Moderate-quality evidence shows no difference in pain on injection when 4% articaine, 1:100,000 epinephrine and 2% lidocaine, 1:100,000 epinephrine were compared, although lidocaine resulted in slightly less pain following injection.Many outcomes tested our primary objectives in simulated scenarios, although clinical alternatives may not be possible.Further studies are needed to increase the strength of the evidence. These studies should be clearly reported, have low risk of bias with adequate sample size, and provide data in a format that will allow meta-analysis. Once assessed, results of the 34 'Studies awaiting classification (full text unavailable)' may alter the conclusions of the review.
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Affiliation(s)
- Geoffrey St George
- Eastman Dental HospitalEndodontics Unit256 Grays Inn RoadLondonUKWC1X 8LD
| | - Alyn Morgan
- Eastman Dental HospitalEndodontics Unit256 Grays Inn RoadLondonUKWC1X 8LD
| | - John Meechan
- The Dental SchoolDepartment of Oral and Maxillofacial SurgeryFramlington PlaceNewcastle Upon TyneUKNE2 4BW
| | - David R Moles
- Peninsula Dental SchoolOral Health Services ResearchThe John Bull Building, Tamar Science Park, Research WayPlymouthUKPL6 8BU
| | - Ian Needleman
- UCL Eastman Dental InstituteUnit of Periodontology and International Centre for Evidence‐Based Oral Health256 Gray's Inn RoadLondonUKWC1X 8LD
| | - Yuan‐Ling Ng
- UCL Eastman Dental InstituteUnit of Endodontology256 Grays Inn RoadLondonUKWC1X 8LD
| | - Aviva Petrie
- UCL Eastman Dental InstituteBiostatistics Unit256 Gray's Inn RoadLondonUKWC1X 8LD
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12
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Gazal G. Is Articaine More Potent than Mepivacaine for Use in Oral Surgery? J Oral Maxillofac Res 2018; 9:e5. [PMID: 30429965 PMCID: PMC6225598 DOI: 10.5037/jomr.2018.9305] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/28/2018] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To investigate the potency and speed of action of 4% articaine and 2% mepivacaine for maxillary teeth extractions. MATERIAL AND METHODS Ninety-four patients, aged between 16 to 70 years old, were recruited in this study. Two regimens were randomly administered over one visit. Patients of treatment group 1 received mepivacaine 2% with 1:100,000 adrenaline, whereas treatment group 2 - articaine 4% with 1:100,000 adrenaline. The onset time of pulp anaesthesia for maxillary teeth indicated for extraction was determined by electronic pulp testing. At any point of trial (10 minutes), the anesthetized tooth becomes unresponsive for maximal pulp stimulation (64 reading), the extraction was carried out. RESULTS In this study, 85 patients had successful local anaesthetic followed by extraction within the study duration time (10 min). However, 5 patients had failed dental extraction (4 in mepivacaine group and 1 in articaine group). Patients in the articaine buccal infiltration group recorded faster onset time of action regarding anaesthesia and teeth extraction than patients in mepivacaine buccal infiltration group (P = 0.03). CONCLUSIONS Articaine is an effective anaesthetic with a rapid onset, comparable to mepivacaine in infiltrative techniques used for maxillary teeth extraction. However, articaine has clinically achieved faster dental anaesthesia and earlier teeth extraction than mepivacaine. So, articaine can be the local anaesthetic of first choice in oral surgery.
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Affiliation(s)
- Giath Gazal
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Taibah University, Madinah Al-MunawwarahSaudi Arabia.
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13
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Feng L, Wang H, Lin M. Effect of painless STA on tooth extraction of elderly patients with periodontal diseases. Exp Ther Med 2018. [PMID: 29541167 PMCID: PMC5838287 DOI: 10.3892/etm.2018.5776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This study compared the effects of tooth extractions under novel painless single tooth anesthesia (STA) and conventional anesthesia on elderly patients with periodontal diseases, and the impact of painless STA on clinical indicators of the patients. Elderly patients (n=116) with periodontal diseases who were treated in Jinan Central Hospital were selected to undergo extraction operation on loose teeth; all the patients were randomly divided into two groups. The tooth extraction operations were performed after painless STA and cartridge anesthesia; the effects of the tooth extraction operations and the operation time were recorded; Visual Analogue Scale (VAS), Kuttner facial expression scale, Frankl treatment compliance scale and Houpt behavior rating scale were utilized to assess and record the clinical indicators of the patients during the operations; the impacts of the two anesthesia techniques on the effect of the tooth extraction of patients with periodontal diseases were comprehensively analyzed. Compared with conventional cartridge anesthesia, painless STA could effectively shorten the operation time (P<0.01); the Frankl treatment compliance score and Houpt behavior rating score of patients receiving painless STA were remarkably higher than those of patients receiving conventional cartridge anesthesia (P<0.01); during the operation, painless STA could effectively reduce the blood pressure and slow the heart rate by comparing with cartridge anesthesia (P<0.01, P<0.05); the scores of STA and Kuttner facial expressions in patients receiving painless STA were significantly lower than those in patients receiving conventional cartridge anesthesia (P<0.01); after the operation, the incidence of adverse reactions, such as pain and swelling, in patients receiving painless STA was obviously decreased compared with that in patients receiving conventional cartridge anesthesia (P<0.01). The novel painless STA can notably shorten the time of tooth extraction of elderly patients with periodontal diseases, reduce postoperative pain and swelling, increase the compliance of the operation, alleviate the impact of tooth extraction operation on the clinical indicators of the patients and relieve the pain of patients caused by the operation.
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Affiliation(s)
- Li Feng
- Customer Service Management Office, Shandong University Affiliated to Jinan Central Hospital, Jinan, Shandong 250013, P.R. China
| | - Haiming Wang
- Department of Stomatology, Jinan Hospital, Jinan, Shandong 250013, P.R. China
| | - Ming Lin
- Department of Stomatology, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
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