A comparison of the efficacy of topical application of Lignocaine Hydrochloride 5% gel and Bupivacaine Hydrochloride 5% gel for extraction of teeth

Comparative Evaluation of Reduction in Pain Perception Using 5% Topical LA vs Freezed Cone as a Preparatory Agent for Intraoral Injection in Children and Effect of VRD as Distraction Technique

Aim

To compare freezed cone and 5% lignocaine as a numbing agent before intraoral injection and evaluate the effect of virtual reality distraction (VRD) as a distraction technique in reducing pain perception in children.

Study design

Around 60 children of 6-11 years old undergoing treatment for the extraction or any pulp therapy of primary tooth were selected. Freezed cone and 5% lidocaine were used to decrease the pain during local anesthesia (LA). VRD was used as a distraction method and to analyze the pain perception, Wong-Baker Faces Pain Rating Scale was used.

Materials and methods

Each child was randomly assigned to receive ice as a topical anesthetic or lignocaine 5% as a topical anesthetic agent. The pain perception was evaluated after the injection of 2% lignocaine hydrochloride (HCL). The primary researcher evaluated the pain during injection using the sound, eye, motor (SEM) scale. The pain experienced during injection was evaluated using Wong-Baker Faces Pain Rating Scale.

Results

In the freezed cone group with the VRD technique, maximum responded to the less pain score. On the contrary, many responded to higher pain scores in the freezed cone group without the VRD technique.

Conclusion

It was concluded that the VRD technique can be used for distraction and the frozen ice cone can be an alternative method to reduce the pain perception during LA.

How to cite this article

Singh R, Gupta N, Gambhir N. Comparative Evaluation of Reduction in Pain Perception Using 5% Topical LA vs Freezed Cone as a Preparatory Agent for Intraoral Injection in Children and Effect of VRD as Distraction Technique. Int J Clin Pediatr Dent 2022;15(5):558-563.

Evaluating the Preemptive Analgesic Effect of Photo-biomodulation Therapy on Pain Perception During Local Anesthesia Injection in Children: A Split-mouth Triple-blind Randomized Controlled Clinical Trial

To evaluate the impact of photobiomodulation therapy (PBMT) on injection pain perception and compare it with a topical oral anesthetic gel. A total of 30 patients of six to nine years old seeking pulpotomy treatment of maxillary secondary primary molars of both sides were considered for this split-mouth triple-blind randomized clinical trial. On one side of the maxilla, the low-level-laser (diode laser, 808 nm, 250 mW; 16.25 J; 32.5 J/cm² ) was irradiated upon the buccal gingiva of the tooth, while a Benzocaine 20% topical anesthetic gel was applied on the other side. A gel with the same taste (strawberry) was applied for the placebo. The Wong-Baker Faces Pain Rating Scale was used to evaluate the injection pain and post-operation pain at two timestamps, one hour and 24 hours after treatment. Patients' heart rate was also evaluated. Paired-T, Wilcoxon-signed-rank test, McNemar and Friedman tests were used for statistical analyses. Results demonstrated that PBMT could significantly decrease the injection pain perception and heart rate alternations compared to the topical anesthetic gels (P=0.000). However, no significant differences were documented between the two methods concerning the 1hour (P=0.26) and 24-hours (P=1.00) post-operation pain. PBMT can be an effective non-pharmacological technique for controlling injection pain.

Local anesthesia in oral and maxillofacial surgery: A review of current opinion

Local anesthesia (LA) is the most important pain management process in oral and maxillofacial surgery. Safe and effective LA not only enable patients to obtain high-quality treatment, but also relieve the anxiety of patients when they come to the clinic. The choices of local anesthetic and injection methods determine the success of LA to a great extent. At present, in most countries or regions, common local anesthetics used in oral and maxillofacial surgery belong to amides and they are injected into patients' body mainly through block or infiltration anesthesia. In addition, the operators' technique level, patient's subjective psychology and anatomical variation of maxillofacial structure also have a strong influence on LA in dental clinic. Due to the existence of above factors, the worldwide success rates of LA in oral and maxillofacial surgery is very different. There are no specific LA methods that ensure 100% successful LA rates. Fortunately, the development of new local anesthetic and injection technology are providing us with new ideas to solve this problem. This review mainly report the new research progress on LA in oral and maxillofacial surgery in recent decades and help clinicians with dental LA operation.

Towards the advance of a novel iontophoretic patch for needle-free buccal anesthesia

The aim of this work was to develop a mucoadhesive iontophoretic patch for anesthetic delivery in the buccal epithelium. The patch was comprised of three different layers, namely i) drug release (0.64 cm²); ii) mucoadhesive (1.13 cm²); and iii) backing (1.13 cm²). Prilocaine and lidocaine hydrochlorides were used as model drugs (1:1 ratio, 12.5 mg per unit). An anode electrode (0.5 cm² spiral silver wire) was placed in between the drug release and mucoadhesive/backing layers to enable iontophoresis. Surface microscopy; mechanical and in vitro mucoadhesive properties; drug release kinetics and mechanism; and drug permeation through the porcine esophageal epithelium were assessed. Topographic analysis evidenced differences in the physical structures for the several layers. All layers presented suitable handling properties i.e., flexibility, elasticity and resistance. Both the release and mucoadhesive layers presented features of a soft and tough material, while the backing layer matched the characteristics of a hard and brittle material. A synergy between the drug release and mucoadhesive layers on the mucoadhesive force and work of adhesion of the tri-layered patch was observed. Passive drug release of both drugs fitted to First-order, Hixson-Crowell and Weibull kinetic models; and the release mechanism was attributed to anomalous transport. Iontophoresis remarkably enhanced the permeation of both drugs, but mainly prilocaine through the mucosa as evidenced by the permeability coefficient parameter (3.0-fold). The amount of these amino amide salts retained in the mucosa were also equally enhanced (4.7-fold), while the application of a tiny constant electric current (1 mA·cm^-2·h^-1) significantly decreased the lag time for lidocaine permeation by about 45%. In view of possible in vitro / in vivo correlations, the buccal iontophoretic patch displays a promising strategy for needle-free and patient-friendly local anesthesia in dentistry.

DentalVibe® versus lignocaine hydrochloride 2% gel in pain reduction during inferior alveolar nerve block in children

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.

Painless injections-a possibility with low level laser therapy

Background

Dental procedures commonly involve the injection of local anesthetic agents, which causes apprehension in patients. The objective of dental practice is to provide painless treatment to the patient. The purpose of this study was to evaluate the effect of Low Level Laser Therapy (LLLT) in reducing the pain due to local anesthetic injection.

Materials and Methods

A prospective, split-mouth study was conducted on 25 patients. In Condition A, LLLT was administered followed by the administration of a standard local anesthetic agent. Patients' perception of pain with use of LLLT was assessed based on a Visual Analogue Scale (VAS). In Condition B, LLLT was directed to the mucosa but not activated, followed by the administration of local anesthesia. VAS was used to assess the pain level without the use of LLLT.

Results

Comparison between Condition A and Condition B was done. A P value < 0.001 was considered significant, indicating a definite statistical difference between the two conditions.

Conclusion

In our study, we observed that LLLT reduced pain during injection of local anesthesia. Further multi-centric studies with a larger sample size and various modifications in the study design are required.

Personalized anesthetic patches for dental applications

Topical anesthetics are widely used in dental procedures. However, most commercially available medications are in the form of liquid or semisolid, which cannot provide prolonged effect intraorally. To address this issue, we proposed the use of three-dimensional printing (3DP) to fabricate a customizable dental anesthetic patch loaded with lidocaine that can be fitted perfectly onto the affected tooth. It has been shown that that patch can adhere on the tooth for more than 1 h, while releasing lidocaine from the patch made of hydrogels. In addition, the results illustrated the possibility of controlling the drug release profile by altering the shape of the patch, as well the use of a 3DP tooth model as the drug testing platform. Taken together, these data further reinforce the vast potential of the application of 3DP technology in personalized medicine.

Comparative evaluation of the efficacy of two anesthetic gels (2% lignocaine and 20% benzocaine) in reducing pain during administration of local anesthesia - A randomized controlled trial

Background and Aims

Topical anesthetic agents are widely used in the field of pediatric dentistry to reduce pain and apprehension during administration of local anesthesia. Various topical anesthetic agents are available, among which the most commonly used ones are lignocaine and benzocaine. Hence we planned this study to compare and evaluate the effectiveness of topical anesthesia on needle insertion pain during administration of inferior alveolar nerve block.

Material and Methods

This double blind clinical study included 30 children of 4-8 years of age who were divided equally into two groups: Group A-2% lignocaine hydrochloride gel (Lox 2%) and Group B-20% benzocaine gel (ProGel-B). The intervention involved assessment of pain perception by the child during administration of inferior alveolar nerve block. The child's pain assessment was done using modified Wong-Baker pain rating scale. The ratings were subjected to statistical analysis.

Results

In Group A, 6.7% (N = 1) showed slight pain, 66.7% (N = 10) showed moderate pain, and 26.7% (N = 4) showed severe pain. In Group B, 46.7% (N = 7) showed no pain, 46% (N = 7) showed slight pain, and 6.7% (N = 1) showed moderate pain on needle insertion. (P value -0.000).

Conclusion

This study demonstrates that there is a highly significant difference between the topical anesthetic effectiveness of 2% lignocaine and 20% benzocaine on needle insertion pain in inferior alveolar nerve block. Twenty percent benzocaine showed better results than 2% lignocaine in reducing the needle insertion pain.

[Survey and analysis of tooth extraction anxiety of dental patients]

OBJECTIVE

This study aims to understand the current status and analyze the influencing factors of tooth extraction anxiety of dental patients.

METHODS

The General Factor Questionnaire and Modified Dental Anxiety Scale (MDAS) were used to survey and analyze tooth extraction anxiety of 800 dental patients. Single-factor and multi-factor analyses were used for statistical data analysis.

RESULTS

A total of 768 qualified questionnaires were received out of 800, the efficiency was 96%. The mean MDAS score was 10.21±3.29. The prevalence percentage of dental anxiety was 14.7%. Significant statistical differences of the incidence of dental anxiety were observed with regard to sex, age, tooth extraction time, accompanying relatives and friends, before tooth extraction, tooth extraction experience for family and friends, pain tolerance, mental health state before tooth extraction, and self-reported oral health status (P<0.05. By contrast, no significant statistical differences in the incidence of dental anxiety were observed with regard to educational level, tooth extraction type, national life experience, profession, and personality (P>0.05). Logistic regression analysis indicated that the risk factors of dental anxiety were sex, accompanying relatives and friends, mental health state before tooth extraction, and self-rated oral health status.

CONCLUSIONS

The prevalence percentage of tooth extraction anxiety is high for dental patients. Gender, age, health satisfaction, tooth extraction time, accompanying relatives and friends, before tooth extraction, tooth extraction experience for family and friends, pain tolerance, mental health state before tooth extraction, and self-reported oral health status are the influencing factors of dental anxiety.

Randomized controlled trial to compare oral analgesic requirements and patient satisfaction in using oral non-steroidal anti-inflammatory drugs versus benzydamine hydrochloride oral rinses after mandibular third molar extraction: a pilot study

Background

Third molar extraction is associated with considerable pain and discomfort, which is mostly managed with oral analgesic medication. We assessed the analgesic effect of benzydamine hydrochloride, a topical analgesic oral rinse, for controlling postoperative pain following third molar extraction.

Methods

A randomized controlled trial was conducted in 40 patients divided into two groups, for extraction of fully erupted third molar. Groups A received benzydamine hydrochloride mouthwash and group B received normal saline gargle with oral ibuprofen and paracetamol. Oral ibuprofen and paracetamol was the rescue analgesic drug in group A. Patients were evaluated on the 3^rd and 7^th post-operative days (POD) for pain using the visual analogue score (VAS), trismus, total number of analgesics consumed, and satisfaction level of patients.

Results

The VAS in groups A and B on POD3 and POD7 was 4.55 ± 2.54 and 3.95 ± 1.8, and 1.2 ± 1.64 and 0.95 ± 1.14, respectively and was statistically insignificant. The number of analgesics consumed in groups A and B on POD3 (5.25 ± 2.22 and 6.05 ± 2.43) was not statistically different from that consumed on POD7 (9.15 ± 5.93 and 10.65 ± 6.46). The p values for trismus on POD3 and POD7 were 0.609 and 0.490, respectively and those for patient satisfaction level on POD3 and POD7 were 0.283 and 0.217, respectively.

Conclusions

Benzydamine hydrochloride oral rinses do not significantly reduce intake of oral analgesics and are inadequate for pain relief following mandibular third molar extraction.

An efficient iodide ion chemosensor and a rewritable dual-channel security display material based on an ion responsive supramolecular gel

The ion stimuli-responsive metallogel PbG could act as a highly selective and sensitive I⁻ sensor and a rewritable dual-channel security display material.

Comparison of efficacy among various topical anesthetics: An approach towards painless injections in periodontal surgery

Background and Aims:

Local anesthetics (LAs) are most commonly used agents in dentistry. They are used to prevent the pain and nociception generated during dental procedures. Since pain associated at the time of injection of LA is uncomfortable, most of the dentists are on pursuit of painless administration of LA injection and use of topical anesthetics prior to the injection has proven effective in reducing anxiety and pain to the patient. The aim of this study is to compare pain responses after application of three types of topical anesthetics with control in the patients referred for periodontal full mouth flap surgery.

Materials and Methods:

A total of 83 patients (42 males and 41 females) participated in the study with age group ranging from 30 to 50 years. The present study is to evaluate the efficacy of three topical anesthetics (Precaine gel, Benzocaine topical paste and Lignocaine spray) before infiltration in altering visual analog scale (VAS) scores of pain during LA injection. The statistical analysis was performed using SPSS version 15.0 software. Repeated analysis of variance was performed to know the effect of each variable and reveal statistical significance.

Results:

Results revealed that Precaine gel had least VAS score compared with other topical anesthetics.

Conclusion:

From the present study, it can be concluded that procaine gel is a better than other topical LA agents, as the number of studies on this subject is rare and clinical results are mixed, further studies are required with a larger sample before its routine application in our field.

Efficacy of lignocaine in gel and spray form during buccal infiltration anesthesia in children: a randomized clinical trial

AIM

To compare the efficacy of 15% lignocaine spray and 8% lignocaine gel as a topical anesthetic, in reducing pain, during buccal infiltration in children.

MATERIALS AND METHODS

Forty-two patients aged between 7 and 12 years requiring restorative procedures/extraction/pulp therapy of primary/ permanent teeth in the maxillary arch, under buccal infiltration anesthesia were selected for the study. The participants were randomly allocated into 2 groups of 21 each. In group A, 8% lignocaine gel and in group B, 15% lignocaine spray was applied prior to buccal infiltration. Pain was assessed using Wong-Baker faces pain rating scale (WBFPRS) and faces legs activity cry and consolability (FLACC) painscale.

RESULTS

Pearson's chi-square test revealed that there was no significant difference in the FLACC scores of the two groups (p = 0.54). Independent t-test demonstrated that there was no significant difference in Wong-Bakers faces pain score between the two agents (p = 0.07).

CONCLUSION

There is no significant difference in the efficacy of 15% lignocaine spray and 8% lignocaine gel as a topical anesthetic in controlling pain during buccal infiltration anesthesia, in children.