An analysis of moderate sedation protocols used in dental specialty programs: a retrospective observational study

Present status and future directions - Mechanisms and management of local anaesthetic failures

Pain control during root canal treatment is of utmost importance for both the patient and the dental practitioner and many studies have investigated ways of overcoming problems with gaining adequate anaesthesia during treatment. The PubMed and Cochrane databases were searched for evidence-based studies regarding local anaesthesia for root canal treatment. Many variables, including premedication, pain during needle insertion, pain on injection, premedication with various types of drugs, volume of anaesthetic solutions, supplemental anaesthetic techniques, and additives to the anaesthetic solutions, may influence pain perception during root canal treatment. Differences between teeth with healthy pulps versus those with irreversible pulpitis should be considered when the effects of variables are interpreted. There are several concerns regarding the methodologies used in studies that have evaluated anaesthesia success rates. There are some conditions that may help to predict a patient's pain during root canal treatment and these conditions could be overcome either by employing methods such as premedication with a non-steroidal anti-inflammatory drug prior to the treatment visit or by using supplementary anaesthetic techniques before or during the treatment. However, authors need to be more careful when reporting details of their studies to reduce concerns regarding their study bias.

Defining Endodontic Residents' Clinical Experiences: A National Survey

Endodontic residency programs across the U.S. vary in the exposure they provide to residents in procedures, protocols, and equipment. Having information on the range of clinical experiences provided in programs would be useful for program directors and for applicants who are seeking the best fit for their residency. The aim of this study was to collect information from residents in U.S. endodontic residency programs about the procedures and equipment they experienced in their programs. In January 2018, a 14-question survey was emailed to all 437 endodontic residents with an email address in the 2016-17 American Association of Endodontists Membership Directory. Survey items asked about the number of endodontic procedures, techniques employed, and products used in residents' programs. A total of 133 endodontic residents responded to all or part of the survey, for a 30% response rate. The majority reported completing 151-250 nonsurgical root canals, 26-50 nonsurgical retreatments, 0-10 surgical retreatments, and 0-10 regenerative endodontic procedures during their residencies. All respondents said they used a surgical operating microscope (SOM), and 82% reported using a multi-file rotary system for nonsurgical procedures. Respondents reported that the main instruments they used were Dentsply Sirona file systems, and the most commonly used obturation technique was warm vertical compaction/condensation, reported by 92% of respondents. These endodontic residents reported being exposed to a variety of procedures, products, and protocols during their residency. Based on information they provided, prospective endodontic residency applicants can expect to use the SOM for treatment, to gain extensive experience in primary nonsurgical endodontic treatment, and to not perform endodontic surgery during their first year of postgraduate training.

Endodontists' Intravenous Sedation-related Attitudes and Professional Behavior: A National Survey

INTRODUCTION

Research shows that a high percentage of endodontic patients are interested in receiving intravenous (IV) sedation. The objectives of this study were to assess endodontists' IV sedation-related education, attitudes, and professional behavior and to explore whether providing versus not offering IV sedation procedures was associated with IV-related education and attitudes and whether background characteristics and education were related with IV sedation attitudes and behavior.

METHODS

Data were collected with an anonymous Web-based survey from 616 members of the American Association of Endodontists (response rate = 29%).

RESULTS

Only 10% of respondents agreed/strongly agreed that they had adequate training in IV sedation. However, 48% agreed/strongly agreed that there was a need for IV sedation in their practice. Although 69% did not offer IV sedation, 26% had another professional provide it, and 4% provided it themselves. These 3 groups of providers differed in the mean quality of their IV sedation-related education (scale from 1-5 with 5 = best education: 1.50 vs 1.62/2.37, P < .001) and the positivity of their attitudes toward IV sedation (2.90 vs 3.50/4.21, P < .001). Although the quality of IV sedation education was not correlated with the graduation year, the more recently respondents had graduated, the more positive they were toward providing education about IV sedation (r = .16, P < .001).

CONCLUSIONS

Most endodontists did not evaluate their IV sedation-related graduate education positively. However, nearly half acknowledged the need for IV sedation in endodontics. The more recently they graduated, the more they agreed that IV sedation-related graduate education was needed but also that staff training and maintenance of equipment would be a problem.

How Can Hypnodontics Manage Severe Gag Reflex for Root Canal Therapy? A Case Report

In endodontics, severe involuntary gagging can have a severe impact on treatment procedure. There are many ways to ease the gag reflex, one of which is hypnosis. A 34-year-old male was referred for root canal treatment of a molar tooth. He had not received any dental treatments for the past nine years due to fear of severe gag reflex. Three hypnotic sessions based upon eye fixation, progressive muscle relaxation and guided imagery techniques were spent for psychosomatic management. The gag reflex was controlled and reduced to a normal level, and the required dental treatments including root canal therapy and restoration were performed successfully. This report shows that hypnosis can control gag reflex for dental treatments.