Injection pain and postinjection pain of the palatal-anterior superior alveolar injection, administered with the Wand Plus® system, comparing 2% lidocaine with 1:100,000 epinephrine to 3% mepivacaine

Hypnosis and Local Anesthesia for Dental Pain Relief-Alternative or Adjunct Therapy?-A Randomized, Clinical-Experimental Crossover Study

This prospective randomized clinical crossover trial was designed to compare hypnosis and local anesthesia for experimental dental pain relief. Pain thresholds of the dental pulp were determined. A targeted standardized pain stimulus was applied and rated on the Visual Analogue Scale (0-10). The pain threshold was lower under hypnosis (58.3 ± 17.3, p < .001), maximal (80.0) under local anesthesia. The pain stimulus was scored higher under hypnosis (3.9 ± 3.8) than with local anesthesia (0.0, p < .001). Local anesthesia was superior to hypnosis and is a safe and effective method for pain relief in dentistry. Hypnosis seems to produce similar effects observed under sedation. It can be used in addition to local anesthesia and in individual cases as an alternative for pain control in dentistry.

Effect of Three Different Injection Sites on the Success of Anterior Middle Superior Alveolar Nerve Block with 3% Mepivacaine: A Randomized Controlled Trial

AIM

Anterior middle superior alveolar (AMSA) nerve block injection targets the anterior superior alveolar nerve and the middle superior alveolar nerve branches of the infraorbital nerve through nutrient canals. Therefore, the central incisor to the second premolar teeth of one quadrant can be anesthetized. The aim of the present study was to evaluate the efficacy of AMSA nerve block injection with 3% mepivacaine solution at three different injection sites.

MATERIALS AND METHODS

In a double-blind crossover study, 47 volunteers participated and three AMSA nerve block injections of 3% mepivacaine solution without epinephrine were administered at the anterior, posterior, and the most common injection sites with a 1-week interval between injections. Anesthesia of the central incisor to the second premolar of the injected side was evaluated by using an electric pulp tester. The success of the injection was considered as lack of response to two consecutive 80 readings. The generalized estimating equation analytic tests were administered (α = 0.05).

RESULTS

The success rate of the AMSA nerve block injection ranged from 27.5-47.5% for the most common injection site and 22.5-42.5% for both the anterior and posterior injection sites.

CONCLUSION

Changing the injection site did not result in statistically significant improvements (p > 0.05).

CLINICAL SIGNIFICANCE

Changing the injection site anteropos-teriorly did not influence the success rate of the AMSA nerve block injection.

The Effect of 2 Injection Speeds on Local Anesthetic Discomfort During Inferior Alveolar Nerve Blocks

This randomized double-blind crossover trial investigated the discomfort associated with 2 injection speeds, low (60 seconds) and slow (100 seconds), during inferior alveolar nerve block by using 1.8 mL of 2% lidocaine with 1 : 100,000 epinephrine. Three phases were considered: (a) mucosa perforation, (b) needle insertion, and (c) solution injection. Thirty-two healthy adult volunteers needing bilateral inferior alveolar nerve blocks at least 1 week apart were enrolled in the present study. The anesthetic procedure discomfort was recorded by volunteers on a 10-cm visual analog scale in each phase for both injection speeds. Comparison between the 2 anesthesia speeds in each phase was performed by paired t test. Results showed no statistically significant difference between injection speeds regarding perforation (P = .1016), needle placement (P = .0584), or speed injection (P = .1806). The discomfort in all phases was considered low. We concluded that the 2 injection speeds tested did not affect the volunteers' pain perception during inferior alveolar nerve blocks.

Efficacy and safety of mepivacaine compared with lidocaine in local anaesthesia in dentistry: a meta-analysis of randomised controlled trials

The objective of the study was to assess the efficacy and safety of mepivacaine compared with lidocaine used in local anaesthesia in dentistry. Medline, Cochrane Central Register of Controlled Trials, EMBASE, Chinese BioMedical Literature Database, China National Knowledge Infrastructure and WHO International Clinical Trials Registry Platform were searched electronically. Relevant journals and references of studies included were hand-searched for randomised controlled trials comparing mepivacaine with lidocaine in terms of efficacy and safety. Twenty-eight studies were included, of which 15 had low risk of bias and 13 had moderate risk of bias. In comparison with 2% lidocaine with 1:100,000 adrenaline, 3% mepivacaine showed a lower success rate (P = 0.05), a shorter onset time of pulpal anaesthesia (P = 0.0005), inferior pain control during injection phase and superior inhibition of heart rate increase (P < 0.0001). In contrast, 2% mepivacaine with 1:100,000 adrenaline gave a higher success rate (P < 0.00001), a similar onset time of pulpal anaesthesia (P = 0.34) and superior pain control during injection phase (P < 0.0001); 2% mepivacaine with 1:20,000 levonordefrin had the same success rate (P = 0.69) and similar onset time of pulpal anaesthesia (P = 0.90). In addition, 3% mepivacaine had shorter onset time (P = 0.004), same level of success rate (P = 0.28) and similar pain control during injection and postinjection compared with 2% lidocaine with 1:50,000 adrenaline. Given the efficacy and safety of the two solutions, 2% mepivacaine with vasoconstrictors is better than 2% lidocaine with vasoconstrictors in dental treatment. Meanwhile, 3% plain mepivacaine is better for patients with cardiac diseases.

Dentists' perceptions of a new local anaesthetic drug--articaine

BACKGROUND

Articaine is a new local anaesthetic drug introduced to the Australian dental market. The aim of this study was to elicit information regarding the use of articaine in Australia, and factors that influence attitudes towards adoption of new technology.

METHODS

A self-administered postal questionnaire was sent to a stratified systematic sample of dentists who were members of the Australian Dental Association, with questions regarding details about articaine use and how influences such as education and scientific literature affect their adoption of new technology.

RESULTS

Of the sample, 53% responded and over 70% of dentists surveyed used articaine, with 95% and 97% of respondents identifying scientific literature and continuing professional development courses respectively as influencing factors in their adoption of new technology. The most common reason for not using articaine was no perceived advantage and the most influential factor that would encourage non-users to start using articaine was a scientifically proven advantage. Senior clinicians, specialists and public sector dentists were less likely to use articaine.

CONCLUSIONS

A majority of Australian dentists were using articaine and cited continuing professional development courses, scientific literature and anecdotal peer reports as being influential in their adoption of new technology.

The pulpal anesthetic efficacy of articaine versus lidocaine in dentistry: a meta-analysis

BACKGROUND

The authors evaluated published evidence from controlled clinical trials regarding the efficacy of two local anesthetic solutions in providing successful pulpal anesthesia.

METHODS

The authors searched MEDLINE and Embase databases to identify peer-reviewed randomized controlled trials in which researchers directly compared articaine and lidocaine local anesthetic solutions in adult participants. They extracted study characteristics and outcomes data as a basis for meta-analysis. They completed subgroup analyses for both infiltration and mandibular inferior alveolar block anesthetic techniques.

RESULTS

Articaine solutions had a probability of achieving anesthetic success superior to that of lidocaine, with an odds ratio of 2.44 (95 percent confidence interval [CI], 1.59-3.76; P < .0001). The greater odds ratio for articaine increased to 3.81 (95 percent CI, 2.71-5.36; P < .00001) when the authors analyzed only infiltration data. There was weaker, but still significant, evidence of articaine's being superior to lidocaine for mandibular block anesthesia, with an odds ratio of 1.57 (95 percent CI, 1.12-2.21; P = .009), and no difference when the authors considered only symptomatic teeth.

CLINICAL IMPLICATIONS

Research evidence supports using articaine versus lidocaine for achieving pulpal anesthesia when the infiltration mode of administration is used. It is premature to recommend articaine for mandibular block anesthesia in cases involving irreversible pulpitis.

Administration of anesthetics using metal syringes. An ex vivo study

The aim of the present study was to assess injection flow rates of metal syringes, with an emphasis on injection speed and the generation of flow pulsations. A cohort of 64 operators (32 practitioners and 32 students) performed 3 consecutive ex vivo simulated injections (SIs) of 1.8-mL cartridges of anesthetic solution. Two needle diameters were tested (27-gauge and 30-gauge). Each SI was filmed and analyzed using a computer. In most cases, the SI lasted longer than 60 seconds with the 30-gauge needle (75%) but not with the 27-gauge needle (47.9%) (P < .0001). Practitioners and men delivered a full cartridge significantly faster than students and women, respectively (P  =  .0007 in both cases). All operators generated 1 pulse in at least 1 of the 3 SIs with both types of needles, especially during the first 3 seconds (254/384; 66.1%). Pulses occurred more frequently with practitioners (P  =  .0176) and with the 27-gauge needle (P  =  .005). Within its methodological limits, the present study showed how difficult it is to control injection pressure when using a metal syringe, especially at the beginning of the injection. Computerized systems may help overcome this problem.

Advanced techniques and armamentarium for dental local anesthesia

Computer-controlled local anesthetic delivery (C-CLAD) devices and systems for intraosseous (IO) injection are important additions to the dental anesthesia armamentarium. C-CLAD using slow infusion rates can significantly reduce the discomfort of local anesthetic infusion, especially in palatal tissues, and facilitate palatal approaches to pulpal nerve block that find special use in cosmetic dentistry, periodontal therapy, and pediatric dentistry. Anesthesia of single teeth can be obtained using either C-CLAD intraligamentary injections or IO injections. Supplementary IO anesthesia is particularly suited for providing effective pain control of teeth diagnosed with irreversible pulpitis.

Pain perception during inferior alveolar injection administered with the Wand or conventional syringe

OBJECTIVE

This study compared a computerised device (the Wand) with a conventional syringe in terms of the pain of needle insertion and injection during inferior alveolar nerve (IAN) block injection.

METHODS AND MATERIALS

The subjects were 40 patients between the ages of 18 and 30 years requiring local anaesthesia for dental restoration in the mandible. Before anaesthetic administration, the patients' anxiety levels were determined. Contralateral IAN injections were administrated at two separate appointments with random use of either the Wand or a conventional syringe. Following the injection, the patients used both the pain rating score (PRS) and a visual analogue scale (VAS) to assess the intensity of pain.

RESULTS

When pain was measured after the injection, the Wand was found to be less painful than the syringe for the pain of both needle insertion and injection (p <0.05).

CONCLUSION

The Wand technique resulted in significantly lower pain scores during the IAN block injections. Most of the patients preferred the IAN injection with the Wand for future dental injections.

Injection pain of the inferior alveolar nerve block in patients with irreversible pulpitis

OBJECTIVE

The purpose of this retrospective analysis was to determine the pain associated with needle insertion, placement, and solution deposition for the conventional inferior alveolar nerve (IAN) block in patients with irreversible pulpitis.

STUDY DESIGN

One hundred two emergency patients with irreversible pulpitis received IAN block injections using 2% lidocaine with 1:100,000 epinephrine. The patients recorded pain of the 3 injection stages on a Heft-Parker visual analog scale (VAS).

RESULTS

Moderate-to-severe pain may occur 57% to 89% of the time with the IAN block. Needle placement was significantly more painful than needle insertion for men and significantly more painful than either insertion or deposition for women (P < .03). There was no statistical difference between the pain for men or women with respect to needle insertion, placement, or deposition pain (P > .05). Deposition of 0.2 to 0.4 mL anesthetic during placement did not significantly reduce placement pain for either gender (P = .753).

CONCLUSION

In conclusion, 57% to 89% of patients presenting with irreversible pulpitis have the potential for moderate to severe pain with the IAN block.

The Effects of a 2-Stage Injection Technique on Inferior Alveolar Nerve Block Injection Pain

The purpose of this prospective, randomized, single-blinded, crossover study was to compare the pain of a traditional 1-stage inferior alveolar nerve (IAN) block injection to a 2-stage IAN block technique. Using a crossover design, 51 subjects randomly received, in a single-blinded manner, either the traditional IAN block or the 2-stage IAN block in 2 appointments spaced at least 1 week apart. For the 2-stage injection, the needle was inserted submucosally and 0.4 mL of 2% lidocaine with epinephrine was slowly given over 1 minute. After 5 minutes, the needle was reinserted and advanced to the target site (needle placement), and 1.8 mL of 2% lidocaine with epinephrine was deposited. For the traditional IAN block, following needle penetration, the needle was advanced while depositing 0.4 mL of 2% lidocaine with epinephrine (needle placement) and then 1.8 mL of 2% lidocaine with epinephrine was deposited at the target site. A Heft-Parker visual analogue scale was used to measure the pain of needle insertion, needle placement, and anesthetic solution deposition. There were no significant differences, as analyzed by Wilcoxon matched-pairs signed-ranks test, between needle insertion and solution deposition for the 2 techniques in men or women. However, there was significantly less pain with the 2-stage injection for needle placement in women. In conclusion, the 2-stage injection significantly reduced the pain of needle placement for women when compared to the traditional IAN technique.

Assessment of a palatal approach-anterior superior alveolar (P-ASA) nerve block with the Wand in paediatric dental patients

OBJECTIVES

The purposes of the study were to compare the reaction of children while receiving local anaesthesia for anaesthetizing maxillary incisors with a computerized device Wand: a periodontal ligament injection (PDLi) and a palatal approach-anterior superior alveolar (P-ASA) nerve block compared with a conventional buccal infiltration (CBi), and to assess the efficacy of the anaesthesia and children's reaction after treatment.

METHODS

One hundred and thirty-eight children aged 24-48 months participated in this study.

RESULTS

More children reacted negatively during injection while receiving the CBi and positively during the injection with the Wand. After treatment, significantly more children scratched the upper lip and/or the nose or complained of numbness of the region after the CBi (P = 0.000).

CONCLUSIONS

Same effectiveness was achieved with the Wand and the CBi. Children displayed better behaviour during injection when they received local anaesthesia with the WanD than they did when the CBi was used. They did not scratch the upper lip/nose and/or cried after treatment when they received the PDLi and the P-ASA, whereas they did when receiving a CBi.