Pain and discomfort levels in patients during root surface debridement with sonic metal or plastic inserts

Patient discomfort and intensity of intraseptal anesthesia of computer-controlled articaine/epinephrine delivery for scaling and root planing

OBJECTIVES

The primary aim was to assess the pain during intraseptal anesthesia (ISA) administration, as well as during and after scaling and root planing (SRP). The secondary aims pertained to comparing the pain in different jaw regions and evaluating the factors affecting pain during ISA administration, during and after SRP.

MATERIAL AND METHODS

ISA was obtained with three different doses of 4% articaine with 1:100,000 epinephrine (4%Ar + Ep) in 360 patients. The pain levels were measured using the visual analogue scales (VAS) for pain intensity during ISA administration (VASa), during SRP (VASi), and after SRP (VASp). These findings were then correlated with periodontal parameters. Regression analysis was performed for pain during ISA, during and after SRP.

RESULTS

Anesthesia administration was painful in 80.8% of cases. VASa negatively correlated with pocket depth (PPD). VASi showed no dose-dependency, except in mandibular premolars. VASi negatively correlated with the clinical attachment level (CAL). VASp positively correlated with PPD and CAL. Positive bleeding on probing reduced the chance of pain during ISA administration. Longer anesthesia duration and wider anesthetic field (orally) increased the prospects of painless SRP.

CONCLUSIONS

No dose-dependent differences were found regarding patient discomfort and pain intensity of ISA delivery of 4%Ar + Ep for SRP.

CLINICAL RELEVANCE

The pain during ISA administration was mild and well tolerated regardless of the anesthetic dose. A lower intensity of pain during SRP can be expected in patients with greater CAL. Post-treatment pain can be anticipated after SRP in the regions with greater PPD and CAL.

CLINICAL TRIALS REGISTRATION NUMBER

NCT04392804 (May 9th, 2020).

Complications and treatment errors in nonsurgical periodontal therapy

Nonsurgical periodontal therapy can be subject to iatrogenesis, which includes all the complications directly or indirectly related to a treatment. These complications include both operator-dependent harms and errors and the consequences and adverse effects of the therapeutic procedures. The complications arising following nonsurgical periodontal treatment can be categorized as intraoperative and postoperative and can affect both soft and hard tissues at an intra-oral and extraoral level. Soft-tissues damage or damage to teeth and restorations can occur while performing the procedure. In the majority of cases, the risk of bleeding associated with nonsurgical therapy is reported to be low and easily controlled by means of local hemostatic measures, even in medicated subjects. Cervicofacial subcutaneous emphysema is not a frequent extraoral intraoperative complication, occurring during the use of air polishing. Moreover, side effects such as pain, fever, and dentine hypersensitivity are frequently reported as a consequence of nonsurgical periodontal therapy and can have a major impact on a patient's perception of the treatment provided. The level of intraoperative pain could be influenced by the types of instruments employed, the characteristics of tips, and the individual level of tolerance of the patient. Unexpected damage to teeth or restorations can also occur as a consequence of procedural errors.

Efficacy of intraseptal anesthesia obtained by computer-controlled articaine with epinephrine delivery in scaling and root planing

OBJECTIVES

The primary aim of this study was to compare the anesthetic efficacy of the intraseptal anesthesia (ISA) obtained with three doses of 4% articaine with 1:100,000 epinephrine (4%Ar + Ep) for scaling and root planing (SRP), using a computer-controlled local anesthetic delivery system (CCLADS). The secondary aims were to compare the clinical anesthetic parameters in relation to different jaw regions and examine the possible influence of sex and smoking habits on them.

MATERIALS AND METHODS

SRP under ISA obtained with different doses (0.1 ml, 0.2 ml, and 0.3 ml) of 4%Ar + Ep was performed in 360 patients. The success rate, onset, duration of soft tissue anesthesia, and the anesthetic field widths were recorded by pinprick testing.

RESULTS

The anesthesia success was high (90-95%). The onset was immediate. The duration and anesthetic field widths showed a dose-related significance, however, without a consistent sex-related or smoking-related significance. The multiple logistic regression analysis revealed a twofold higher chance of anesthesia success by increasing the dose and increased bleeding on probing-related and female sex-reduced probability of anesthesia success.

CONCLUSIONS

ISA obtained with 0.3 ml of 4%Ar + Ep delivered by a computer-controlled local anesthetic delivery system provided a high anesthetic success and the adequate clinical anesthetic parameters for SRP in all regions of both jaws.

CLINICAL RELEVANCE

ISA obtained with 4%Ar + Ep provides an effective anesthesia for SRP. The anesthetic success rate may be reduced in the presence of gingival inflammation and in females as well. The study was registered in a Clinical Trials database (NCT04392804, registration date May 9, 2020).

DIAGNOdent Pen versus tactile sense for detection of subgingival calculus: an in vitro study

The objective of this study is to compare the performance of the DIAGNOdent laser fluorescence (LF) Pen to conventional periodontal probing for detection of subgingival calculus under defined laboratory conditions. Extracted teeth with various levels of subgingival deposits of calculus were mounted anatomically in stone casts, and an impression material was used to replicate periodontal soft tissues. The casts were examined for the presence of subgingival calculus at eight surfaces per tooth (240 sites) using LF and a periodontal probe. Sites were rescored after 1 and 3 weeks. Direct imaging of the root surfaces under magnification was the gold standard. As a result, for an experienced operator, LF was more accurate than tactile assessment (across all sites, 84.0% vs. 59.8%). The performance difference was greater for multi-rooted teeth (85.8% vs. 56.9%) than single-rooted teeth (77.2% vs. 66.7%). The performance of LF in this laboratory trial was influenced strongly by clinician skill and experience. When used by an experienced operator, LF was more sensitive (75.1% vs. 69.2%), specific (92.6% vs. 86.3%), and accurate (84% vs. 77.9%) than for an inexperienced operator. In conclusion, under the defined laboratory conditions used, LF had better performance than tactile examination, particularly for multi-rooted teeth. This method may have value clinically as an adjunct for detecting subgingival deposits of calculus in clinical practice. The usefulness of the method improves with operator experience.

Hemodynamic changes associated with a novel concentration of lidocaine HCl for impacted lower third molar surgery

BACKGROUND

The authors studied the hemodynamic effect influent by using the novel high concentration of lidocaine HCl for surgical removal impacted lower third molar. The objective of this study was to evaluate the hemodynamic change when using different concentrations of lidocaine in impacted lower third molar surgery.

METHODS

Split mouth single blind study comprising 31 healthy patients with a mean age of 23 years (range 19-33 years). Subjects had symmetrically impacted lower third molars as observed on panoramic radiograph. Each participant required 2 surgical interventions by the same surgeon with a 3-week washout period washout period. The participants were alternately assigned one of two types of local anesthetic (left or right) for the first surgery, then the other type of anesthetic for the second surgery. One solution was 4% lidocaine with 1:100,000 epinephrine and the other was 2% lidocaine with 1:100,000 epinephrine. A standard IANB with 1.8 ml volume was used. Any requirement for additional anesthetic and patient pain intra-operation was recorded. Post-operatively, patient was instructed to fill in the patient report form for any adverse effect and local anesthetic preference in terms of intra-operative pain. This form was collected at the seven day follow up appointment.

RESULTS

In the 4% lidocaine group, the heart rate increased during the first minute post-injection (P < 0.05). However, there was no significant change in arterial blood pressure during the operation. In the 2% lidocaine group, there was a significant increase in arterial blood pressure and heart rate in the first minute following injection for every procedure. When the hemodynamic changes in each group were compared, the 4% lidocaine group had significantly lower arterial blood pressure compared to the 2% lidocaine group following injection. Post-operatively, no adverse effects were observed by the operator and patient in either local anesthetic group. Patients reported less pain intra-operation in the 4% lidocaine group compared with the 2% lidocaine group (P < .05).

CONCLUSIONS

Our results suggest that a 4% concentration of lidocaine HCl with 1:100,000 epinephrine has better clinical efficacy than 2% lidocaine HCl with 1:100,000 epinephrine when used for surgical extraction of lower third molars. Neither drug had any clinical adverse effects.

The Prevalence of Root Sensitivity following Periodontal Therapy: A Systematic Review

The reported prevalence of dentine/root (hyper)sensitivity (DH/RS) in the published literature varies, and this may be due in part to a) the different study populations and (b) the different methodologies employed in evaluating the pain response. According to von Troil et al. (2002) there are limited data available in terms of the prevalence and intensity of DH/RS following periodontal therapy. Objectives. The aim of the present study was therefore to review the literature in order to identify all relevant studies for inclusion and to determine whether there was any evidence of DH/RS following periodontal procedures in the published literature up to 31st December 2009 using an agreed search protocol. Methods. 840 papers were identified, from searching both electronic databases (PUBMED) and hand searching of relevant written journals. Twelve papers were subsequently accepted for inclusion. Results. The results of the present study would indicate that the reported prevalence for DH/RS (following nonsurgical therapy) was between 62.5% and 90% one day after treatment decreasing to approximately 52.6% to 55% after one week. The prevalence of DH/RS following surgical therapy was between 76.8% and 80.4% one day after treatment subsequently decreasing over time to 36.8% after 1 week, 33.4% after 2 weeks, 29.6% after 4 weeks, and 21.7% after 8 weeks. Conclusions. It is evident from reviewing the included studies that patients may suffer from mild discomfort following periodontal procedures although both the prevalence and intensity of DH/RS may vary depending on the duration and the type of procedure involved. Most of the studies included in this paper would tend to suggest that DH/RS may be relatively mild/moderate in nature and transient in duration.

Relationship between dental anxiety and pain perception during scaling

Dental pain, anxiety and fear are important factors that prevent patients from seeking dental care. In this study, we aimed to evaluate the pain perception of patients during scaling and its relationship with dental anxiety. One hundred dental patients participated in the study. Pain levels after scaling were assessed with a Visual Analog Scale (VAS) and an Anxiety Questionnaire consisting of seven questions. The mean VAS score for the entire study group was 17.3 ± 13.8 with no statistically significant differences between gender and different age groups. The mean anxiety score was 11.66 ± 4.17. This was significantly higher in women (P = 0.005), but there were no statistically significant differences between different age groups. There was a statistically significant correlation between VAS and total anxiety score (P < 0.001) as well as each question, except for questions number 3 and 4 in men. Patients were found to experience only limited pain during scaling. They were anxious because they expected pain, women being more anxious than men. Hence, dentists should seek to alleviate or reduce pain and anxiety related to treatment not only to successfully complete the treatment, but also to sustain and carry the patients into successful maintenance and patient recall.

Locoregional anesthesia for dental treatment in cardiac patients: a comparative study of 2% plain lidocaine and 2% lidocaine with epinephrine (1:100,000)

OBJECTIVES

This study analyzes hemodynamic changes in patients with cardiac valvular diseases submitted to dental treatment under local anesthesia containing epinephrine.

METHODS

This randomized clinical trial was performed at the Dental Division of the Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Brazil). Patients were separated into two groups with the help of an aleatory number table: 2% plain lidocaine (PL, n= 31) and 2% lidocaine with epinephrine (1:100,000) (LE, n= 28). Blood pressure, heart rate, oxygenation and electrocardiogram data were all recorded throughout the procedure. State and trait anxiety levels were measured.

RESULTS

Fifty-nine patients were selected for the LE group (n=28), with an average age of 40.3 +/- 10.9, or for the PL group (n=31), age 42.2 +/- 10.3. No differences were shown in blood pressure, heart rate and pulse oximetry values before, during and after local anesthesia injection between the two groups. State and trait anxiety levels were not different. Arrhythmias observed before dental anesthesia did not change in shape or magnitude after treatment. Complaints of pain during the dental procedure were more frequent within the PL group, which received a higher amount of local anesthesia.

CONCLUSION

Lidocaine with epinephrine (1:100,000) provided effective local anesthesia. This treatment did not cause an increase in heart rate or blood pressure and did not cause any arrhythmic changes in patients with cardiac valvular diseases.

Pain levels in patients during periodontal probing and mechanical non-surgical therapy

The purpose of this study was to assess the degree of pain during periodontal probing and mechanical non-surgical therapy according to age, gender, and intersubject variation such as tooth type, tooth surfaces or regions of mouth, probing depth, and bleeding on probing. The study was carried out on 64 patients with chronic periodontitis. Pain/discomfort of patients during both periodontal probing and scaling and root planing (SRP) was measured using a visual analog scale (VAS). During periodontal probing and SRP, VAS scores decreased with increasing age for two procedures (Spearman rho, -0.301 and -0.348, respectively; P < 0.01). VAS scores were considerably lower for oral sites than for facial sites. VAS scores in probing were significantly higher in sites > or =4 mm deep than sites <4 mm deep. Sites bleeding on probing had a significantly higher VAS scores than sites no bleeding on probing (p < 0.05). The results showed that although there is no difference between genders, the intensity of pain during periodontal probing and SRP was different dramatically between patients as well as vary between different locations in the same mouth. If pain responses for probing in different several regions in the same mouth during initial examination were noted into patient chart used for initial examination, the therapist will recognize patients with elevated pain responses. If need be, they will then apply some pain control medication or anesthetic for patients during probing and SRP.

A Training Program to Improve the Ability of Periodontal Residents to Estimate Patients' Pain Experience

BACKGROUND

The purpose of this study was to determine whether periodontal residents could enhance their ability to assess the pain levels experienced by their patients from probing, using visual analog scale (VAS) to record pain. We hypothesized that with increasing experience by repeated comparisons of the patients' VAS pain ratings with independent ratings by the residents, they would improve their ability to assess their patients' pain experiences.

METHODS

For each of three periodontal residents, 40 consecutive patients with periodontal disease were asked to express the degree of pain they experienced during the probing. Independently, the residents rated the pain levels they perceived that the patients experienced. Subsequently, the residents compared the two VAS ratings and discussed differences in ratings with the patients. Descriptive statistics and intraclass correlation coefficients were used to analyze the findings.

RESULTS

Differences between patients' and residents' VAS scores gradually became smaller over time for two of the residents. Results for the third resident were less compelling.

CONCLUSIONS

This study indicated that the training program improved the residents' ability to estimate the pain experiences of their patients, at least for two of the three participating residents. This training program, using periodontal probing as a model, could serve as an educational tool for students and practitioners who want to improve their sensitivity to their patients' pain experiences.

Ability of Examiners to Estimate the Pain Experienced by Patients From Probing During Initial Periodontal Examination

BACKGROUND

The aims of the present study were to identify the level of pain experienced by patients from probing during periodontal examination, and to determine to what extent the examining periodontist and the dental assistant could estimate the degree of pain experienced by the patients.

METHODS

For each of three periodontists, 20 patients referred for periodontal diagnosis and treatment were selected. The periodontist carried out his examination, which included probing at six sites per tooth. Following probing, the patients rated the pain using a visual analog scale (VAS). The periodontist and the dental assistant who helped out during the examination independently rated the pain level they perceived that each patient experienced, also using a VAS.

RESULTS

Most patients showed low pain responses to probing. However, using an arbitrary threshold of VAS > or =40 mm to indicate significant pain, some patients had a painful experience. Differences were observed between the pain levels expressed by the three groups of patients. While two of the three periodontists were able to appraise the pain experienced by their patients, the third was not.

CONCLUSIONS

It seems important that the periodontist at the first encounter with the patient should be sensitive to the discomfort the examination may entail. This may influence the patients' decision to accept the required treatment, and may also affect the patients' attitude to and co-operation with the subsequent treatment.

Influence of handling-relevant factors on the behaviour of a novel calculus-detection device

OBJECTIVES

The aim of periodontal therapy is always the complete debridement of root surfaces with the removal of calculus and without damaging cementum. We have recently demonstrated the feasibility of a surface recognition device that discriminates dental surfaces by mathematical analysis of reflected ultrasound waves. This principle should enable the construction of calculus detecting ultrasonic device. Pre-clinical test results are presented here.

MATERIAL AND METHODS

An impulse generator, coupled to a conventional piezo-driven ultrasonic scaler, sends signals to the cementum via the tip of an ultrasound device. The oscillation signal reflected from the surface contains the information necessary to analyse its characteristics. In order to discriminate different surfaces, learning sets were generated from 70 extracted teeth using standardized tip angle/lateral force combinations. The complete device was then used to classify root surfaces unknown to the system.

RESULTS

About 80% of enamel and cementum was correctly identified in vivo (sensitivity: 75%, specificity: 82%). The surface discrimination method was not influenced by the application conditions examined. A new set of 200 tests on 10 teeth was correctly recognized in 82% of the cases (sensitivity: 87%, specificity: 76%).

CONCLUSIONS

It was shown in vitro that the tooth surface recognition system is able to function correctly, independent of the lateral forces and the tip angle of the instrument.

Pain Experienced by Patients During Periodontal Maintenance

BACKGROUND

The aims of this study were to determine: 1) the degree of pain experienced by patients during probing and debridement; 2) whether the treating hygienists could estimate the degree of pain experienced by the patients; and 3) whether the patients' pain responses could be predicted by factors such as the patients' age, gender, number of residual periodontal lesions, and answers to a questionnaire on dental anxiety.

METHODS

Prior to periodontal maintenance procedures, two groups of 20 adult patients to be treated by two hygienists completed an anxiety questionnaire. Subsequently, measurements of probing depths were performed, followed by pain ratings by each patient using a visual analog scale (VAS). The hygienists also completed a VAS, estimating the pain level they perceived their patient to have experienced. The same protocol was repeated for instrumentation (debridement).

RESULTS

Most patients showed low pain responses to both probing and instrumentation. However, using an arbitrary threshold of VAS > or = 40 mm, 20% to 33% of the patients had a significant pain experience. The hygienists were quite accurate in their relative estimates of their patients' pain experiences. Regression analyses disclosed that significant portions of the pain responses could be predicted by the patients' answers to one of the dental anxiety questions.

CONCLUSIONS

Recognition of patients who are likely to experience significant pain during periodontal treatment may be facilitated by the use of one question on dental anxiety. During treatment, the ability to gauge and respond to patients' pain experiences would seem to be an important component of a therapist's clinical skills.

A systematic review of the prevalence of root sensitivity following periodontal therapy

OBJECTIVES

To systematically review the evidence on the prevalence of root sensitivity following periodontal therapy.

MATERIAL AND METHODS

Cross-sectional and longitudinal clinical studies were searched for in electronic databases, hand searched journals and through contact with authors directly. The screening and data extraction were conducted by several reviewers independently. The main outcome measure was prevalence of root sensitivity following periodontal therapy.

RESULTS

The prevalence of root sensitivity was 9-23% before and 54-55% after periodontal therapy. An increase in the intensity of root sensitivity occurred 1-3 weeks following therapy, after which it decreased.

CONCLUSIONS

It is concluded that there are insufficient randomized controlled trials to adequately address the stipulated question. However, based on the scarce evidence from only two studies, root sensitivity occurs in approximately half of the patients following subgingival scaling and root planing. The intensity of root sensitivity increases for a few weeks after therapy, after which it decreases. In clinical practice, it may be recommended that patients should be made aware of the potential for root sensitivity prior to treatment. In research, it may be recommended to conduct randomized controlled and prospective studies with both short and long follow-up periods. Furthermore, to investigate the effects and the relationship of root instrumentation with the aetiology of root sensitivity, the efficacy of preventive and therapeutic regimes for root sensitivity, and the incidence and severity of root sensitivity by subjective patient-reporting, and the response to different modes of stimuli. Protocols should follow the criteria used in dentine hypersensitivity studies.

Clinical significance of non-surgical periodontal therapy: an evidence-based perspective of scaling and root planing

Analysis of Egyptian hieroglyphics and medical papyri indicate that non-surgical periodontal treatment was common 3000-4000 years ago. Even today, scaling and root planing (SRP) remains an essential part of successful periodontal therapy. The collective evidence from numerous clinical trials reveals a consistency of clinical response in the treatment of chronic periodontitis by SRP using manual, sonic, or ultrasonic instrumentation. Thus, SRP remains the 'gold standard' to which more recently developed therapeutic modalities must be compared. Inherent to the clinical evaluation of SRP are such concerns as manual versus sonic and ultrasonic instrumentation, control of sub-gingival bacterial populations, removal of calculus, root smoothness and changes in various clinical parameters, e.g. probing depth, attachment levels, bleeding on probing and gingival inflammation. Lastly, an abbreviated discussion is presented on a relatively new paradigm of complete mouth 'disinfection' in a compressed time-frame that includes SRP as a significant component of the treatment regimen.

Pain experienced by patients during periodontal maintenance treatment

BACKGROUND

The aims of this study were to assess the degree of pain experienced by patients during probing and debridement and to determine whether the pain responses could be predicted by the patient's age, gender, percentage of sites > or = 4 mm deep, and responses to a questionnaire on dental anxiety.

METHODS

Prior to the maintenance procedures, 26 adult patients completed an anxiety questionnaire. Subsequently, measurements of probing depths were performed. The patients activated a tallying device at each probe entry that evoked pain (pain frequency). Pain levels for each quadrant were also assessed with a visual analog scale (VAS). Following probing, the same protocol was repeated during instrumentation (debridement).

RESULTS

Most patients showed low pain responses to both probing and instrumentation as evaluated by both methods of measurement. However, using arbitrary thresholds of pain frequency > or = 50% and VAS > or = 40 mm, approximately 15% of the patients had a painful experience. Stepwise multiple regression analyses disclosed that significant portions of the pain levels could be predicted by gender and the patients' answers to 2 of the dental anxiety questions.

CONCLUSIONS

Recognition of patients who are likely to experience pain during periodontal treatment can be facilitated by the use of 2 questions on dental anxiety and the VAS response to probing during examination.

Position paper: sonic and ultrasonic scalers in periodontics. Research, Science and Therapy Committee of the American Academy of Periodontology

Ultrasonic and sonic scalers appear to attain similar results as hand instruments for removing plaque, calculus, and endotoxin. Ultrasonic scalers used at medium power seem to produce less root surface damage than hand or sonic scalers. Due to instrument width, furcations may be more accessible using ultrasonic or sonic scalers than manual scalers. It is not clear whether root surface roughness is more or less pronounced following power-driven scalers or manual scalers. It is also unclear if root surface roughness affects long-term wound healing. Periodontal scaling and root planing includes thorough calculus removal, but complete cementum removal should not be a goal of periodontal therapy. Studies have established that endotoxin is weakly adsorbed to the root surface, and can be easily removed with light, overlapping strokes with an ultrasonic scaler. A significant disadvantage of power-driven scalers is the production of contaminated aerosols. Because ultrasonics and sonics produce aerosols, additional care is required to achieve and maintain good infection control when incorporating these instrumentation techniques into dental practice. Preliminary evidence suggests that the addition of certain antimicrobials to the lavage during ultrasonic instrumentation may be of minimal clinical benefit. However, more randomized controlled clinical trials need to be conducted over longer periods of time to better understand the long-term benefits of ultrasonic and sonic debridement.

Cardiovascular responses in patients and dentists during dental treatment

Changes in mean heart rate and in mean systolic and diastolic blood pressure are induced by both the patient's anticipation of scheduled treatment and the actual dental treatment. Most of these changes are within the normal physiological variations, but significant changes are observed before administration of a local anaesthetic, during subgingival debridement and during extractions. Individual changes in heart rate and blood pressure are affected by age, gender, hypertension and previous dental experience. Pain also plays an important role in the cardiovascular response during dental treatment, which stresses the need for adequate analgesia. For this purpose, local anaesthetics with low concentrations of epinephrine seem preferable. They induce less pronounced cardiovascular responses than local anaesthetics with higher concentrations of epinephrine or without epinephrine. The changes in heart rate and blood pressure that occur in the dentist during the treatment are also discussed.

Cardiovascular changes during subgingival debridement

During dental hygiene sessions, systolic and diastolic blood pressure and heart frequency were registered continuously with a finger manometer to investigate the possible cardiovascular effects of root planing/scaling. Ultrasonic subgingival debridement was performed for an average period of 10.6 +/- 2.1 min. Analysis of variance showed significant changes of systolic and diastolic blood pressure, heart rate and the rate pressure product during debridement. The increases in systolic and diastolic blood pressure both correlated significantly with the length of the debridement. After completion of the dental hygiene session, the urinary excretion of adrenaline was increased. The data from this study suggest that painful stimuli during ultrasonic subgingival debridement have extensive cardiovascular effects.

Cardiovascular responses induced by dental treatment

Changes in mean heart rate and mean systolic and diastolic blood pressure are induced in both the patient's anticipation of scheduled treatment and the actual dental treatment itself. Significant changes have been observed before application of a local anesthetic, during restorative treatment, during extractions, and when epinephrine-impregnated retraction cords were used. These cardiovascular responses may vary according to the local anesthetic used and the choice of vasoconstrictor. The individual changes in heart rate and blood pressure are affected by pain and such individual factors as age, gender, hypertension, dental experience, and psychological responses. Although for the most part the cardiovascular changes induced by dental treatment are limited and within the normal physiological variation, this review stresses the importance of eliminating pain and minimizing patient anxiety.

The effect of electronic dental analgesia during sonic scaling

The aim of the present study was to investigate the effects of electronic dental analgesia (EDA) during sonic scaling. The clinical trial included 30 healthy adult subjects and was conducted as a randomised single-blind split-mouth design. The applied procedure consisted of periodontal scaling by means of a sonic scaler, while using the EDA device either in an active or placebo state. Rather similar results were obtained for the subjective pain rating in both the active and the placebo trials. When patients rated their discomfort on a scale 0-4 from no pain to very severe pain, the mean (s.d.) score for both the EDA and the placebo was 1.2 (0.6). The subjective pain estimate was positively correlated to the electrical current intensity provided. This implied that with a stronger pain experience, patients tried to administer more anaesthesia by turning the dial of the control box to an increased intensity of the electrical current. This remained insufficient to eliminate pain sensation. It was concluded that application of electronic dental anaesthesia in periodontal treatment remains questionable.