1
|
Djoric J, Djinic Krasavcevic A, Barac M, Kuzmanovic Pficer J, Brkovic B, Nikolic-Jakoba N. Patient discomfort and intensity of intraseptal anesthesia of computer-controlled articaine/epinephrine delivery for scaling and root planing. Clin Oral Investig 2023; 27:6221-6234. [PMID: 37644233 DOI: 10.1007/s00784-023-05238-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023]
Abstract
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).
Collapse
Affiliation(s)
- Jelica Djoric
- Department of Periodontology and Oral Medicine, School of Dental Medicine, University of Belgrade, Dr Subotica 4, Belgrade, Serbia.
| | - Ana Djinic Krasavcevic
- Department of Periodontology and Oral Medicine, School of Dental Medicine, University of Belgrade, Dr Subotica 4, Belgrade, Serbia
| | - Milena Barac
- Department of Periodontology and Oral Medicine, School of Dental Medicine, University of Belgrade, Dr Subotica 4, Belgrade, Serbia
| | - Jovana Kuzmanovic Pficer
- Department of Medical Statistics and Informatics, School of Dental Medicine, University of Belgrade, Dr Subotica 1, Belgrade, Serbia
| | - Bozidar Brkovic
- Department of Oral Surgery, School of Dental Medicine, University of Belgrade, Dr Subotica 4, Belgrade, Serbia
| | - Natasa Nikolic-Jakoba
- Department of Periodontology and Oral Medicine, School of Dental Medicine, University of Belgrade, Dr Subotica 4, Belgrade, Serbia
| |
Collapse
|
2
|
Santos EC, Huller D, Brigola S, Ferreira MD, Pochapski MT, dos Santos FA. Pain management in periodontal therapy using local anesthetics and other drugs: an integrative review. J Dent Anesth Pain Med 2023; 23:245-256. [PMID: 37841520 PMCID: PMC10567545 DOI: 10.17245/jdapm.2023.23.5.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023] Open
Abstract
Background Surgical and non-surgical periodontal procedures often lead to postoperative pain. Clinicians use pharmacological methods such as anesthetics, anti-inflammatory drugs, and analgesics for relief. However, the multitude of options makes it challenging to select the best approach for routine dental care. Objective This review aimed to describe previous studies regarding the pharmacological management used for pain control during periodontal procedures as well as factors that may interfere with patients' perception of pain. Methods We included studies (period of 2000-2023, whose approach corresponded to the pharmacological protocols used for preoperative, trans-operative, and postoperative pain control in adult patients undergoing surgical and non-surgical periodontal therapy. Results A total of 32 studies were included in the analysis, of which 17 (53%) were related to anesthetic methods and 15 (47%) were related to therapeutic protocols (anti-inflammatory/analgesic agents). These studies predominantly involved nonsurgical periodontal procedures. Studies have reported that factors related to age, type of procedure, and anxiety can influence pain perception; however, only seven of these studies evaluated anxiety. Conclusions Numerous methods for pain control can be applied in periodontal therapy, which are accomplished through anesthetic methods and/or therapeutic protocols. Factors such as anxiety, age, and type of procedure are related to pain perception in patients. Thus, it is the responsibility of dentists to evaluate each clinical situation and define the best protocol to follow based on the literature.
Collapse
Affiliation(s)
| | - Daniela Huller
- Department of Dentistry, Universidade Estadual de Ponta Grossa, Paraná, Brazil
| | - Sabrina Brigola
- Department of Dentistry, Universidade Estadual de Ponta Grossa, Paraná, Brazil
| | | | | | | |
Collapse
|
3
|
Liu Y, Zhang C, Wu J, Yu H, Xie C. Evaluation of the relationship among dental fear, scaling and root planing and periodontal status using periodontitis stages: A retrospective study. J Dent Sci 2022; 17:293-299. [PMID: 35028050 PMCID: PMC8739248 DOI: 10.1016/j.jds.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/01/2021] [Indexed: 12/20/2022] Open
Abstract
Background/purpose Patients with periodontal disease have higher dental fear levels, which may have negative effects on their clinical outcome during scaling and root planing (SRP). The present study used the new classification of periodontitis and validated questionnaires to assess the relationship among dental fear, SRP pain and periodontal status. Materials and methods A total of 120 periodontitis patients were enrolled and staging according to the new classification of periodontitis. SRP was performed, and the visual analog scale (VAS) to assess pain was used with every patient after treatment. Questionnaires, including Corah's Dental Anxiety Scale (DAS), Dental Fear Survey (DFS), and short-form Dental Anxiety Inventory (S-DAI) were implemented from the first attendance and subsequent visits after 6 months. The patients were grouped by DAS scores. The statistical analysis was performed using T-test, chi-square, Pearson and Spearman correlative analysis. Results Compared to pre-SRP treatment, the dental fear level on DFS was decreased in the posttreatment period for all periodontitis stages. There were no statistically significant differences in S-DAI and DAS between pretreatment and posttreatment periods in stage I and II; meanwhile, there were statistically differences in stage III and IV. The correlation among periodontitis stages, VAS and dental fear level was significant. The proportion of high periodontitis stages was increased in high dental fear group. Conclusion SRP can reduce dental fear levels in all periodontitis stages, especially in stage III and IV. Correlations exist among periodontal status, dental fear and SRP pain. High dental fear is associated with poor periodontal status.
Collapse
Affiliation(s)
- Yeungyeung Liu
- Department of Periodontology, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Caimei Zhang
- Department of Endodontics, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Jingyi Wu
- Department of Implantology, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Huimin Yu
- Department of Periodontology, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Chengjie Xie
- Department of Periodontology, Stomatological Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
4
|
Gupta R, Kaur S, Dahiya P, Kumar M. Comparative evaluation of efficacy of EMLA and needleless jet anesthesia in non-surgical periodontal therapy. J Oral Biol Craniofac Res 2018; 8:118-121. [PMID: 29892533 PMCID: PMC5993459 DOI: 10.1016/j.jobcr.2018.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/07/2018] [Accepted: 04/12/2018] [Indexed: 12/27/2022] Open
Abstract
The treatment of periodontitis primarily consists of mechanical debridement carried out by means of thorough scaling and root planing that might sometimes be a painful procedure which requires the administration of some form of local anesthesia. The present study comparatively evaluates the anesthetic effect of three such forms, viz; eutectic mixture of 25 mg/g lignocaine plus 25 mg/g prilocaine (EMLA) and needleless jet anesthesia during SRP. 30 patients with probing depth of 5 mm or more and visual analog scale (VAS) score of ≥30 mm on probing were selected and asked to assess the pain by VAS and verbal rating scale (VRS) during SRP after application of the two agents. The difference between the visual analogue values of control, EMLA and Madajet XL is highly significant (p < 0.001). According to the VRS scores, 6.7% of the subjects in the EMLA group reported no pain, 80% mild pain, and 13.3% moderate pain. In the Madajet XL group, 46.7% reported no pain and 53.3% mild pain. In the control group 100% of the patients reported moderate pain when none of the anesthetic was administered. None reported severe pain. Thus, the data suggest that both anesthetics are able to produce anesthesia of the tissues. The needleless anesthesia was relatively superior in performance to EMLA.
Collapse
Affiliation(s)
| | | | - Parveen Dahiya
- Department of Periodontics, Himachal Institute of Dental Sciences, Paonta Sahib, Himachal Pradesh, India
| | | |
Collapse
|
5
|
Wambier LM, de Geus JL, Boing TF, Chibinski ACR, Wambier DS, Rego RO, Loguercio AD, Reis A. Intrapocket topical anesthetic versus injected anesthetic for pain control during scaling and root planing in adult patients. J Am Dent Assoc 2017; 148:814-824.e2. [DOI: 10.1016/j.adaj.2017.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/17/2017] [Accepted: 06/17/2017] [Indexed: 11/27/2022]
|
6
|
Lee HS. Recent advances in topical anesthesia. J Dent Anesth Pain Med 2016; 16:237-244. [PMID: 28879311 PMCID: PMC5564188 DOI: 10.17245/jdapm.2016.16.4.237] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 11/20/2022] Open
Abstract
Topical anesthetics act on the peripheral nerves and reduce the sensation of pain at the site of application. In dentistry, they are used to control local pain caused by needling, placement of orthodontic bands, the vomiting reflex, oral mucositis, and rubber-dam clamp placement. Traditional topical anesthetics contain lidocaine or benzocaine as active ingredients and are used in the form of solutions, creams, gels, and sprays. Eutectic mixtures of local anesthesia cream, a mixture of various topical anesthetics, has been reported to be more potent than other anesthetics. Recently, new products with modified ingredients and application methods have been introduced into the market. These products may be used for mild pain during periodontal treatment, such as scaling. Dentists should be aware that topical anesthetics, although rare, might induce allergic reactions or side effects as a result of an overdose. Topical anesthetics are useful aids during dental treatment, as they reduce dental phobia, especially in children, by mitigating discomfort and pain.
Collapse
Affiliation(s)
- Hyo-Seol Lee
- Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
| |
Collapse
|
7
|
Antoniazzi RP, Cargnelutti B, Freitas DN, Guimarães MB, Zanatta FB, Feldens CA. Topical intrapocket anesthesia during scaling and root planing: a randomized clinical trial. Braz Dent J 2016; 26:26-32. [PMID: 25672380 DOI: 10.1590/0103-6440201300131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 11/24/2014] [Indexed: 12/18/2022] Open
Abstract
Although the use of injectable anesthesia prior to subgingival scaling and root planing (SRP) reduces pain, many patients report fear and prolonged numbness of adjacent tissues. The aim of the present study was to compare the effects of a eutectic mixture containing 25 mg/g of lidocaine and 25 mg/g of prilocaine, injectable 2% lidocaine, topical 2% benzocaine and a placebo substance on reducing pain during SRP. In this randomized, split-mouth, masked clinical trial, thirty-two patients presenting more than two teeth with probing depth and clinical attachment level ≥ 5 mm in at least 4 sextants were randomly allocated to four groups: EMLA(r); injectable 2% lidocaine; topical 2% benzocaine and placebo. Pain and discomfort were measured using a visual analogue scale (VAS) and verbal scale (VS). Repeated-measures analysis of variance and Poisson regression were used for analysis. Patient satisfaction with the anesthesia was determined at the end of each treatment session. VAS and VS scores did not differ between injectable 2% lidocaine and EMLA (p > 0.05) and both substances showed significantly better pain control compared to 2% benzocaine and placebo (p < 0.05). 93.7% and 81.2% of the individuals were satisfied with the injectable anesthetic and EMLA, respectively (p = 0.158). Dissatisfaction with benzocaine and placebo was approximately 10 times greater than injectable anesthesia (p = 0.001). In conclusion, EMLA showed an equivalent effect on pain control when compared to the injectable anesthesia and performed better than 2% benzocaine in SRP. Thus, EMLA is a viable anesthetic option during scaling and root planning, despite the frequent need for second application.
Collapse
Affiliation(s)
| | - Bruna Cargnelutti
- Dental School, Franciscan University Center, Santa Maria, RS, Brazil
| | - Daniela Napoleão Freitas
- Postgraduate Program in Dentistry, UFSM - Federal University of Santa Maria, Santa Maria, RS, Brazil
| | | | - Fabricio Batistin Zanatta
- Postgraduate Program in Dentistry, UFSM - Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Carlos Alberto Feldens
- Postgraduate Program in Dentistry, ULBRA - Lutheran University of Brazil, Canoas, RS, Brazil
| |
Collapse
|
8
|
Daneshkazemi A, Abrisham SM, Daneshkazemi P, Davoudi A. The efficacy of eutectic mixture of local anesthetics as a topical anesthetic agent used for dental procedures: A brief review. Anesth Essays Res 2016; 10:383-387. [PMID: 27746520 PMCID: PMC5062240 DOI: 10.4103/0259-1162.172342] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Dental pain management is one of the most critical aspects of modern dentistry which might affect patient's quality of life. Several methods are suggested to provide a painless situation for patients. Desensitization of the oral site using topical anesthetics is one of those methods. The improvements of topical anesthetic agents are probably one of the most important advances in dental science in the past 100 years. Most of them are safe and can be applied on oral mucosa with minimal irritation and allergic reactions. At present, these agents are various with different potent and indications. Eutectic mixture of local anesthetics (EMLA) (lidocaine + prilocaine) is a commercial anesthetic agent which has got acceptance among dental clinicians. This article provides a brief review about the efficacy of EMLA as a topical anesthetic agent when used during dental procedures.
Collapse
Affiliation(s)
- Alireza Daneshkazemi
- Department of Operative Dentistry, Social Determinant of Oral Health Research Center, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyyed Mohammad Abrisham
- Department of Prosthodontics, Yazd Dental School, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Pedram Daneshkazemi
- School of Dentistry, Shahid Behesthi University of Medical Sciences, Tehran, Iran
| | - Amin Davoudi
- Dental Students Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
9
|
Dayakar MM, Akbar SM. A randomized placebo-controlled trial to evaluate a novel noninjectable anesthetic gel with thermosetting agent during scaling and root planing in chronic periodontitis patients. Saudi J Anaesth 2016; 10:192-7. [PMID: 27051372 PMCID: PMC4799613 DOI: 10.4103/1658-354x.168823] [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: 11/10/2022] Open
Abstract
Aim: To study the efficacy of a noninjectable anesthetic gel with a thermosetting agent in the reduction of pain during scaling and root planing (SRP) in untreated chronic periodontitis patients. Materials and Methods: This study is a randomized, double-masked, split-mouth, placebo-controlled trial. Thirty patients were enrolled who underwent SRP in a split-mouth (right side/left side) manner. Before commencement of SRP, both quadrants on each side were isolated and had a randomized gel (either placebo or test gel) placed in the periodontal pockets for 30 s. The pain was measured using numerical rating scale (NRS) and verbal rating scale (VRS). Results: The median NRS pain score for the patients treated with the anesthetic test gel was 1 (range: 0-4) as opposed to 5 (range: 3-7) in the placebo treated patients. The mean rank of pain score using NRS in test gel was 16.18 as compared to 44.82 in placebo treated sites. Hence, significant reduction in pain was found in test gel as compared to placebo using NRS (P < 0.001). The VRS showed that the majority of patients reported no pain or mild pain with a median of 1 as compared to placebo treated sites with a median of 2 suggestive of moderate pain. Conclusions: The NRS and VRS pain scores showed that the side treated with anesthetic gel was statistically more effective than the placebo in reducing pain during SRP.
Collapse
Affiliation(s)
- M M Dayakar
- Department of Periodontics, KVG Dental College and Hospital, Sullia, DK, Karnataka, India
| | - S M Akbar
- Department of Periodontics, KVG Dental College and Hospital, Sullia, DK, Karnataka, India
| |
Collapse
|
10
|
Sanz I, Alonso B, Carasol M, Herrera D, Sanz M. Nonsurgical Treatment of Periodontitis. J Evid Based Dent Pract 2012; 12:76-86. [DOI: 10.1016/s1532-3382(12)70019-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|