Effects of Local Anesthetics With Vasoconstrictors on Dental Pulp Blood Flow and Oxygen Tension

Adrenaline dilution in dental local anesthetic: a preliminary study to prevent coring in cartridges

Many patients with underlying medical conditions are treated with local anesthetics in dental clinics. Dental local anesthetic cartridges contain the vasoconstrictor adrenaline, which can affect the cardiovascular system. For this reason, the adrenaline in the cartridge (2% lidocaine + 1:80,000 adrenaline) is sometimes diluted in order to avoid hemodynamic changes in these patients. However, at the same time, considerations have to be made for coring. Coring is a process in which a piece of rubber is scraped off when a needle is inserted into a rubber stopper, and the rubber is mixed with the drug solution. Particles generated during the coring process contaminate local anesthetic solutions. In this study, we closely observed the puncture site of a 33G dental needle inside a cartridge to investigate a safe dilution method that considers coring. The puncture site was located within 1.50 ± 0.08 mm (mean ± SD) of the diameter from the center of the rubber stopper of the cartridge head. Punctures were made with a 0.75-mm outer diameter metal needle outside the 1.50-mm diameter range from the center of the rubber stopper to reduce the overlap between puncture sites and minimize the risk of coring. After discarding half of the cartridge, 2% lidocaine without adrenaline was injected by piercing the end of the rubber stopper at the cartridge head with a 22-27G metal needle (outer diameter approximately 0.4-0.7 mm). This method minimizes the risk of rubber displacement and coring while ensuring a safe and effective dilution process. Providing a safer method for adrenaline dilution reduces the risk of coring and contamination in dental anesthetic cartridges.

Adrenaline in pulp capping treatment of reversible pulpitis

BACKGROUND

The role of epinephrine in the treatment of pulp capping in patients with reversible pulpitis is not clear.

AIM

To explore the role of epinephrine in the treatment of pulp capping in patients with reversible pulpitis.

METHODS

A total of 100 patients with reversible pulpitis who were treated in Anhui Jieshou People's Hospital from January 2020 to December 2021 were included in the study. They were categorized into an observation group (n = 50; treatment with adrenaline) and a control group (n = 50; treatment with zinc oxide eugenol paste). The 24-h postoperative pain, regression time of gingival congestion and redness, clinical efficacy, and incidence of adverse reactions were compared between the groups. Patients were further categorized into the ineffective and effective treatment groups based on clinical efficacy. Logistic multiple regression analysis explored factors affecting the efficacy of pulp capping treatment.

RESULTS

A significant difference in 24-h postoperative pain was observed between the groups (P < 0.05), with a higher proportion of grade I pain noted in the observation group than in the control group (P < 0.01). The regression time of gingival congestion and swelling was lower in the observation group (2.61 ± 1.44 d and 2.73 ± 1.36 d, respectively) than in the control group (3.85 ± 1.47 d and 4.28 ± 1.61 d, respectively) (P < 0.05). The 2-wk postoperative total effective rate was lower in the control group (80.00%) than in the observation group (94.00%) (P < 0.05). The incidence of adverse reactions was not significantly different between the control (14.00%) and observation (12.00%) groups (P > 0.05). The proportion of adrenaline usage was lower (P < 0.05) and that of anaerobic digestion by Streptococcus and Fusobacterium nucleatum was higher in the ineffective treatment group than in the effective treatment group (P < 0.05). Logistic multiple regression analysis revealed adrenaline as a protective factor (P < 0.05) and anaerobic digestion by Streptococcus and F. nucleatum as risk factors for pulp capping in reversible pulpitis (P < 0.05).

CONCLUSION

Adrenaline demonstrated therapeutic efficacy in pulp capping treatment for reversible pulpitis, reducing pain and improving clinical symptoms safely. It is a protective factor for pulp capping, whereas Streptococcus and F. nucleatum are risk factors. Targeted measures can be implemented to improve clinical efficacy.

Micro-Morphological Features of the Er:YAG-Lased Interface in Primary Teeth: 12 Months Randomized Split-Mouth Trial

Despite considerable improvements in oral health, dental caries remains a public health issue. The most frequently used technique to remove caries is through rotating drills. New minimally invasive strategies were introduced into dental practice, such as the use of lasers to perform highly controlled tissue ablation while limiting pain and discomfort, as well as overcoming drill phobia. The objective was to assess and compare treatment with Er:YAG laser versus a conventional rotary treatment during cavity preparation in children with regard to bond interface quality. In a randomized trial using a split-mouth design, 40 (9-12 year-old) children with 80 carious primary molars were included. The cavity in one quadrant was treated conventionally using a bur, while the cavity in the other quadrant was prepared using an Er:YAG laser. Twenty restored teeth were extracted after one year. The SEM histological evaluation of bond interface results demonstrated no statistically significant differences between restorations placed following bur preparation and those placed following the Er:YAG laser preparation, and both treatments demonstrated promising results. Over a one-year period, no statistically significant differences in the bond interface quality were observed following class I cavity preparation in primary teeth with either Er:YAG laser or a conventional rotary bur.