Determining toothache severity in pediatric patients: A study

Ice versus lidocaine 5% gel for topical anaesthesia of oral mucosa - a randomized cross-over study

BACKGROUND

Topical anaesthesia is important to optimize pain control during dental injection. Our aim was to describe a new simple method for topical anaesthesia of oral mucosa and to compare the effectiveness of ice and lidocaine 5% gel for topical anaesthesia of oral mucosa.

METHODS

A total of 40 patients aged 10.7-19.5 years were included. The side and method of application were both randomized. Heart rate was recorded, and discomfort and pain were evaluated with a visual analogue scale (VAS). A paired t-test was used to compare mean values, a chi² test was used to compare proportions, and a Pearson correlation test was used to examine correlations between variables.

RESULTS

When ice was used, buccal injection VAS pain was rated lower (p = 0.044), and VAS discomfort was rated higher (p = 0.001), in comparison to when lidocaine 5% gel was used. There was no significant difference in relative heart rate change between ice and lidocaine 5% gel at either needle stick or injection. Lidocaine 5% gel produced a relative heart rate reduction after palatal injection (0.99 ± 0.06) while buccal injection produced an increased relative heart rate (1.02 ± 0.08) (p = 0.010). Unpleasant taste was more frequently reported when lidocaine 5% gel was used (p = 0.025). An application time of 1 min was sufficient for both ice and lidocaine 5% gel to achieve pain reduction from needle stick in buccal mucosa.

CONCLUSION

The cheap and readily available described method using ice for topical anaesthesia of oral mucosa before dental injection is an effective alternative to lidocaine 5% gel.

TRIAL REGISTRATION

The European Union Drug Regulating Authorities Clinical Trials Database EudraCT201300530531. Date of registration: February 10th, 2014.

A study on Evaluation of efficacy of bethanechol in the management of chemoradiation-induced xerostomia in oral cancer patients

Objectives:

Squamous cell carcinoma is the most common oral cancer. Radiotherapy with concomitant chemotherapy is an ideal treatment modality largely used for oral cancers, which precipitates many side effects, of which the most challenging and debilitating side effect is xerostomia. This study aimed to evaluate the efficacy of bethanechol in patients with xerostomia following chemoradiation therapy for oral cancer.

Materials and Methods:

Fifty patients with xerostomia postchemoradiation therapy, aged between 30 and 65 years, were selected based on selection criteria. Thirty patients in the study group were administered 25 mg bethanechol three times daily (TDS) and 20 patients in the control group with placebo capsules. The subjective symptoms of oral dryness were periodically evaluated at baseline, at the end of 1^st, 2^nd and 3^rd weeks using a self-reported questionnaire. Salivary analysis such as whole resting saliva and whole stimulated saliva (WSS) volumes, amylase, pH and sodium potassium ratio were evaluated before and 3 weeks after bethanechol and placebo therapy.

Results:

Twenty-four (80%) patients in bethanechol group and only 2 (10%) patients in control group showed subjective improvement in oral dryness at the end of 3^rd week. A significant difference was found between two groups in whole resting and stimulated saliva volume, pH and amylase. However, there was no statistically significant difference in sodium potassium ratio with insignificant adverse effects after 3 weeks of bethanechol therapy.

Conclusions:

25 mg bethanechol (TDS) has shown subjective improvement in oral dryness in 24 (80%) patients with significant improvement in whole resting and WSS volumes, pH and salivary amylase with insignificant adverse effects.

Expression of pain and distress in children during dental extractions through drawings as a projective measure: A clinical study

AIM: To evaluate the efficacy of drawings as a projective measure of pain and distress in children undergoing dental extractions.

METHODS: Children in the age range of 4-13 years with existence of untreatable caries or over-retained primary teeth, indicated for extractions were included. Pain was assessed using one behavioral, faces, legs, activity, cry and consolability (FLACC) scale; and a self report measure; faces pain scale-revised (FPS-R), at two points of time, after completion of local anesthetic administration and after extraction. The general behavior of children was assessed with Wright’s modification of Frankl rating scale. At the end of the session, children were instructed to represent, themselves along with the dentist and their experiences of the dental treatment through drawing. The drawings were scored utilizing Child drawing: Hospital scale (CD: H) manual and correlated with FLACC, FPS-R and Frankl using Pearson correlation test.

RESULTS: A positive correlation, though statistically not significant, was observed between CD: H scores and all other considered parameters (Frankl, FPS-R and FLACC) in the present study.

CONCLUSION: Drawings could not act as surrogate measure of child’s pain; however, they acted as a narrative of his/her experiences and reflection of inner emotions. Hence, drawings can be used as an additional dental armamentarium.

Relationships between pathology and pain severities: a review

The relationships between pathology severity and pain severity are reviewed using the literature available for humans. The aim is to help veterinary radiologists, physicians and pathologists recognise the disorders in which severity of a lesion is likely to be related to the severity of pain or to incipient pain. Specific features or lesions within the following conditions showed a relationship with pain score, which was usually assessed with a visual analogue scale: inflammation; pancreatitis; ileitis; mucositis; fasciitis; synovitis; arthritis; lower back pain; disc herniation; sciatica; scoliosis; myalgia; cancer; arteriosclerosis; skin ulcers; mastalgia; skin and oral neuropathies; endometriosis; hepatopathy and chronic pulp diseases of the teeth. As experience with magnetic resonance imaging grows, there will be further opportunities to look for quantitative relationships in humans between pathology and pain severities. This information will be useful to veterinarians and other people working with animals in evaluating pain in animals in their care.

The language of pain: A short study

Background:

Pain perception is a very controversial topic in child patients. It is affected by various factors such as fear, anxiety, previous experiences, parental factors, and pain threshold. The communication of such pain by the child to the parent is also very confusing with children having rudimentary and developing communication skills. A study to evaluate the pain perception of children and the parental understanding of the children's pain would be helpful in this scenario. The effect on behavior due to pain is also attempted in this particular study.

Materials and Methods:

A cross-sectional study of 100 children aged between 5-13 years accompanied by either parent was performed. Data collection was done with the help of questionnaires, which assessed the parental understanding of the child's pain. Pain perception recording was done with the Visual Analog Scale of Faces (VASOF). The behavior of the child was noted using the Frankl's behavior rating scale. Data was collated and statistical analysis was performed using the SPSS (version 10) software.

Results and conclusion:

The results show that parental factors such as education, work culture, influence parental understanding of pain. VASOF proves to be a reliable tool for pain perception in children. Behavior of the child shows a positive correlation to pain perception.