The language of pain: A short study

Is it possible to extract primary maxillary molars without palatal injection?: a controlled clinical trial

OBJECTIVES

The absolute necessity of a palatal injection for the extraction of primary maxillary molars has never been explored, despite the fact that it is widely known that children do not tolerate local anesthetic injections into the palatal tissue well. The aim of this study was to compare separately the perception of pain in the absence of palatal injection after anesthesia and maxillary primary molar tooth extraction using different anesthetic solutions and different post-anesthetic waiting times.

MATERIALS AND METHODS

A single-blinded randomized controlled study was conducted in 78 participants (26 patients with palatal anesthesia (the control groups), and 26 patients with 5 min and 26 patients with 8 min post-anesthetic waiting time without palatal anesthesia (the study groups)). Subjective experiences of pain were evaluated separately after anesthesia and tooth extraction using the Visual Analog Scale (VAS) and the Wong-Baker Faces Pain Rating Scale (WBS).

RESULTS

In terms of VAS scores obtained following administration of anesthesia, there was a statistically significant difference between the groups (p<0.05). VAS pain scores were reported to be lower in the groups without palatal anesthesia than in the groups with palatal anesthesia. No statistically significant difference was observed in VAS and Wong-Baker scores after tooth extraction between the groups with and without palatal anesthesia (P>0.05).

CONCLUSIONS

While the pain reported following administration of anesthesia was found to be higher in the groups receiving palatal anesthesia, no difference was found between the groups in the pain reported after tooth extraction.

CLINICAL RELEVANCE

Extraction of maxillary primary molars is possible without palatal injection by injecting 4% articaine or 2% lidocaine into the buccal vestibule of the tooth with a waiting time of 5 or 8 min.

Assessment of pain in paediatric dental patients during administration of local anesthesia with and without the use of audiovisual distraction

Background

Infants and children who experience pain in early life, show long-term changes in terms of pain perception and related behaviors. Local anesthesia is integral to the practice of painless dentistry but the pain of injection itself is deterrent to successful administration of local anesthesia and can be a most anxiety-provoking procedure. Distraction as a behavior management technique is successfully known to reduce pain and manage children's dental behavior by diverting their attention away from painful stimuli during invasive dental procedure. This study aimed to compare the pain associated with local anesthetic injection delivered with and without the use of distraction as a behavior management technique in 6-8-year-old children.

Materials and Methods

In this randomized, clinical, in vivo study with a split-mouth design we compared the pain of 30 children (6-8-year-old), requiring dental treatment necessitating the use of local anesthesia bilaterally in either of their maxillary and mandibular arches. Treatment was done in two visits, 1 week apart. Children were randomly assigned to receive the distraction (iPad) at one visit while no distraction in other visits. Two different pain assessment scales were used: Wong-Baker faces pain scale (FPS) and FPS-Revised. The Chi-square test was used for statistical analysis. P ≤ 0.05 was considered to be statistical significance.

Results

Children who received local anesthesia with audiovisual distraction had lower pain rating scores than those who received local anesthesia with no distraction.

Conclusion

Audiovisual distraction significantly reduces pain associated with injection of local anesthesia.

Comparative Evaluation of Fixed Functional Cantilever Space Maintainer and Fixed Nonfunctional Space Maintainer: A Randomized Controlled Trial

Background and objectives

Effective way to prevent mesial drift after the early loss of primary first molars is by inserting a durable space maintainer. Several space maintainers are available; fixed nonfunctional (FNF) space maintainer (crown and loop) is commonly used when abutment teeth need full-coronal restoration. Disadvantages of crown and loop space maintainer are nonfunctional, nonesthetic, and fracture of solder loop. To overcome this drawback, new design of fixed functional cantilever (FFC) space maintainer (crown and pontic) using bis-acrly composite resin. The study evaluated the longevity and acceptance of an FFC and compared it with a FNF space maintainer.

Materials and methods

A total of 20 healthy children, aged 6-9 years, were selected having bilateral premature loss of lower deciduous first molars. FFC space maintainer in one quadrant and FNF space maintainer in the other was cemented. The subject's acceptance of treatment was checked using a visual analog scale after the treatment completion. Criteria for complication leading to the failure was assessed in both the designs in the 3rd, 6th, and 9th month. Cumulative success longevity was obtained at a 9 month evaluation.

Results

Patient acceptability was greater in group I (FFC) in comparison to group II (FNF). In group I, fracture of the crown and pontic was the common complication leading to failure, followed by attrition of the crown and loss of material due to abrasion. In group II, fracture of the solder joint was the common complication leading to failure, followed by slippage of the loop gingivally and cement loss. The longevity of groups I and II were 70 and 85%, respectively.

Conclusion

FFC can be considered a viable alternative to conventional FNF space maintainers.

How to cite this article

Sathyaprasad S, Krishnareddy MG, Vinod V, et al. Comparative Evaluation of Fixed Functional Cantilever Space Maintainer and Fixed Nonfunctional Space Maintainer: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2022;15(6):750-760.

Impact of hydroxyurea on hospital stay & analgesic utilization in sickle cell anaemia with vaso-occlusive crises

Background & objectives

Hydroxyurea (HU) has been useful in preventing sickle cell vaso-occlusive crises (VOC). A few studies also suggest utility of HU, during acute VOC. Sickle cell anaemia (SCA) is of high prevalence in western districts of Odisha State, India, and VOC is a common presentation, despite being mostly of Arab-Indian haplotype. This study was undertaken to evaluate the impact of HU on hospital stay and analgesic utilization in acute painful VOC of SCA.

Methods

Homozygous sickle cell disease (HbSS) patients were categorized as cases who were receiving low-dose HU (10 mg/kg/day) and patients who were not on HU were considered as control. Days of hospital stay, analgesic utilization and visual analogue scale (VAS) score in patients were compared with that of control. Analgesics used to control pain were tramadol hydrochloride, ketorolac and diclofenac.

Results

A total of 359 homozygous sickle cell disease (SCD) patients with VOC were studied (187 patients and 172 controls). The patient group had lesser mean days of hospital stay (1.4 days less than controls, P<0.001) and required lesser days of analgesic utilization than controls (1.18 days less than controls, P<0.001). Significant differences were observed between patients and controls concerning VAS score and amount of tramadol hydrochloride, ketorolac and diclofenac utilization (P<0.05).

Interpretation & conclusions

In this study, HU was found to have beneficial effects in acute VOC of homozygous SCD, which includes shortening the duration of hospital stay and reducing the net amount of analgesic utilization during hospitalization.

Comparing the Influence of Conventional and Rotary Instrumentation Techniques on the Behavior of the Children: A Randomized Clinical Trial

Background

Pulpectomy has gained popularity in the pediatric dental practice for preserving the primary teeth in its position until exfoliation. There has been a paradigm shift from using manual instrumentation to rotary instrumentation for canal preparation in primary teeth. While studies show that there is a reduction in the instrumentation time with the use of rotary instruments which in turn influences the behavior of the child, its direct effect on the behavior of the children has not been evaluated.

Aim

To compare the behavior of the children during manual and rotary instrumentation for pulpectomy in the primary molars.

Materials and methods

A single-blinded randomized clinical trial was conducted in 88 children in any one of the mandibular primary molars indicated for pulpectomy. The canal preparation was done using manual K files and rotary ProTaper (44 children in each group). The influence of these instrumentation techniques on the children was assessed with three different scales- Frankl Behavior Rating Scale; Venham Interval Rating Scale; Wong Baker FACES Pain Scale for evaluating the behavior, anxiety, and the pain experienced by the children, respectively during canal preparation.

Results

A total of 88 participants, comprising 50 females and 38 males, participated in the study. An equal distribution of the participants with respect to age (p = 0.064), gender (p = 0.389), and teeth (p = 0.877) was observed between the groups. More cooperative behavior (p < 0.001); lesser anxiety levels (p < 0.001); lower intensity of pain (p < 0.001) were recorded in the children instrumented using Rotary files.

Conclusion

The present study concludes that it is preferable to use rotary instrumentation for primary canal preparation in pediatric practice as it has a more positive influence on the behavior of the children, which eventually determines the success of the treatment.

Clinical significance

With rise in the use of rotary files for pulpectomy in primary teeth, the present paper demonstrates the influence of rotary instrumentation technique for canal preparation during pulpectomy on the behavior of the children in a dental chair. This paper throws light for the pedodontists to effectively perform pulpectomy in children with ease without leaving a psychological impact on the children.

How to cite this article

Govindaraju L, Subramanian EMG, Jeevanandan G. Comparing the Influence of Conventional and Rotary Instrumentation Techniques on the Behavior of the Children: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2021;14(S-2):S179-S185.

Caries removal by Er,Cr:YSGG laser and Air-rotor handpiece comparison in primary teeth treatment: an in vivo study

AIM

The aim of this study was to evaluate and compare caries removal by Er,Cr:YSGG Laser and conventional method using Air-rotor handpiece in primary teeth.

MATERIALS AND METHODS

25 children with at least two class I carious lesions on primary teeth with Diagnodent readings not differing more than ± 10 for both teeth were included in the study. All 50 teeth in the study received treatment by the same operator. Time taken for caries removal was recorded using a timer. Pain assessment was done using Wong Baker Modified Faces Pain Rating Scale and Visual Analog Scale before and after the procedure. After caries removal, caries detection dye was applied to the prepared cavity to check the efficacy of the procedure. In addition, after completion of treatment, each child was asked to indicate which method of caries removal, Er,Cr:YSGG Laser or Air-rotor handpiece, was more comfortable.

RESULTS

The difference between the mean values for post-procedural Wong Baker Faces Pain Rating Scale scores and Visual Analog Scale scores in Group A and Group B were compared, which showed that children experienced less pain during the caries removal procedure with Er,Cr:YSGG Laser than with Air-rotor handpiece. Time taken for caries removal procedure was more in Group A than in Group B. It was seen that in both the groups caries detection dye was completely removed and both the procedures were equally efficacious for caries removal. Children indicated caries removal procedure with Laser to be more comfortable.

CONCLUSION

Within the parameters and limitations of the present study, it is suggested that Er,Cr:YSGG Laser seems to be an acceptable tool for caries removal in primary teeth. Children found caries removal with Er,Cr:YSGG Laser to be more comfortable even though time taken was more than the conventional method using Air-rotor handpiece.

Effect of Intrasocket Application of Manuka Honey on Postsurgical Pain of Impacted Mandibular Third Molars Surgery: Split-Mouth Randomized Controlled Trial

Background and Purpose

Sufficient evidence exists recommending the use of honey in the management of wounds. Studies revealed that the healing effect of honey could be classified by its antibacterial and anti-inflammatory properties of its components. Since surgical extraction of impacted molars is one of the most common operations in the oral cavity and the postoperative pain disturbing the patient may reduce the quality of health service, this study aimed to assess the analgesic potential of Manuka honey application into the extraction socket of impacted mandibular third molars.

Methods

This randomized split-mouth controlled study included 33 patients undergoing impacted bilateral lower third molars surgery under local anesthesia (n = 66). Randomization was carried out by coin flipping. One of the two impacted third molars was assigned to treatment group (Manuka honey applied just before suturing), other side to control group (nothing applied). Postsurgical pain was evaluated using visual analogue scale (VAS) of faces 7 days after extraction. The total analgesic dose used was also evaluated.

Results

In treatment group, postoperative VAS scores were significantly lower compared to that in control group regarding first and second days postoperatively (P < 0.05). Total analgesic intake in the control group was significantly higher (P = 0.0001).

Conclusion

This study demonstrated that intrasocket application of Manuka honey after surgical extraction of impacted lower third molar is an effective method for reducing acute postsurgical pain.

'Metal to resin': a comparative evaluation of conventional band and loop space maintainer with the fiber reinforced composite resin space maintainer in children

AIMS

To compare the clinical efficacy of two space maintainers namely, conventional band and loop and Fiber Reinforced Composite Resin (FRCR) space maintainers.

SUBJECTS AND METHODS

Thirty healthy children, aged 5 to 8 years were selected having at least two deciduous molars in different quadrants indicated for extraction or lost previously. FRCR space maintainer was placed in one quadrant and in the other quadrant band and loop space maintainer was cemented. All the patients were recalled at 1 st, 3 rd, and 6 th months for evaluation of both types of space maintainer. Patient acceptability, time taken, and clinical efficacy was recorded.

STATISTICAL ANALYSIS USED

The observations thus obtained were subjected to statistical analysis using Chi- square test and Mann-Whitney U test.

RESULTS

Patient acceptability was greater in Group I (FRCR) in comparison to Group II (band and loop space maintainer). The time taken by Group I was significantly lower as compared to that of Group II. In Group I, debonding of enamel, composite was the most common complication leading to failure followed by debonding of fiber composite. In Group II, cement loss was the most common complication leading to failure followed by slippage of band and fracture of loop. The success rates of Groups I and Group II weares 63.3% and 36.7%, respectively.

CONCLUSION

The study concluded that FRCRFiber Reinforced Composite Resin (Ribbond) space maintainers can be considered as viable alternative to the conventional band and loop space maintainers.

A comparison of two pain scales in the assessment of dental pain in East delhi children

Pain is the most common symptom of oral diseases. Pain perception in children is highly variable and unreliable due to poor communication. Therefore we designed a study to compare pain measurement techniques, that is, visual analogue scale (VAS) and Wong-Baker faces pain rating scale (WBFPS) among Delhi children aged 3 to 14 years undergoing dental extraction. Method. A cross-sectional study was conducted on 180 patients aged 3 to 14 years who had undergone dental extraction. Children were assessed for their pain sensitivity using visual analogue scale (VAS) and Wong-Baker faces pain rating scale (WBFPS ). Result and Conclusion. Pain threshold tends to decline, and the self-management of pain becomes more effective with increasing age. Genderwise result shows that communication ability of boys and girls is similar in all age groups.