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Das S, Govind S, Jena D, Dash S, Jena SP, Yadav D, Karan S, Kancherla J, Jena A, Mishra L, Bal SCB, Pattanaik S. Local Anesthesia Onset and Pain Perception in Hemophilic and Thalassemic Conditions. J Clin Med 2023; 12:jcm12113646. [PMID: 37297841 DOI: 10.3390/jcm12113646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/16/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
The study aims to evaluate and compare the onset of local anesthesia (LA) and pain perception during endodontic treatment in hemophilic and thalassemic patients. Methods: The study included 90 patients with symptomatic irreversible pulpitis of the mandibular molars. Three groups (n = 30 in each group) were included. Group 1: hemophilic patients; group 2: thalassemic patients; and group 3: individuals without any systemic diseases. Onset of LA and visual analogue scale (VAS) scores was recorded immediately after the administration of local anesthesia, during the pulp exposure procedure, and during canal instrumentation, and were compared between the three groups. Frequency distribution, ANOVA, and linear regression analysis (p < 0.05) were applied. Results: The mean onset time was 46 ± 34 s in the hemophilic group, 42 ± 23 s in the thalassemic group, and 38 ± 12 s in controls, but the differences were statistically insignificant. After LA administration (LA-VAS), all three groups experienced a statistically significant reduction in pain (p = 0.048). On pulp exposure (PE-VAS) (p = 0.82) and during canal instrumentation (CI-VAS) (p = 0.55), there was no statistically significant difference in pain perception between the groups. The coefficients indicate a positive correlation between the VAS and onset time, indicating a positive reduction in the VAS following the administration of LA. Conclusions: Hemophilic patients exhibited a clinically longer average onset time for LA. However, the difference among the three groups with regard to the overall pain perception after LA administration, during and after pulp exposure, and during canal instrumentation was statistically insignificant.
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Affiliation(s)
- Supriya Das
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Shashirekha Govind
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Debkant Jena
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Sumit Dash
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Siba Prasad Jena
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Deepika Yadav
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Smita Karan
- Department of Dentistry, Shadan Institute of Medical Sciences Research Centre and Teaching Hospital, Himayat Sagar, Hyderabad 500086, Telangana, India
| | - Jyothsna Kancherla
- Department of Dentistry, Dr.V.R.K. Women's Medical College Teaching Hospital and Research Centre, Aziz nagar, Hyderabad 500075, Telangana, India
| | - Amit Jena
- Department of Conservative Dentistry and Endodontics, Sriram Chandra Bhanja Dental College & Hospital, Cuttack 753007, Odisha, India
| | - Lora Mishra
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Sourav Chandra Bidyasagar Bal
- Department of Public Health Dentistry, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Satabdi Pattanaik
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
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Singhal N, Vats A, Khetarpal A, Ahlawat M, Vijayran VKR, Harshita. Efficacy of articaine versus mepivacaine administered as different supplementary local anesthetic techniques after a failed inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis: An in vivo study. J Conserv Dent 2022; 25:654-660. [PMID: 36591593 PMCID: PMC9795688 DOI: 10.4103/jcd.jcd_299_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 01/04/2023] Open
Abstract
Aim The aim of the present study was to assess the efficacy of articaine versus mepivacaine administered as different supplementary local anesthetic techniques after a failed inferior alveolar nerve block (IANB) with lidocaine in patients with irreversible pulpitis. Materials and Methods A total of 120 patients were included in the study. Patients were given IANB with 2 ml of 2% lidocaine hydrochloride with 1:80,000 epinephrine. Patients who showed subjective symptoms of IANB but did not secure pulpal anesthesia were randomly allocated to one of the following four groups by random sampling for supplementary local anesthesia - Group 1: buccal infiltration (BI) with 4% articaine with 1:100,000 epinephrine, Group 2: four-site intraligamentary (IL) injection with 4% articaine with 1:100,000 epinephrine, Group 3: BI with 2% mepivacaine with 1:100,000 epinephrine, and Group 4: four-site IL injection with 2% mepivacaine with 1:100,000 epinephrine. Results Group 1 - BI with articaine provided anesthesia success in 27 cases (90%, n = 30). Group 2 - IL injection with articaine provided anesthesia success in 20 cases (66.67%, n = 30). Group 3 - BI with mepivacaine provided anesthesia success in 21 cases (70%, n = 30). Group 4 - IL injection with mepivacaine provided anesthesia success in 15 cases (50%, n = 30). A significant difference between the four groups was found. Conclusion In patients with a mandibular first molar exhibiting symptomatic irreversible pulpitis, block injection with lidocaine along with supplemental BI with articaine allowed more pain-free treatments. Articaine showed better results when compared with mepivacaine.
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Affiliation(s)
- Neha Singhal
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
| | - Asit Vats
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
| | - Ambica Khetarpal
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
| | - Monika Ahlawat
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
| | - Vijay K. R. Vijayran
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
| | - Harshita
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
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Parirokh M, Abbott P. Present status and future directions - Mechanisms and management of local anaesthetic failures. Int Endod J 2022; 55 Suppl 4:951-994. [PMID: 35119117 DOI: 10.1111/iej.13697] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 11/05/2022]
Abstract
Pain control during root canal treatment is of utmost importance for both the patient and the dental practitioner and many studies have investigated ways of overcoming problems with gaining adequate anaesthesia during treatment. The PubMed and Cochrane databases were searched for evidence-based studies regarding local anaesthesia for root canal treatment. Many variables, including premedication, pain during needle insertion, pain on injection, premedication with various types of drugs, volume of anaesthetic solutions, supplemental anaesthetic techniques, and additives to the anaesthetic solutions, may influence pain perception during root canal treatment. Differences between teeth with healthy pulps versus those with irreversible pulpitis should be considered when the effects of variables are interpreted. There are several concerns regarding the methodologies used in studies that have evaluated anaesthesia success rates. There are some conditions that may help to predict a patient's pain during root canal treatment and these conditions could be overcome either by employing methods such as premedication with a non-steroidal anti-inflammatory drug prior to the treatment visit or by using supplementary anaesthetic techniques before or during the treatment. However, authors need to be more careful when reporting details of their studies to reduce concerns regarding their study bias.
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Affiliation(s)
- Masoud Parirokh
- Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Paul Abbott
- School of Dentistry, University of Western Australia, Perth, Australia
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