Amount Of Anesthetic Solution Research Articles

Acutely infected teeth: to extract or not to extract?

Not only laymen but also dentists generally believe that extraction of acutely infected teeth should be avoided until the infection subdues by using systemic antibiotics. The aim of this study was to compare perioperative complications in routine extractions of acutely infected teeth with extractions of asymptomatic teeth. This prospective study was performed with 82 patients. Severe pain on percussion of the relevant tooth was considered as basic criteria for acute infection. The acutely infected teeth were labeled as the study group (n = 35) and the asymptomatic teeth as the control group (n = 47). The extractions were done using standard procedures. The amount of anesthetic solution used and duration of extractions were recorded. Postoperative severe pain and exposed bone with no granulation tissue in the extraction socket were indications of alveolar osteitis (AO). The level of statistical significance was accepted as 0.05. Symptoms that could indicate systemic response, including fever, fatigue, and shivering were not found. There was no statistically significant difference between groups in terms of AO, amount of anesthetic solution used, and duration of extraction. The presence of an acute infection characterized by severe percussion pain is not a contraindication for tooth extraction. Infected teeth should be extracted as soon as possible and the procedure should not be postponed by giving antibiotics.

Pain perception and effectiveness of palatal approach anterior superior alveolar block anesthesia using single tooth anesthesia in children: A randomized controlled trial

Background: Restoring multiple anterior teeth in children using conventional infiltration is challenging due to the need of multiple injections, a considerable amount of anesthetic solution, and lip numbness. The palatal approach anterior superior alveolar block injection (P-ASA) using the Wand single tooth anesthesia (STA) provides an alternative and innovative technique that overcomes several challenges and should be furtherly tested. Aim: The aim of this study was to compare the pain perception and the effectiveness of P-ASA injection using STA (Milestone Scientific, Inc.) and a 30 G × 0.5 inch needle, to the regular multiple maxillary infiltration local anesthetic technique (MIT) in restoring primary anterior maxillary teeth. Design: This study was designed as a randomized controlled clinical trial in which 64 healthy children who need restoration and/or pulp treatment on primary maxillary anterior teeth were assigned to either receiving P-ASA block injection or regular (MIT). Children's behavior was assessed during anesthesia administration objectively using face, legs, activity, cry, and consolability behavioral pain assessment scale (FLACC). Children's self-reported pain was evaluated subjectively at two different time points (directly after injection of anesthesia and after full dental treatment) using the Wong–Baker FACES pain rating scale (WBFPRS). Data were statistically analyzed using SPSS version 13.0 and statistical significance was determined as P ≤ 0.05. Results: Children receiving the P-ASA reported less pain both during and after anesthesia administration (P = 0.0001). Similar results of pain were reported after treatment completion using both techniques (P = 0.464). Conclusion: P-ASA can be considered as an excellent alternative to administer deep, fast, effective, and less painful anesthesia of the upper primary anterior teeth and related gingival tissues compared to MIT.

Comparison of acceptance, preference and efficacy between pressure anesthesia and classical needle infiltration anesthesia for dental restorative procedures in adult patients.

Introduction:Intraoral local anesthesia is essential for delivering dental care. Needless devices have been developed to provide anesthesia without injections. Little controlled research is available on its use in dental restorative procedures in adult patients. The aims of this study were to compare adult patients acceptability and preference for needleless jet injection with classical local infiltration as well as to evaluate the efficacy of the needleless anesthesia.Materials and Methods:Twenty non fearful adults with no previous experience of dental anesthesia were studied using split-mouth design. The first procedure was performed with classical needle infiltration anesthesia. The same amount of anesthetic solution was administered using MADA jet needleless device in a second session one week later, during which a second dental restorative procedure was performed. Patients acceptance was assessed using Universal pain assessment tool while effectiveness was recorded using soft tissue anesthesia and pulpal anesthesia. Patients reported their preference for the anesthetic method at the third visit. The data was evaluated using chi square test and student's t-test.Results:Pressure anesthesia was more accepted and preferred by 70% of the patients than traditional needle anesthesia (20%). Both needle and pressure anesthesia was equally effective for carrying out the dental procedures.Conclusion:Patients experienced significantly less pain and fear (p<0.01) during anesthetic procedure with pressure anesthesia. However, for more invasive procedures needle anesthesia will be more effective.

Periodontal intraligament injection as alternative to inferior alveolar nerve block—meta-analysis of the literature from 1979 to 2012

In a first meta-analysis, inferior alveolar nerve block (IANB) and periodontal intraligamentary injection anesthesia (ILA) were compared with focus on the failure rate of local anesthesia, pain during injection, additional injections, cardiovascular disturbances (CVD), and method-inherent differences (unwanted side effects, latency time, amount of anesthetic solution, duration of anesthesia) in adult patients. Prospective and retrospective studies with clinical comparison of both injection techniques considering the relevant outcome parameters in adult patients from 1979 to 2012 were included. A specific tool for assessing risk of bias in each included study was adopted. Data were assessed for methodological reliability and extracted and supplemented by sensitivity analysis by two independent reviewers. Seven studies were included [evidence grade Ib (n=1), IIb (n=3), and III (n=3)]. For other parameter than CVD, the significant heterogeneity of the random effects did not allow the reporting of pooled summary effect estimates. CVD were found significantly more often after IANB [odds ratio (OR): 0.12 (0.02-0.69)]. Further analysis revealed less injection pain in cases of ILA [OR: 0.32 (0.1-1)]. For failure rates as well as for needed additional injections, no significant differences were detected. IANB showed a latency of >3 min, whereas ILA had nearly none. The effect of IANB is longer than for ILA. Methodological and reporting flaws were consistently observed in the included articles. Except for CVD, it could not be shown that ILA is neither superior nor inferior compared to IANB. IANB as "gold standard" for routine dental treatments should be discussed.

Comparison of 4% articaine with epinephrine (1:100,000) and without epinephrine in inferior alveolar block for tooth extraction: double-blind randomized clinical trial of anesthetic efficacy

The purpose of this clinical prospective, randomized, double-blind study was to compare the anesthetic efficacy of 4% articaine with epinephrine (1:100,000) and without epinephrine in inferior alveolar nerve block anesthesia for extractions of mandibular teeth. Eighty-eight patients received intraoral inferior alveolar nerve blocks using 4% articaine with 1:100,000 epinephrine (n = 41; group 1) or without epinephrine (n = 47; group 2) for extractions of mandibular teeth. The primary objectives were differences in onset as well as in length of soft tissue anesthesia. The amount of anesthetic solution, need of a second injection, pain while injecting, pain during treatment, postoperative pain, and possible complications were surveyed. In both groups, anesthesia was sufficient for dental extractions. In group 1, a significantly faster onset of the anesthetic effect (7.2 min vs. 9.2 min; P = .001) and a significantly longer duration of soft tissue anesthesia (3.8 h vs. 2.5 h; P < .0001) were seen. There was no significant difference in the amount of anesthetic solution needed, in the need for a second injection, in the injection pain, in pain during treatment, or in postoperative analgesia. In both groups, no complications were seen. To minimize the epinephrine-induced side effects, 4% articaine without epinephrine is a suitable anesthetic agent for dental extractions in the mandible after inferior alveolar nerve block anesthesia. There could be less postoperative discomfort due to the shorter duration of anesthesia without increased postoperative pain.

Anestésicos Locais: Como Escolher e Previnir Complicações Sistémicas

The discovery of substances that cause a loss of sensitivity was a benchmark in the history of medicine and dentistry and is considered one of the ten most important discoveries in medicine. Such substances allow performing surgical procedures without pain, which had previously been considered an unachievable ideal in academic circles. One of the most frequent errors in dentistry is systematically employing the same local anesthetic. Dentists should choose an anesthetic solution based on the patient and procedure to be carried out. Prevention is the best treatment for systemic complications stemming from local anesthesia and is achieved through an adequate anamnesis and physical exam, which allow choosing the safest anesthetic solution for each specific case. The aim of the present study was to carry out a literature review on local anesthetics, providing readers with information to guide them in the choice and amount of anesthetic solution, thereby preventing the occurrence of systemic complications.

Local Distribution of a Low Dose of Anesthetic for Cervical Plexus Block in Carotid Endarterectomy

Cervical plexus block (CPB) for carotid endarterectomy is typically performed with a large amount of anesthetic solution (20–40 ml). Our aim was to demonstrate the local distribution of a low dose of anesthetic solution for CPB. Ten patients (aged 66–79 years) underwent CPB with a single injection technique using 8 ml of ropivacaine 0.75% mixed with 1 ml of iodinated non-ionic contrast agent. Digital fluoroscopy and computed tomography (CT) were performed to define the anesthetic distribution before carotid endarterectomy. Effectiveness of the block was evaluated during and after surgery. The cranial-caudal extent of the anesthetic solution in the paravertebral space was demonstrated by both digital fluoroscopy and CT: C2–C4 (n=1), C2–C5 (n=1), C2–C6 (n=1), C2–C7 (n=5), and C3–C7 (n=2). In addition, CT showed an anterior-posterior spreading of 2–3 cm in diameter in five patients and of more than 3 cm in five patients. All patients had a sufficient deep and superficial CPB; superior cervical ganglion block was obtained in three patients, with a prevalent anterior spreading of the anesthetic in two of them. Out of the seven patients without superior cervical ganglion block, none had a prevalent anterior spreading and two had mild pain during artery dissection. We observed phrenic nerve block in ten, brachial plexus block in eight, and laryngeal block in one patient, other side effects in none. Digital fluoroscopy and CT demonstrate the anesthetic distribution in neck spaces. A dose of anesthetic low as 8 ml of ropivacaine 0.75%, seems to be sufficient to obtain CPB for carotid endarterectomy.