Dental Anaesthesia Research Articles

Child oral health-related quality of life following treatment under dental general anaesthetic (DGA).

Data sources PubMed, EMBASE, Web of Science, CINAHL and the Cochrane Library.Study selection Two independent reviewers selected studies which employed validated QoL instruments, Early Childhood Oral Health Impact Scale (ECOHIS) and the Child Oral Health-Related Quality of Life (COHRQoL) questionnaire to evaluate the change in child oral health-related quality of life (OHRQoL), following dental treatment under general anaesthesia (DGA) for caries.Data extraction and synthesis Risk of bias was assessed using the Cochrane collaboration tool. A meta-analysis was conducted, dividing studies based on the OHRQoL measure used.Results Twenty-two research articles were included in the review, which included 12 studies employing each of the two OHRQoL measures. Risk of bias in the included studies varied considerably. An overall improvement in OHRQoL was identified in all studies following DGA. The mean difference in scores post-treatment for ECOHIS and COHRQoL were 1.62 (95% CI 1.52-1.71; P <0.00001; I2 = 0%) and 0.86 (95% CI 0.74-0.99; P <0.00001; I2 = 0%), respectively, with medium to large effect sizes. There was no evidence of heterogeneity.Conclusions Treatment under DGA significantly improved the OHRQoL of children, as reported by their parents. The authors suggest that studies of longer than three months are required to assess whether these changes are sustained in the long-term.

What is the impact on families of children having dental treatment under general anaesthetic?

Data sources PubMed, Medline, CINAHL, Cochrane Library, and Web of Science databases.Study selection Studies involving patients aged between 0-16 years of age having dental general anaesthetic (DGA), where Early Childhood Oral Health Impact Scale (ECOHIS) and Child Oral Health-Related Quality of Life (COHRQoL) pre- and post-operative assessments were made, were considered.Data extraction and synthesis The quality of studies was assessed by two reviewers using the Newcastle-Ottawa Scale for cohort studies. Information on study design and instruments used to record family impact scale (FIS) were extracted. The main outcome was changes in the FIS section presented as mean difference (MD).Results After an initial search of 105 studies in the database, 21 articles were included in the analysis. A positive outcome in the FIS changes was identified in all studies. The combined MD for FIS using ECOHIS and COHRQoL was 1.52 (95% CI 1.15-1.89; P <0.00001; I2 = 87%) and 1.10 (95% CI 0.68-1.52; P <0.00001; I2 = 79%), respectively.Conclusions Dental treatment with general anaesthesia for children had a significant positive impact on parental emotions, activity, and conflict. Following DGA, there was significant improvement in the FIS, with large MD.

Effect of a Vibration System on Pain Reduction During Injection of Local Dental Anaesthesia in Children

Effect of a Vibration System on Pain Reduction During Injection of Local Dental Anaesthesia in Children

Increase in pulse pressure on administration of a dental local anesthetic solution, prilocaine hydrochloride with felypressin in male diabetic patients with coronary heart disease.

This study aimed to evaluate pulse pressure fluctuation on dental local anesthetic administration in diabetic patients with and without coronary heart disease undergoing tooth extraction. This retrospective study in diabetic patients undergoing tooth extraction included 33 patients with coronary heart disease (mean age 79.3 ± 7.4, 64% male) and 49 patients without coronary heart disease (mean age 78.6 ± 6.5, 29% male). The increase in pulse pressure before and after administration of local anesthetics was compared between diabetic patients with and without coronary heart disease. Pulse pressure was increased in male diabetic patients with coronary heart disease compared with those without coronary heart disease following administration of 3% prilocaine hydrochloride with felypressin 0.03IU/mL (prilocaine) (15.6 ± 15.4mmHg in those with coronary heart disease (n = 11) versus 4.3 ± 10.9mmHg in those without coronary heart disease (n = 13), p = 0.03). Prilocaine administration increased pulse pressure in male diabetic patients with coronary heart disease compared with those without coronary heart disease. Further study is needed to reveal the mechanisms involved in the increase in pulse pressure. This is the first study of pulse pressure fluctuation in diabetic patients with and without coronary heart disease following administration of local anesthetics. Our findings can help guide the choice of local anesthetics and serve as a predictor of coronary vascular condition in diabetic patients during dental treatment.

Frequency, variation and cost of dental extractions for adults in secondary care in Great Britain.

Aims We have conducted a survey of administrative data, aiming to investigate the reported provision of dental extraction under general anaesthesia in the NHS for adults in secondary care in the following aspects: 1) anaesthetic data accessibility by NHS organisations; 2) the number and proportion of dental extraction episodes by anaesthetic modality and procedure type; 3) the economic cost of dental general anaesthesia (DGA) for adults; 4) variations in the anaesthetic provision between commissioning regions and organisation types. Methods We collected data from individual secondary care NHS organisations that provide dental extraction services in England, Wales and Scotland. A data collection form was devised to capture the number of episodes of dental extraction under each relevant oral surgery procedure code per anaesthetic modality per institution from October 2015 to September 2016. Results The majority (64.0%, n = 96,659) of the episodes were categorised into an anaesthetic modality; 39.2% (n = 37,902) under general anaesthesia, 18.7% (n = 18,050) under sedation, and 42.1% (n = 40,707) under local anaesthesia. The majority of sedation provision (84.9%) derived from dental hospitals. A substantial proportion (37.0%) of the episodes could not be assigned an anaesthetic modality. Variations in dental general anaesthesia activity were observed with respect to the commissioning regions and organisation types. The annual cost of adult DGA from 81 out of 150 organisations that provided DGA data was estimated to be over £19 million, based on the NHS payment by results tariff 2015-2016. Conclusion Our data suggest that the number of adult DGA episodes and the associated cost are considerable, and highlights the scope for improving the quality of data for commissioners and providers to support discussions over patient pathways.

Classification of the Methods of Local Anesthesia and Special Features of Vascular-Diffuse Injection

The main feature of modern injection methods of dental anesthesia is in the local venous spreading of the anesthetic in the near-toothed spongy substance of the bone and dental pulp. The vascular mechanism is controlled by the epinephrine anesthetic solution and patient vegetal system. Spongy dental anesthesia is universal, highly effective, relatively safe, easy to implement and increasingly widespread.

Study of Normal Anatomy of Mandibular Canal and its Variations in Indian Population Using CBCT.

Identification of detailed anatomy of mandibular canal (MC) with its contents including the position, course, and morphology is extremely important for the management of various surgical procedures including dental implant placement, third molar surgery, dental anesthesia, mandibular osteotomy, bone-harvesting procedure from the ramus and body of mandible, bone plating in angle and body region of mandible, or any other surgical procedure involving the mandible. This prospective randomized study was carried out in the Department of Oral and Maxillofacial Surgery, Saraswati Dental College, Lucknow, on 100 randomly selected cone-beam computed tomography (CBCT) mandibular views displaying the entire mandible. Various parameters of the canal were studied in detail and subjected to statistical analysis using SPSS 20 software. For all the observations, paired t test was applied to compare right and left sides and independent t test for the comparison of gender. For centuries MC has been a paramount topic of discussion, and with the contraption of CBCT, we can finally decipher the canal in great detail. CBCT acts as a guide to prevent damage to the neurovascular bundle as the canal traverses its course and sometimes with certain variations.

A debreceni Stomatologiai Klinika története Adler Péter professzor vezetése alatt (1946–1979)

History of the Stomatology Clinic in Debrecen under the Leadership of Professor Péter Adler (1946–1979). With the approaching front of the 2nd World War in October 9, 1944, Professor András Csilléry head of the Stomatology Clinic left Debrecen because of his political views, so the institution remained without a leader until 17th November. Thereafter as a substitute, trainees then Stefánia Morvay Assistant Lecturer under the supervision of Professor Gyula Verzár was the head. From June 20, 1946, Péter Adler was assigned to the lead, which was one of the longest leading positions of the Faculty of Medicine since he was director of the clinic until July 1, 1979. Péter Adler graduated from the University of Vienna, where he specialized in the field of Dentistry and worked at the Department of Orthodontics at the Polyclinic of Vienna, while in spring 1939 he had to return home for political reasons. During the war he worked as a translator and then assigned to forced labor, and after the war, he was placed to the Stomatology Clinic in Debrecen. From 1948 he worked as a chief clinician, in 1952 he became candidate of sciences (CSc), and in 1953 he was appointed as a university professor. He received Doctor of Science (DSc) degree in 1957. He was a member of the editorial board of several foreign professional journals, he was accepted by several international editorial boards, wrote several textbooks. He translated two books written by others into German. He was chairman of the Association of Hungarian Dentists and Editor-in-Chief of the Stomatologica Hungarica. The main topics of the research at the Stomatology Clinic are: examination of hypersensitivity to dental anesthetics, clarification of many details of caries epidemiology, proof of the protective effect of fluoride against caries. Under his leadership there was a dynamic scientific work on the Stomatology Clinic, proven by the fact that between 1945–1980 12 books, 487 publications, book chapters and monographs appeared, which was unique among similar national institutions. He lay down the fundaments of the dental education in 1976 and contributed the architectural and professional requirements of the new Stomatology Clinic in 1981.

Dental treatment under general anesthesia in adults with special needs at the University Hospital of Dental Prosthetics and Restorative Dentistry of Innsbruck, Austria: a retrospective study of 12\xa0years

ObjectivesSpecial needs patients are prone to insufficient oral care and subsequent caries or periodontitis. The aim of this retrospective study was the assessment of demand for restorative therapy and tooth extractions under general anesthesia in adults with intellectual and/or physical disablement (IPD) or psychiatric disorders (PDs) with inherent dentist phobia at the University Hospital of Innsbruck with regard to demographic factors.Materials and methodsA total of 444 consecutive cases of scheduled dental general anesthesia (DGA) in adults from 2003 to 2014 were included. From patient files, demographic data, the presence of either IPD or a PD, attested by a mandatory certificate, and restorative therapy and tooth extractions performed under DGA were obtained. Data analysis was carried out by means of descriptive and comparative statistics.ResultsFour hundred two cases (mean age 37.5 ± 13.87 years) assigned to 283 individuals with IPD and 42 cases (mean age 36.09 ± 13.03 years) assigned to 39 individuals with PDs arose in the observed period. Patients with PDs required significantly more restorations (in 7.98 ± 5.4 versus 5.34 ± 4.41 teeth; p = 0.002; Mann-Whitney U test) and extractions (of 4.86 ± 4.51 versus 2.6 ± 3.96 teeth; p < 0.001; Mann-Whitney U test) than patients with IPD.ConclusionsDemand for dental treatment was high in the collective of special needs patients. Oral health status was worse in patients with PDs than in patients suffering IPD.Clinical relevanceWhile in patients with severe disablement, DGA presents the only treatment option, specific preventive programs should be implemented for patients with minor disablement or dentist phobia. In these patients, alternative approaches should be promoted.

Allergic manifestations to local anaesthetic agents for dental anaesthesia in children: a review and proposal of a new algorithm.

The purpose of this review was to evaluate allergic manifestations to dental local anaesthetic (LA) in children and to propose an algorithm for the diagnosis of LA allergy, in order to minimise the number of children who are wrongly categorised as allergic. A comprehensive literature survey was performed on LA allergy in children before a dental treatment. In proposing a diagnostic algorithm, evidences from literature have been integrated with personal experience. Data from literature showed that overall less than 1% of young patients tested for suspected LA have a positive subcutaneous test and have a positive diagnosis. A complete diagnostic procedure should include: clinical history reported by patients, objective medical records, results of skin tests and provocation test with the suspected drug. Patients with negative skin tests should perform a subcutaneous challenge, while patients with a positive skin test should be tested for a different unrelated LA. Allergy to LA is a rare condition. A complete diagnostic algorithm will allow to identify paediatric patients correctly.

АНЕСТЕЗИЯ И КСЕНОН В ДЕТСКОЙ СТОМАТОЛОГИИ

The review was carried out using the medical databases PubMed, Scopus, The Cochrane Library, CyberLeninka. The objective : evaluate the range of methods used for anesthesia in dentistry in children. Results. Inhalation anesthesia is most commonly used with halogenated volatile anesthetics, in combination with local or intravenous anesthesia. Xenon is a perspective inhalation anesthetic for general anesthesia in dentistry. However, information its use in children is limited.

Role of 0.5 M mannitol as an adjuvant with lidocaine with or without epinephrine for inferior alveolar nerve block: A randomized control trial.

BackgroundThe most commonly used local anesthetic in dentistry is lidocaine. For decades, mannitol is the most widely used agent in the management of raised intracranial pressure and as prophylaxis against acute renal failure surgeries.Material and Methods120 patients were randomly divided into four groups, 30 patients in each group. Group A was administered 2% lidocaine with 1:80000 epinephrine; group B, 2% lidocaine with 1:80000 epinephrine and 0.5 M mannitol; group C, 2% lidocaine and 0.5 M mannitol; and group D (control group), 2% lidocaine for achieving local anesthesia. Extraction of lower erupted tooth was done under inferior alveolar nerve block. Parameters taken were onset of anesthesia, duration of anesthesia and pain. Heft-Parker visual analogue scale was taken to evaluate the pain response during procedure after every 10 minutes until complete return of sensation by probing. The Chi-square test was used to compare the pain among the groups. The continuous variables were compared among the groups by one way analysis of variance (ANOVA) followed by Tukey’s post-hoc comparison tests. The p-value <0.05 was considered significant.ResultsThe onset of tingling sensation was higher among the patients of group C (1.53±0.57) than group B (1.50±0.58), group D (1.48±0.51) and group A (1.45±0.62) but difference among the groups was statistically insignificant (p >0.05). The total time in return of sensation was higher among the patients of group C (70.30±4.34) than group A (65.94±3.45), group B (62.23±7.47) and group D (47.70±8.04) but difference among the groups was found to be statistically significant (p=0.0001). There was no significant (p >0.05) difference in the pain at baseline and at start. No pain was found among all the patients from 10 minutes to subsequent time intervals.ConclusionsMannitol was effective in increasing the efficacy of lidocaine as an adjuvant to local anesthetic solution in inferior alveolar nerve block. Key words:Inferior alveolar nerve block, lidocaine, local anesthesia, mannitol.

Radiographic detecting for the presence of extra chin foramen for the chosen Ramadi City Community Iraq

Aims and Objectives: The extra chin foramen (ECF) is a scarce structure in the anatomy of human lower jaw. When it is present, the dental surgeon should take care during anesthesia and surgical procedures for anterior teeth. To investigate the existence of the ECF and the direction in relation to chin foramen in chosen Ramadi City community persons, Al-Anbar Governorate, Iraq, digital panoramic and conventional intraoral (bisecting line angle technique) X-ray was used. Materials and Methods: A total of 100 patients (200 sides of mandible), 54 males and 46 females were selected. Each one was subjected to digital panoramic and conventional intraoral technique. The obtained images were evaluated for the existence of ECF in both male and female patients on each direction of lower jaw (left and right). Age relation to ECF existence was reported. Position of ECF to chin foramen (anterior or posterior) was calculated. The collected data were treated by the Statistical Package for the Social Sciences (SPSS) software, version 22. Results: ECFs were seen within 3.5% of the chosen population. Nonsignificant variations were observed between the existence of ECFs regarding gender, side of mandible, age coterie, and position of ECF to chin foramen (P > 0.05). Conclusion: A total of 7 (3.5%) ECFs were detected from 200 sides of mandible. ECFs were observed more in males (5 ECFs, 2.5%), at left side of mandible (4 ECFs, 2%), young patients (4 ECFs, 2%), and anterior to chin foramen (5 ECFs, 2.5%), so they were subjected to complications of damage to nerves and vessels during interventional dental surgery and anesthesia.

Prevalence of deep caries in preschoolers who underwent either scheduled or emergency dental general anesthesia. Does toothache make a difference? A retrospective analysis

Prevalence of deep caries in preschoolers who underwent either scheduled or emergency dental general anesthesia. Does toothache make a difference? A retrospective analysis

Safety profile of phentolamine mesylate as reversal agent of pulpal and soft tissue dental anesthesia: a systematic review and meta-analysis.

To systematically review the safety of phentolamine mesylate as a reversal agent for pulpal and soft tissue dental anesthesia. Comprehensive search, up to August 2018, was performed in three major electronic databases. The methodologic quality of all the included studies was assessed using Cochrane Collaboration for randomized clinical trials. A total of nine studies were included for qualitative and quantitative assessment. The number of events was 269 in 2,057 participants in the phentolamine mesylate group, and 179 in 1,338 participants of the control group (odds ratio 1.19; 95% confidence interval 1.03 to 1.39). In the data segregated based on age, four studies conducted on children and adolescents revealed an odds ratio of 0.68, whereas two studies on adults revealed an odds ratio of 1.58. There were no severe complications reported in any of the included studies, but the occurrence of adverse events (mild and moderate) was greater in the phentolamine mesylate group compared to the control group. Age has a significant effect on the possibility of adverse events with phentolamine mesylate.

Basic and clinical research in division of dental anesthesia

Basic and clinical research in division of dental anesthesia

Illinois Dental Anesthesia and Sedation Survey for 2016.

A statewide decennial survey was sent to practicing dentists holding sedation or general anesthesia permits to identify office sedation/general anesthesia trends and practices over the last 10 years. This survey constitutes the third such survey, spanning a total of 20 years. Of the 234 respondents in the 2016 survey, 34% held an Illinois moderate sedation permit and 64% held a general anesthesia permit. Oral and maxillofacial surgeons represented the majority of respondents (143/234; 61%). The remainder of responses were from general dentists (39; 17%) pediatric dentists (32; 14%), periodontists (16; 7%), dentist anesthesiologists (3; 1.3%) and 1 periodontist/dentist anesthesiologist. Surveys over the 20 years revealed the following significant trends: an increase in practitioners current in advanced cardiac life support certification, an increase in the number of non-oral maxillofacial surgeons with a sedation permit, an increase in providers of moderate sedation, and an increase in offices equipped with end-tidal CO2 and electrocardiogram monitoring. However, a number of providers were identified as not compliant with certain state mandates. For example, many respondents failed to meet minimum office team staffing requirements during sedation, hold semiannual office emergency drills, and establish written emergency management protocols.

Is prilocaine safe and potent enough for use in the oral surgery of medically compromised patients.

To investigate the potency and speed of action of 2% lidocaine and 3% prilocaine for upper teeth extractions. This prospective clinical study was conducted from November 2016 to May 2017. Ninety-six patients, aged between 16 to 70 years old were recruited in this study. Two regimens were randomly administered over one visit. Patients, treatment group I, received 2% lidocaine with 1:00.000 adrenaline. Patients treatment group II received prilocaine 3% and felypressin 0.03 I.U. per ml. The efficacy of pulp anesthesia was determined by electronic pulp testing. At any point of trial (10 minutes), the anesthetized tooth becomes unresponsive for maximal pulp stimulation (64 reading), the extraction was carried out. Results: There were no significant differences in the mean onset time of pulpal anesthesia and extraction between the prilocaine and lidocaine buccal infiltration groups (p=0.28). However, clinically, the patients in prilocaine group recorded faster onset time of anesthesia and teeth extraction than those in lidocaine group.Conclusion: Prilocaine has a better clinical performance in terms of providing rapid dental anesthesia and earlier teeth extraction than lidocaine but the differences were not significant. Prilocaine with felypressin could be a good choice for patients who have contraindication to the use of lidocaine with adrenaline.

Mortality and Morbidity in Office-Based General Anesthesia for Dentistry in Ontario.

Our objective was to estimate the prevalence of mortality and serious morbidity for office-based deep sedation and general anesthesia (DS/GA) for dentistry in Ontario from 1996 to 2015. Data were collected retrospectively in 2 phases. Phase I involved the review of incidents, and phase II involved a survey of DS/GA providers. In phase I, cases involving serious injury or death for dentistry under DS/GA, sourced from the Office of the Chief Coroner of Ontario and from the Royal College of Dental Surgeons of Ontario (RCDSO), were reviewed. Phase II involved a survey of all RCDSO-registered providers of DS/GA in which they were asked to estimate the number of DS/GAs administered in 2015 and the number of years in practice since 1996. Clinician data were pooled to establish an overall number of DS/GAs administered in dental offices in Ontario from 1996 to 2015. Prevalence was calculated using phase I (numerator) and phase II (denominator) findings. The estimated prevalence of mortality in the 20-year period from 1996 to 2015 was 3 deaths in 3,742,068 cases, with an adjusted mortality rate of 0.8 deaths per 1 million cases. The estimated prevalence of serious morbidity was 1 injury in 3,742,068 cases, which adjusts to a serious morbidity rate of 0.25 per 1 million cases. The mortality rate found in this study was slightly lower than those published by earlier studies conducted in Ontario. The risk of serious morbidity was found to be low and similar to other studies investigating morbidity in office-based dental anesthesia.

Is prilocaine safe and potent enough for use in the oral surgery of medically compromised patients

Objectives:To investigate the potency and speed of action of 2% lidocaine and 3% prilocaine for upper teeth extractions.Methods:This prospective clinical study was conducted from November 2016 to May 2017. Ninety-six patients, aged between 16 to 70 years old were recruited in this study. Two regimens were randomly administered over one visit. Patients, treatment group I, received 2% lidocaine with 1:00.000 adrenaline. Patients treatment group II received prilocaine 3% and felypressin 0.03 I.U. per ml. The efficacy of pulp anesthesia was determined by electronic pulp testing. At any point of trial (10 minutes), the anesthetized tooth becomes unresponsive for maximal pulp stimulation (64 reading), the extraction was carried out.Results:There were no significant differences in the mean onset time of pulpal anesthesia and extraction between the prilocaine and lidocaine buccal infiltration groups (p=0.28). However, clinically, the patients in prilocaine group recorded faster onset time of anesthesia and teeth extraction than those in lidocaine group.Conclusion:Prilocaine has a better clinical performance in terms of providing rapid dental anesthesia and earlier teeth extraction than lidocaine but the differences were not significant. Prilocaine with felypressin could be a good choice for patients who have contraindication to the use of lidocaine with adrenaline.