Drugs In Dentistry Research Articles

Knowledge and Attitude Regarding Local Anesthesia among Dental Professionals and Awareness in General Population

Background: Local anesthetics (LA) are stereotype drugs in dentistry. Though these drugs are used routinely, most of the dentists are unaware of the dose calculations, effective dose or complications and another vital knowledge about the drug. The objective of the survey was to evaluate the knowledge, attitude of dental professionals regarding local anesthesia and its implementation in their daily practice. Awareness of local anesthesia among general population and their expectations from the clinicians was also evaluated. Method: A survey was conducted on 1080 patients and 540 dental professionals of Odisha through google form survey and hand forms. Questionnaire were made in English and Odia language. Data were analyzed using SPSS statistics 24.0. Result: Out of 504 dental professional 31% were general dentist, 32.5% were specialist and 36.5 % were undergoing post graduate training. 73.3% of the clinicians didn’t knew the equivalent weight of adrenalin in 2% local anesthesia with 1:200000 concentration. 76.2% were wrong regarding dosage of lignocaine. 84% of the clinicians lacked in knowledge about LA allergy testing and 91.8% were unaware about Articaine. MDS especially more than 15 years of experience (100%) were found to be more knowledgeous and have a positive attitude towards local anesthesia when compared with PGs and BDS but when it comes to practice MDS (51.1%) with <5years (40.4%) experience implement better. Out of 1080 general population, 50% have fear for injections. 75.6% are unaware about the different complications of local anesthesia. 83% are unaware about different techniques of nerve block. 84.1% of the patients expect their clinicians to explain the techniques to them. Conclusion: Desired level of knowledge regarding local anesthesia is lacking among dental professionals, and a deliberate effort must be made to improve it. Lack of awareness of local anesthesia was found among general population.

Comparative study of articaine and lidocaine without palatal injection for maxillary teeth extraction.

There is significant evidence that articaine and lidocaine buccal injections alone are sufficient for painless extraction of maxillary teeth. The aim of this study was to evaluate the extraction of permanent maxillary teeth and to compare pain control between articaine and lidocaine without palatal injection. Group A received buccal and palatal injections of 2% lidocaine with 0.015mg/ml epinephrine. Group B received only buccal local anesthetic injection of 2% lidocaine with 0.015mg/ml epinephrine. Group C received only buccal injection of 4% articaine with 0.012mg/ml epinephrine. The patients' perception of pain was assessed using visual analogue scale and verbal response scale after the injection and the extraction. Statistical analysis showed that the difference in pain perception of local anesthetic injection was statistically significant between groups A and B and between groups A and C (p < 0.05). The extraction of permanent maxillary teeth is possible without palatal injections and there is no difference between articaine and lidocaine. Local anesthetic agents are the most frequently administered drugs in dentistry and represent the primary method of pain control for patients undergoing intraoral procedures.

Avaliação da prescrição de antimicrobianos para tratamento de urgência endodôntica

Introdução: O uso de medicamentos em Odontologia tem por finalidade cessar a dor e prevenir a instalação ou a disseminação do processo infeccioso e inflamatório do paciente. Objetivo: Avaliar a prescrição de antimicrobianos para os casos mais comuns de urgência endodôntica. Materiais e métodos: Trata-se de um estudo de corte transversal, com amostra constituida de 209 cirurgiões-dentistas atuantes na cidade de Vitória da Conquista. Utilizou-se um questionário que abordou o tratamento de urgência endodôntica e informações sobre o uso de medicamentos nesses casos. Os dados foram tabulados e analisados no IBM SPPP Statistics para Windows, e comparados pelo teste qui-quadrado e teste exato de Fisher. Resultados: A maior parte da amostra possui atividade profissional entre 5 e 10 anos. Destes, 49,3% responderam que para casos de pulpite aguda indicaria pulpectomia associada à medicação intracanal. A pulpectomia associada a analgésicos e antibióticos para casos de periodontite apical aguda seria indicada por 35,9%. Nos casos de tratamento de abcesso apical agudo, 70,8% indicariam drenagem e antibióticos. Ainda, 56% dos entrevistados responderam que o tratamento do canal radicular seria o mais indicado para dentes com lesão periapical. Conclusão: A prescrição de antimicrobianos por parte dos profissionais entrevistados diante de casos de urgências endodônticas foi elevada, ocorrendo

Corticosteroids in dentistry

Steroids are one of the widely used drugs in dentistry. These are immunosuppressive agents. The reason for its use is its anti-inflammatory as well as immunosuppressive properties. Corticosteroids have revolutionized the management of several disabling conditions, but its use in term of dosage is inappropriate. The current review highlights its uses, contraindications, side-effects as well as a guideline for its use in dentistry.

Dentists, antibiotics and Clostridium difficile-associated disease.

Dentists prescribe significant volumes of antimicrobial drugs within primary care settings. There is good evidence that many of the prescriptions are not justified by current clinical guidance and that that there is considerable misuse of these drugs in dentistry. One of the risks associated with antibiotic administration is Clostridium difficile-associated disease (CDAD), an entity of which many healthcare workers, including dentists, have little knowledge or understanding. This review seeks to identify the extent and nature of the problem and provides an up to date summary of current views on CDAD, with particular reference to community acquired disease. As for all healthcare workers, scrupulous attention to standard infection control procedures and reducing inappropriate antibiotic prescribing are essential to reduce the risks of CDAD, prevent emergence of further resistant strains of microorganisms and maintain the value of the arsenal of antibiotics currently available to us.

Blindness! A Terrible Aftermath of Dental Treatment

AbstractLocal anesthetics are the most commonly used drugs in dentistry. Despite preoperative patient evaluation, proper tissue preparation and meticulous administration techniques many local and systemic complications with the local anesthesia or tooth extraction have been reported from time to time. Extension of dental infections from maxillary teeth and other nearby structures to orbital spaces and tissues surrounding the eye present a rare but serious problem with the potential for causing significant impairment. The practioner should be aware of the severe consequences that may result from tooth extraction or local anesthesia.

Local anesthetics dosage still a problem for most dentists: A survey of current knowledge and awareness

Local anesthetics are the most commonly used drugs in dentistry. Although they are considered effective and safe in controlling pain during dental procedures, complications related to their use appear inevitable. Many dentists use these drugs routinely but are unaware of the dose calculations required and the maximum safe and effective dose of the drug. The aim of this study was to determine the knowledge that general dental practitioners and dental specialists, in three different cities in Saudi Arabia, have regarding dose calculations and the maximum dose required of the most commonly used local anesthetics. A one page survey questionnaire was used in this study and data were analyzed using SPSS software. The respondents comprised 51% general dental practitioners and 49% dental specialists, with ages ranging from 26–50 years; 58% of the total respondent was females and 42% males. A total of 69% of the respondents were unaware of the maximum recommended dose for use on adult, healthy patients and 85% were still confused about the maximum numbers of cartridges containing 2% lidocaine with adrenaline that can be given to a patient. A total of 53% of general dental practitioners and specialists do not perform aspiration when injecting local anesthetics , while only 43% performed the aspiration in inferior nerve block technique, while only 4% performed aspiration in all types of injection techniques. A high percentage of the dentists (87%) who responded are unaware of how to calculate the local anesthetic dose and 35% of them encountered complications during, or after, local anesthetic administration. General practitioners and dental specialists appear to have an inadequate knowledge about local anesthetics maximum-dose and dose calculations; further educational courses are recommended to update them regarding such important aspects of dentistry.

Management of a dentigerous cyst in a medically compromised geriatric patient: a case report

Because of the increasing number of older persons seeking dental care, the growing trend towards a longer dental appointment and increased administration of drugs in dentistry, the possibility of occurrence of medical emergencies in dental offices has shown an upward trend. This case report discusses enucleation of a central dentigerous cyst in a 72-year old male on long-term low dose aspirin therapy. Surgical removal of impacted tooth with total enucleation of cystic lesion was performed in the dental chair under 2% lidocaine with 1:200,000 adrenaline, 3 days after aspirin cessation. After complete debridement of the surgical site, the wound was sutured and a gauge saturated with 10% tranexamic acid was placed on surgical site for 30 minutes. No post-operative complications or bleeding was seen on subsequent appointment and healing was normal. A geriatric and medically compromised patient demands special care and attention; and the decision to cease aspirin before surgery or not is of critical importance.

Intravenous lipid emulsion – rescued at LAST

The accidental overdose of local anaesthetics may prove fatal. The commonly used amide local anaesthetics have varying adverse effects on the myocardium and beyond a certain dose all are capable of causing death. Local anaesthetics are the most frequently used drugs in dentistry and although uncommon, local anaesthetic systemic toxicity (LAST) accounts for a high proportion of mortalities in the dental office, with local anaesthetic-induced cardiac arrest particularly resistant to standard resuscitation methods. Over the last decade there has been convincing evidence of using intravenous lipid emulsions as a rescue in local anaesthetic - cardiotoxicity and anaesthetic organisations over the globe have developed guidelines on the use of this drug. Despite this, however, awareness among practitioners appears to be lacking. All who use local anaesthetics in their practice should have an appreciation of patients at high risk of toxicity, early symptoms and signs of toxicity, preventative measures when using these drugs and the initial management of systemic toxicity with intravenous lipid emulsion. In this review we intend to discuss the pharmacology and pathophysiology of local anaesthetic toxicity, and the rationale for intravenous lipid emulsion therapy.

An emphasis on the wide usage and important role of local anesthesia in dentistry: A strategic review.

Local anesthesia forms the major part of pain-control techniques in dentistry. The prevention and elimination of pain during dental treatment has benefited patients, their doctors and dental hygienists, enabling the dental profession to make tremendous therapeutic advances that would otherwise have been impossible. Introduced in the late 1940s, the amide local anesthetics represent the most used drugs in dentistry. Local anesthetics also represent the safest and most effective drugs in all of medicine for the prevention and management of pain. They are also accompanied by various adverse effects which should be well known and be able to be controlled by the clinician. The article reviews the types of agents used as local anesthetics and their effects on the human body.

Lidocaine‐induced apoptosis of gingival fibroblasts: participation of cAMP and PKC activity

Local anaesthetics are drugs that prevent or relieve pain by interrupting nervous conduction and are the most commonly used drugs in dentistry. Their main targets of action are voltage-dependent Na+ channels. The Na+ channel is modulated by phosphorylation of two enzymes: PKA (protein kinase A) and PKC (protein kinase C). We studied the ability of lidocaine to modulate programmed cell death of human gingival fibroblasts and the mechanisms involved in this process. Lidocaine (10-5 to 10-7 M) stimulated apoptosis in primary cultures and the caspase-3 activity in a concentration-dependent manner. The stimulatory effect of lidocaine on apoptosis was attenuated in the presence of HA 1004 (PKA inhibitor) and stimulated by staurosporine and Go 6976 (PKC inhibitors). Lidocaine-induced apoptotic nuclei correlated positively with cAMP accumulation and negatively with PKC activity. These results show that lidocaine promotes apoptosis in human gingival fibroblasts at concentrations used for local anaesthesia. The mechanism involves PKA stimulation and PKC inhibition, which in turn stimulates caspase-3 and leads to programmed cell death.

Interaction of articaine hydrochloride with prokaryotic membrane lipids

Objective. Local anesthetics are the most commonly used drugs in dentistry, with a wide range of effects, including antimicrobial activity. High antimicrobial effects have recently been reported on oral microbes from articaine hydrochloride, revealed by the minimum inhibitory concentration and minimal bactericidal concentration. Additionally, articaine has recently been used as an alkaline component in endodontic materials with a proposed antibacterial activity. However, the detailed mechanisms of action have not been discussed. Material and Methods. We determined the Langmuir surface pressure/molecular area isotherms of prokaryotic lipid monolayers, as well as the phospholipid phase transitions, by employing differential scanning calorimetry on unilamellar prokaryotic liposomes (bilayers). Results. Articaine hydrochloride was found to interact with the prokaryotic membrane lipids in both monolayers and bilayers. An increase of the phospholipid molecular area of acidic glycerophospholipids as well as a decrease in phase transition temperature and enthalpy were found with increasing articaine hydrochloride concentration. The thermodynamic changes by adding articaine hydrochloride to prokaryotic membrane lipids are potentially related to the effects observed from antimicrobial peptides resulting from membrane insertion, aggregate composition, pore formation, and lysis. Conclusion. Interaction of articaine hydrochloride with prokaryotic membrane lipids is indicated. Hence, further research is necessary to gain insight into where these compounds exert their effects at the molecular level.

Local Anesthetics: Dentistry’s Most Important Drugs, Clinical Update 2006

Local anesthetics are the safest most effective drugs in medicine for the control and management of pain. They also represent the most important drugs in dentistry. Today, dentistry has a spectrum of local anesthetics that permit pain control to be tailored to the specific needs of the patient: short-, intermediate-, and long-acting drugs. Bupivacaine has become a standard part of the armamentarium for postsurgical pain control while articaine has become the second-most used local anesthetic in the United States since its introduction in 2000. Despite an increase in anecdotal reports of paresthesia since articaine's introduction there is yet, no supporting scientific evidence.

Análise comparativa entre os anestésicos locais Articaína 4% e Prilocaína 3% na extração de terceiros molares retidos em humanos.

The local anesthesics are the most used drugs in Dentistry. They are frequently used in surgery, because pain has been described as an unpleasant experience, both on sensorial and psychological levels. The aim of this study was to obtain further knowledge about articaine 4% as well as to compare the effects of local anesthesics articaine with adrenaline 4% (Articaine&reg;) and prilocaine with felipressine 3% (Prilonest&reg;). The anesthesics were used in 21 surgeries, 8 articaine and 13 prilocaine, to remove semi-retained eruption of upper and lower third molar. Pre-surgery medication was administrated one hour before: Dexamethasone 4 mg and 35 drops (Dipyrone 500 mg) in post-surgery when needed. Onset of anesthesia, surgery duration, length of anesthesics effects and adverse reaction were observed, as well as the quantity of pain killers used. Data on articaine were similar to the ones found in literature.

Therapeutic uses of non-steroidal anti-inflammatory drugs in dentistry.

The non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used classes of drugs for the management of acute and chronic pain in dentistry. Their therapeutic efficacy and toxicity are well-documented and provide evidence that NSAIDs generally provide an acceptable therapeutic ratio of pain relief with fewer adverse effects than the opioid-mild analgesic combination drugs that they have largely replaced for most dental applications. The great many studies done with the oral surgery model of acute pain indicate that a single dose of an NSAID is more effective than combinations of aspirin or acetaminophen plus an opioid, with fewer side-effects, thus making it preferable for ambulatory patients. The combination of an NSAID with an opioid generally results in marginal analgesic activity but with an increased incidence of side-effects, which limits its use to patients in whom the NSAID alone results in inadequate analgesia. The selective COX-2 inhibitors hold promise for clinical efficacy with less toxicity from chronic administration and may prove advantageous for the relief of chronic orofacial pain. The use of repeated doses of NSAIDs for chronic orofacial pain should be re-evaluated in light of a lack of documented efficacy and the potential for serious gastrointestinal and renal toxicity with repeated dosing.

Side effects of drugs in dentistry.

Side effects of drugs in dentistry.

Significant Adverse Interactions of Drugs in Dentistry

An attempt has been made to discuss the adverse responses that can occur when two or more drugs are administered to the same patient. Several drugs used in dental practice or drug classes were given in tabular form as they might interact with each other or with drugs the patient might already be taking. Only those combinations of drug that are believed to produce significant adverse interactions were included. However, our knowledge of interactions of drugs is incomplete and potentially significant interactions may have been overlooked. Furthermore, new drugs with another set of actions are being marketed each year, making an attempt to simply memorize interactions a frustrating experience. Ultimately, it is the practitioners familiarity with current clinical literature and the understanding of drug actions and mechanisms by which drugs can interact that will do the most for preventing iatrogenic responses associated with multiple drug usage.

Anti-inflammatory drugs in dentistry and a criterion for judging efficacy of it

Anti-inflammatory drugs in dentistry and a criterion for judging efficacy of it

Book Reviews

Book reviewed in this article:Drugs in Dentistry. Dental Practitioner Handbook No. 9, by L. W. Kay.The Dentist, His Practice, and His Community, by W. 0. Young and D. F. Striffler.Biology of the Periodontium, edited by A. H. Melcher and W. H. Bowen.McCracken's Partial Denture Construction: Principles and Techniques, by D. Henderson and V. L. Steffel.Oral Signs and Symptoms: A Diagnostic Handbook, by Norman Wahl.Human Nutrition and Dietetics, by Sir Stanley Davidson and R. Passmore.Emergency Dental Treatment, by H. S. M. Crabb.Saad DigestComprehensive Review fob Dental Hygienists, edited by Shailer Peterson.

Analgesic Drugs of Value in the Control of Dental Pain

1. The essential features of analgesia are discussed. 2. The most important analgesic drugs and mixtures are described and appraised. 3. Therapeutic suggestions are offered. 4. An estimate is made of the future status of analgesic drugs in dentistry. 5. Information concerning the narcotic drugs which are most important in dentistry is summarized in Tables 1 and 2.