Inferior Alveolar Nerve Block Anesthesia Research Articles

Influence of computerized intraosseous anesthesia compared with traditional mandibular nerve block on children's behavior: A randomized clinical trial.

Effective pain management is crucial for the successful completion of dental procedures in children. Research has examined whether computerized intraosseous anesthesia (CIOA) could serve as a safe and viable substitute for the conventional inferior alveolar nerve block (IANB) technique in pediatric patients. This study investigates the efficacy of CIOA, aiming to determine its effectiveness as an alternative anesthesia method. This study compared the efficacy of local intraosseous anesthesia using a computerized device (QuickSleeper 5) to conventional IANB anesthesia on cooperation and pain perception in children, using a randomized controlled trial design. The study included 88 healthy children, aged between 6 and 9 years, who required pulpotomy for their mandibular second primary molars. The study was approved by the local research ethics committee and registered at clinicaltrials.gov (NCT05193487). The heart rate and Venham behavior rating scale were recorded and analyzed. Categorical data were analyzed using Fisher's exact test. Age and heart rate were compared using an independent t-test for intergroup comparison. The intragroup comparison was carried out using repeated measures ANOVA, followed by the Bonferroni post hoc test. The Mann-Whitney U-test was used to analyze the Venham scale scores. The significance level was set at p < .05 RESULTS: The mean Venham score was slightly higher in the IANB group than in the CIOA group, but was not statistically significant (p = .852). One minute after anesthesia administration, the heart rate (beats per minute [BPM]) was significantly higher in the IANB group (92.30 ± 13.45) than in the CIOA group (83.20 ± 10.40) (p < .001). Additionally, there was a significant difference in heart rate values measured at different intervals within the IANB group. The QuickSleeper 5 device was found to be a feasible alternative for IANB in children over 6 years old.

Expediting the reversal of inferior alveolar nerve block anesthesia in children with photobiomodulation therapy.

In pediatric dentistry, complications arising from extended soft tissue anesthesia can negatively impact patient comfort and trust in dental care. This study evaluates the clinical efficacy of diode laser-based photobiomodulation therapy (PBMT) in expediting the resolution of anesthesia in children aged 6-9 receiving inferior alveolar nerve block (IANB) injections. In this split-mouth double-blind randomized clinical trial, 36 pediatric subjects aged 6-9, requiring pulpotomy procedures on both sides of the mandible, received IANBs (single cartridge of 2% lidocaine/1:100,000 epinephrine). PBMT and sham laser were alternately applied to each side of the mandible, in two separate sessions, with the envelope method determining treatment allocation and intervention side on the first treatment day. During the laser session, laser (808nm, 250 mW, 23s continuous, 0.5cm², 11.5J/cm², direct contact) irradiated two points at the injection site, five intra-oral and five extra-oral points along the infra-alveolar nerve's pathway. Soft tissue anesthesia reversal was quantified through tactile assessment. Soft tissue trauma was also assessed by the researcher and reported by parents 24h post-dental visit. All data were analyzed using IBM SPSS Statistics v25.0 via Paired T-test, two-way repeated measures ANOVA, and McNemar's test. The laser group exhibited a mean lip anesthesia duration of 122.78 ± 2.26min, while the sham laser group experienced 134.44 ± 21.8min, indicating an 11.66-minute reduction in anesthesia duration for the laser group. (P < 0.001) Soft tissue trauma occurred in two sham laser group patients and one laser group patient, with no significant difference. (P = 1) The findings indicate that employing laser with defined parameters can reduce the length of IANB-induced anesthesia.

Assessment of photobiomodulation by a 660-nm diode laser on the reversal of soft tissue anesthesia in children: A randomized controlled clinical trial.

Soft tissue anesthesia (STA) following inferior alveolar nerve block (IANB) anesthesia lasts 3-5 h. It is important to reverse STA after treatment to prevent soft tissue injury (STI). This study evaluated photobiomodulation using a 660 nm diode laser on STA reversal and its impact on STI following IANB anesthesia. A randomized controlled clinical trial was conducted on 32 children, aged 5-8 years, allocated into the test and control groups. Anesthesia was administered; the operative procedure was performed followed by exposure to laser. STA reversal was monitored through lip tapping, current perception threshold (CPT) tests, and paediatric Functional Assessment Battery. The test group showed significantly faster recovery to normal sensation following exposure to laser than the control group which did not undergo any reversal (p < .0001), with a median time of 115 and 60 min according to lip tapping and CPT tests, respectively. The test group also showed significantly faster recovery to normal function (p = .016). The incidence of STI in the form of redness was significantly higher in the control group (p = .022). Photobiomodulation using a 660 nm diode laser can be considered as an efficient approach to minimize STA and STI after dental interventions.

Student training in administering inferior alveolar nerve block anesthesia with a simple manufactured simulation model.

To compare the effectiveness of administering inferior alveolar nerve blocks (IANB) for the first time with or without a previous practical lesson using a simple manufactured simulator. This was a study designed to compare students' first administration of IANB anesthesia during 2022, with or without a previous practical lesson. Students were randomized into two groups. The experimental group attended both theoretical lessons and a practical lesson with a simulator device, while the control group attended only theoretical lessons. The theoretical lesson included usual contents such as anatomy, physiology, technical maneuvers for administering anesthesia, tips, and complications, and the practical lesson consisted of the administration of anesthesia using a simple manufactured simulator. After students applied their first IANB, its efficacy, and their answers to a questionnaire on a 5-point Likert scale were recorded. Statistical analysis consisted of the Chi-square test (p<0.05). The study recorded 60 anonymous surveys. The main difference observed was in instrument handing (p<0.05), and there was a tendency in the ease of recognition of the anatomical marks used for the technique-pterygomandibular raphe and coronoid notch of the mandible (p=0.08 and 0.11, respectively). No difference in success was observed (p>0.05). Self-confidence and personal feelings did not differ statistically. All students agreed strongly or partially that training with the simulator model was helpful. Students who used simple manufactured simulators achieved better outcomes for instrument handling, and possibly for identification of anatomical landmarks, than those who received only theoretical lessons.

A Comparative Evaluation of Pain Experience and Time of Onset of 2% Lignocaine and 4% Articaine in Inferior Alveolar Nerve Block among Pediatric Population: A Clinical Study.

The objective of this research was to conduct a comparison and evaluate the pain perception and time of onset of 2% lignocaine 1:80,000 epinephrine with 4% articaine 1:100,000 epinephrine in the pediatric population. A split-mouth randomized control trial was conducted on 50 children aged 9-14 years who required inferior alveolar nerve block (IANB) anesthesia for bilateral dental treatment in the mandibular arch. The time of onset was recorded when no sensation was reported even when maximum electrical stimulus was applied in an electric pulp testing (EPT). The pain perception was assessed using a visual analog scale (VAS) rated by the patient for subjective symptoms and face, legs, activity, cry, and consolability (FLACC) scale for objective pain rated by the operator. The mean onset of time, pain-VAS, and FLACC score decreased by 1.31, 12.07, and 18.39%, respectively in 4% articaine as compared to 2% lignocaine but the difference did not reach statistical significance (p > 0.05), that is, found to be statistically the same.In conclusion, it can be inferred that the utilization of 4% articaine is as potent as 2% lignocaine solution but showed slightly better onset of anesthesia and pain experience among the children although the findings were not statistically significant. Local anesthesia (LA) is one of the main methods of pain management in pediatric practice which makes it essential to choose an LA agent with a shorter time of onset and less pain on administration. Singh SS, Koul M. A Comparative Evaluation of Pain Experience and Time of Onset of 2% Lignocaine and 4% Articaine in Inferior Alveolar Nerve Block among Pediatric Population: A Clinical Study. Int J Clin Pediatr Dent 2024;17(1):67-71.

Effect of Virtual Reality on Dental Pain in Children during Local Anesthesia Administration

ABSTRACT Background: Dental procedures often generate anxiety and fear in children. Virtual reality (VR) is a novel method of distraction for behavior management during dental treatment. Aim: To evaluate the effect of using VR eyeglasses on anxiety/pain during local anesthesia (LA) administration for children. Materials and Methods: Children aged 6–12 years, rated to be Frankl +(positive) or −(negative) without any systemic background were included. Children receiving inferior alveolar nerve block anesthesia were randomized into two groups: Control group (n = 20) exposed to Tell-Show-Do (TSD) alone and study group (n = 20) exposed to TSD with VR through the use of head-mounted immersive type of display powered by a smartphone VR box. Oxygen saturation (SpO2), pulse rate (PR), and anxiety/pain were monitored preoperatively, during LA administration and postoperatively. Results: SpO2 showed no significant difference between the groups, whereas PR and perceived pain levels were significantly different between the groups. Conclusions: PR and pain scores were reduced with the use of VR in children during the administration of LA. VR can be an effective tool in managing behavior of children rated Frankl positive and negative.

Role of Age, Gender and Vertical Facial Type on Anatomical Location of Mandibular Foramen in Paediatric Population: A Cross-sectional Study

Introduction: Pain management is paramount in paediatric dental care, influencing patient cooperation and future perceptions of dental treatment. The widely used Inferior Alveolar Nerve Block (IANB) anaesthesia faces challenges in children due to anatomical variations. The position of the mandibular foramen, which evolves with age, growth patterns, and facial types, necessitates customised approaches for effective paediatric pain management. Aim: To identify the position of the mandibular foramen amongst children aged 7-14 years with respect to age, gender, and facial types. Materials and Methods: In a cross-sectional study conducted in West Bengal, India, 126 children aged 7-14 were investigated from March 2021 to August 2022. The Orthopantomograms (OPG) and lateral cephalograms were assessed for the location of the mandibular foramen with respect to age, sex, and facial type in clear radiographs with normal growth. Statistical analysis encompassed descriptive statistics, Analysis of Variance (ANOVA), and multiple linear regression analysis. Results: A total of 126 x-rays were analysed across age, gender, and facial types, showing a mean age of 10.78 years. There were 52 (41.3%) males and 74 (58.7%) females. The distribution of subjects according to facial types was as follows: short (n=33, 26.2%), normal (n=19, 15.1%), and long (n=74, 58.7%). The vertical position of the mandibular foramen increased with age. No significant gender difference was observed regarding the vertical position of the mandibular foramen. However, a significant variation across facial types was observed, with individuals with normal faces exhibiting a greater vertical position. Conclusion: This study revealed that the vertical position of the mandibular foramen increases with age. There was no significant difference found between males and females in the location of the mandibular foramen; however, individuals with normal faces exhibited a greater vertical position of the same

Topographical anatomy of the mandibular foramen in the dromedary camels (Camelus dromedarius): an extraoral approach for the inferior alveolar nerve blocks.

Understanding the clinical anatomy of the head is essential for performing proper inferior alveolar nerve (IAN) block anesthesia to facilitate invasive dental procedures in camels. However, osteometric data related to the IAN in camels are lacking. This study was carried out to accurately locate the mandibular foramen (MF) and the course of the IAN in the camel head and to establish an approach for its localization in clinical practice. To achieve these aims, eight osteometric measurements were used to determine the location of the MF in relation to its surrounding structures in six cadaveric skulls of adult camels. Four camel heads were dissected, and the course of the IAN inside the mandibular canal was studied. In addition, four heads were used as a trial for the extraoral approach to the IAN block using contrast radiographs based on established metric indices. Dissection of the four camel heads revealed that the MF was located near the intersection of two lines passing through the occlusal surface of the mandibular cheek teeth and at the midpoint of the zygomatic process of the temporal bone. Significant differences were not observed between the right and left mandibles. Successful deposition of the contrast medium near the MF was observed in all examined specimens. This study reports a new, simple approach to reaching the IAN at the MF. However, further clinical validation of the proposed technique is required.

Research on cone-beam CT of mandibular foramen location in children aged 7-10 years

Objective: Cone-beam CT (CBCT) images were used to investigate the relative position changes of mandibular foramen in the mandible of children and the relative position relationship with the occlusal plane, so as to provide clinical guidance for inferior alveolar nerve block (IANB) anesthesia of children. Methods: The CBCT data of 202 children aged 7-10 years in the image database of the First Affiliated Hospital of Zhengzhou University from March 2021 to February 2023 were included. Patients were divided into 4 groups according to age diffrences as 7-year-old, 8-year-old, 9-year-old and 10-year-old. There were 20 males and 22 females in the 7-year-old group, 31 males and 28 females in the 8-year-old group, 30 males and 26 females in the 9-year-old group, and 22 males and 23 females in the 10-year-old group, respectively. Forty-six adults aged 25-30 years were selected as control group, 24 males and 22 females included. The distance between the center point of mandibular foramen with the anterior edge of ascending ramus of mandible (MF-A), the posterior edge of the ascending ramus of mandible (MF-P) and the shortest distance between the center point of mandibular foramen with occlusal plane (MF-OP) were measured. The angle between the center point of the mandibular foramen with the sagittal plane of the mandibular first deciduous molar (or mandibular first premolar) and mandibular second deciduous molar (or mandibular second premolar) (∠A) was measured. The data of mandibular foramen were compared between the left and right sides and among different genders and different age groups. Results: The position of mandibular foramen in children aged 7-10 years maintained bilateral symmetry, and mandibular growth and development were relatively consistent between different genders (P>0.05). MF-A increased with age, from (15.83±1.28) mm in 7-year-old group to (17.10±1.60) mm in 10-year-old group gradually. There were significant differences in MF-A between the 10-year-old group with the 7-year-old group, the 8-year-old group [(15.98±1.53) mm] and the 9-year-old group [(16.43±1.49) mm] respectively (P<0.05). MF-P increased with age, from (9.12±1.17) mm in 7-year-old group to (11.25±1.60) mm in 10-year-old group. There were statistically significant differences in MF-P among all age groups (P<0.05). MF-OP increased with age, from below the plane (-0.24±2.31) mm in the 7-year-old group to above the plane (1.08±1.95) mm in the 10-year-old group. There were significant differences between the 10-year-old group with the 7-year-old group, the 8-year-old group [(-0.01±1.93) mm], and the 9-year-old group [(0.31±1.95) mm] (P<0.05). The ratio of MF-A to MF-P decreased as the age increased, from 1.77±0.30 in the 7-year-old group to 1.55±0.29 in the 10-year-old group. There were statistically significant differences in MF-A/MF-P among all age groups (P<0.05), except for between the 8-year-old group (1.66±0.19) and the 9-year-old group (1.65±0.28) (P>0.05). The ∠A of children in all age groups was significantly greater than the reference value (45°) (P<0.05), and there was no statistical significance among all groups (P>0.05). The differences of MF-A, MF-P, MF-OP, MF-A/MF-P and ∠A between children of all age groups and the control group were statistically significant (P<0.05). Conclusions: In children aged 7-10 years, the mandibular foramen is located behind the midpoint of the anteroposterior diameter of the mandibular ramus. With the increase of age, the mandibular foramen gradually moves from below the occlusal plane to above, and is flush with the occlusal plane at the age of 8 years. Compared with adults, the mandibular foramen in children is more backward and lower on the medial side of the mandibular ramus. When IANB is operated to children, the syringe can be moved distally from the contact area of the contralateral deciduous molars or premolars, so that the injection angle can be greater than the reference value 45° to improve the accuracy of IANB.

Effectiveness of buccal infiltration anaesthesia compared to inferior alveolar nerve block anaesthesia in primary mandibular molar extractions: a randomised controlled study.

Aim The current study assessed the efficiency of buccal infiltration (BI) and inferior alveolar nerve block (IANB) during the extraction of deciduous mandibular molars.Subjects and method A total of 112 children aged between 5-8 years with mandibular molar indicated for extraction were divided into two groups at random. The BI group was injected with 4% articaine using BI, while the IANB group was injected with 2% lidocaine using IANB. The effectiveness of both techniques was examined using the Wong-Baker FACES Pain Rating Scale (W-BFPRS); Faces, Legs, Activity, Cry, and Consolability (FLACC) scale; and pulse oximetry.Results Using the W-BFPRS scale, success rates were 83.9% and 75.0% for the BI group and 82.1% and 71.4% for the IANB group during the injection and extraction, respectively, while using the FLACC scale, success rates were 83.9% and 92.9% for the BI group and 78.6% and 89.3% for the IANB group. In terms of pulse rate and oxygen saturation, there was no significant difference between the two groups.Conclusions BI with articaine is as efficient as IANB with lidocaine in the extraction of deciduous mandibular molars.

Efficacy of inferior alveolar nerve block and intraligamentary anesthesia in the extraction of primary mandibular molars: A randomized controlled clinical trial

ObjectiveThe study aims to compare the effectiveness and quality of intraligamentary anesthesia (ILA) and inferior alveolar nerve block (IANB) for primary mandibular molar extraction. MethodsThis prospective, randomized clinical study included patients aged 5 to 13 years scheduled for primary mandibular molar extraction. A total of 208 participants were randomly allocated into two groups (n = 104 each group), IANB and ILA, who were administered 2% lignocaine with epinephrine 1:100,000. Patients rated their pain during injection and extraction (VAS pain score). Frankl’s behavior rating score, quality of anesthesia as perceived by clinician, and duration of procedure were recorded. Demographic and other variables were analysed using Pearson x2 test, Pearson correlation coefficient, Fisher exact test, or an analysis of variance, as appropriate. ResultsIn patients who received IANB, the clinician reported a slightly better quality of anesthesia (p = 0.19) than those who received ILA (VAS score 1.3 ± 0.7 Vs 1.6 ± 0.4). Mean (±SD) score for pain during extraction were found be 1.7 (±0.6) for the IANB group and 1.8 (±0.5) for the ILA group. The clinician observed 46.2% of patients in the IANB group and 39.4% of patients in the ILA group had no discomfort during extraction. Frankl’s behavior score was negatively correlated with the quality of anesthesia and the time taken to complete the extraction (p = 0.017 and p = 0.053, respectively). ConclusionThe efficacy of conventional ILA was similar to IANB, and thus ILA might be a good alternative to the IANB while extracting primary mandibular molars.

Effectivness of submucosal, oral and intramuscular routs of dexamethasone administration in trismus, swelling, and pain reduction after the third lower molar surgery

Background/Aim. Surgical extraction of impacted lower third molars is inevitably followed by the postoperative occurrence of trismus, swelling, and pain sensations to some degree. Corticosteroids (dexamethasone in particular) are commonly used drugs in the prevention of these complications. The aim of this study was to determine the effectiveness of dexamethasone in the prevention of postoperative complications, edema, trismus, and pain after the surgical extraction of impacted lower third molars, depending on the method of its administration. Methods. This prospective study involved 30 healthy patients, aged 18 years and above, of both sexes, with fully impacted lower third molar ? class I or II and position B or C, according to Pell and Gregory classification system and vertical position according to Winter classification. All patients were divided randomly into three groups de-pending on the way of dexamethasone administration: oral ? dexamethasone administered in the form of oral tablets in a dose of 4 mg one hour before the surgery; submucosal ? dexamethasone solution administered submucosally in a dose of 4 mg in the area of the buccal sulcus, after the inferior alveolar nerve block anesthesia and additional anesthesia for the buccal nerve; intramuscular ? dexamethasone solution administered intramuscularly in a dose of 4mg into the area of the deltoid muscle, right before the intervention. Preoperatively and at every follow-up (on the first, second, and seventh day postoperatively), interincisal distance, the degree of edema, and the level of pain with the use of a visual analog scale (VAS) were measured. On the seventh postoperative day, the total number of analgesics taken by the patients was recorded. Results. In the postoperative period, there was no statistically significant difference be-tween the examined groups in terms of effectiveness in swelling, trismus, and pain reduction (p &gt; 0.05). Conclusion. There is no significant difference in dexamethasone effectiveness in postoperative trismus, swelling, and pain reduction after the third lower molar surgery, regarding the route of administration ? oral, intramuscular, or local submucosal.

A Comparison between Inferior Alveolar Nerve Block and Crestal Anesthesia in Children Undergoing Dental Extraction Procedure

A Comparison between Inferior Alveolar Nerve Block and Crestal Anesthesia in Children Undergoing Dental Extraction Procedure

Anaesthetic efficacy and influence on cardiovascular parameters change of intraosseous computerised anaesthesia versus inferior alveolar nerve block anaesthesia in acute irreversible pulpitis of mandibular molars: study protocol for a prospective randomised controlled trial

BackgroundIrreversible pulpitis is a highly painful inflammatory condition of the dental pulp. The recommended care is the removal of the coronal pulp (pulpotomy) for emergency treatment in multi-rooted teeth. However, achieving adequate analgesia in the case of mandibular molars presents many difficulties according to the dental literature. Intraosseous computerised anaesthesia (ICA), in particular, the QuickSleeper™ system, has already been demonstrated to be clinically efficient, but ICA is known to increase the heart rate reversibly in a manner that depends on the speed of injection. Therefore, accelerated heart rate was examined as a potential adverse effect of this injection. This trial aims to compare the cardiovascular effects and the anaesthetic efficacy of ICA versus inferior alveolar nerve block anaesthesia (IANB) in acute irreversible pulpitis of mandibular molars.MethodsThis study is a non-inferiority prospective, randomised, controlled, single-blind, two-group trial conducted at the Nantes University Hospital. The study design included two parallel arms at a ratio of 1:1 that will allocate seventy-two patients into two groups: the first group will receive QuickSleeper™ intraosseous anaesthesia; the second will receive an inferior alveolar nerve block before emergency treatment (pulpotomy). This study will include patients requiring emergency dental care under local anaesthesia with confirmed irreversible pulpitis in mandibular molars. The primary outcome is the time taken for the fluctuations in the cardiovascular parameters to return to baseline values during endodontic treatment in two different anaesthetic techniques. The secondary outcomes include efficacy of the technique, patient’s pain perception before and after care, any post-operative effects, and factors associated with the delay of recovery of cardiovascular parameters between the 2 anaesthetic techniques.DiscussionThis trial will evaluate the factors associated with heart rate increase during local anaesthesia administration. The use of blood pressure and cardiovascular measurements can be considered an asset and additional safety in managing local anaesthesia. Detecting early signs of potential adverse events (AEs), particularly patients with certain medical conditions (cardiac rhythm disorders), would suggest caution in administering anaesthesia.Trial registrationClinicalTrials.gov ID: NCT03802305 registered January 14, 2019. (version no. 1.2; 5 November 2021)

Impact of Clinical Expertise on Inferior Alveolar Nerve Block Anaesthesia Resulting in Transient Facial Nerve Palsy; A Cross-sectional Study Amid Pakistani Dental Graduates

Objective: The purpose of the study is to observe the impact of clinical expertise on inferior alveolar nerve block (IANB) anaesthesia resulting in transient facial nerve palsy (FNP) in dental operators having different levels of clinical experience. Methodology: This observational cross-sectional study was conducted in the Department of Dentistry, Jinnah Postgraduate Medical Center. The study was conducted over a period of six months, starting from September 2021 and lasting till February 2022. The patients who required IANB for any dental treatment in lower posterior teeth were divided into three groups between dental operators: Undergraduates (Interns), Graduates (House Officers), and Postgraduate trainees, having 100 cases in each group. A structured questionnaire was administered through convenience sampling to dental operators. Data was analyzed by using SPSS version 24. Results: A total of 300 cases were part of the study. According to the results, 28% (n=84) of patients suffered from transient facial nerve palsy following IANB. Out of this 84%, 15% (n=45 of total cases) were by Undergraduates (Interns), 10% (n=30 of total cases) were caused by Graduates (Interns), and only 3% (n=9 of total) incidences happened following IANB by Postgraduate trainees. Conclusions: The incidence of IANB-related facial nerve palsy (FNP) is comparatively more in junior dental operators, which depicts their lack of clinical experience.

A Systematic Review on Nerve-Related Adverse Effects following Mandibular Nerve Block Anesthesia.

Inferior alveolar nerve (IAN) block injections are commonly used in clinical practice, but they are not free from complications. The aim of the present systematic review is to assess the nerve-related adverse effects of IAN block anesthesia. A structured and systematic search was performed on the major electronic databases (PubMed, Cochrane Library, Web of Science, Scopus and CINAHL) for studies published in English until 30 September 2021. A total of 131 articles were identified through database searching using combinations of keywords. Fifteen papers were included and assessed for eligibility. Overall, nerve damage following an IAN block anesthesia injection is a rare occurrence, probably due to the direct nerve trauma of the needle, a neurotoxic effect of the used anesthetic solution and/or a combination of them. From a medico-legal point of view, a balanced discussion prior to nerve block anesthesia should be pursued in order to avoid patients’ reluctance to undergo necessary dental treatment due to the remote eventuality of nerve injury.

Anatomical review of the mandibular lingula for inferior alveolar nerve block.

The purpose of this study was to perform a review of the literature related to the anatomy of the mandibular lingula and to provide information to improve the execution of effective anaesthesia of the inferior alveolar nerve in clinical practices of the mandible. Prognathic mandibles have a lingula that is located more posterior and superior than non-prognathic mandibles. Most of the lingulae are located above the occlusal plane, but it is occasionally located at or below the occlusal plane. The lingula of the triangular shape was generally located slightly more superior and posterior than other shapes. The mandibular lingula is an important anatomical landmark, and accurate information for exact lingula features is required during inferior alveolar nerve block anaesthesia. Proper evaluation of the lingula is key to effective anaesthesia and decreases the failure rate of the inferior alveolar nerve in clinical practices of the mandible.

The Effect of Pretreatment Conditioning by Mothers on Dental Behavior of Children: A Randomized Clinical Trial

Background: Behavior management techniques are an integral component of pediatrics dental visits. Objectives: This study aimed to evaluate the effect of child pretreatment conditioning by mothers on the dental behavior of children during dental treatment. Methods: Following a randomized clinical trial design, this study was conducted on 72 child-mother dyads, attending the pediatric dental department of Zahedan University of Medical Sciences (southeast of Iran). The children were 3 to 6 years old and required pulpotomy of one asymptomatic carious primary mandibular molar under inferior alveolar nerve block anesthesia. The dyads were randomly divided into control and intervention groups. Data on age and gender of children, mother’s age, and parents’ education were collected. Mothers in the intervention group received a brochure, containing information on how to prepare the child at home to better cope with the dental procedure. Those in the control group received no intervention. A one-month interval was set between the randomization and treatment. For both groups, an experienced pedodontist performed pulpotomy and stainless steel crown placement in a single session. The dental behavior of children during the operation was scored by a blind instructed and calibrated observer, using the Franckle behavior rating scale. Data were analyzed using the chi-square test, Fisher’s exact test, and Mann-Whitney U test in SPSS version 20 at a significance level of 0.05. Results: The child dental behavior in the intervention group was more frequently acceptable than their counterparts, and a significant difference was found between the groups (P = 0.047). The intervention was successful, regardless of the child's gender and age, mother’s age, and parents’ education (P &gt; 0.05). Conclusions: Based on the results, dental practitioners can promote child behavior by engaging mothers to prepare their children before dental procedures.

Risks posed by bilateral inferior alveolar nerve block: Myth or reality?

BackgroundThanks to scientific advances and the widespread availability of information, knowledge and clinical guidelines are being constantly reviewed. Some beliefs previously well entrenched are now outdated, but nevertheless remain deeply anchored. In the era of evidence-based medicine, we decided to examine one of these myths: the risks posed by bilateral inferior alveolar nerve block (BIANB) anaesthesia. Material and methodsAn electronic survey containing nine questions was circulated to a large group of dental and maxillofacial surgeons practicing in Belgium. The questions concerned both their own practice and their views on this method. A review of the literature was also carried out. Results742 participants answered the questionnaire. Of those who responded, 42% considered that this technique of local anaesthetic should be avoided. Half of those participants composing this 42% believed that this type of anaesthesia exposed patients to serious health risks. No report of any complications was found in the literature. ConclusionDespite widespread apprehensions about bilateral inferior alveolar nerve block, the absence of scientific evidence concerning the complications of BIANB, supported by considerable clinical experience in the use of this loco-regional anaesthesia, shows that BIANB is a safe method and one that improves the quality of life of patients.

EFFECT OF PHENTOLAMINE MESYLATE ON THE INCIDENCE OF SELF-INFLICTED SOFT TISSUE INJURY FOLLOWING INFERIOR ALVEOLAR NERVE BLOCK ANESTHESIA IN CHILDREN: (RANDOMIZED CONTROLLED CLINICAL TRIAL)

INTRODUCTION:One of the shortcomings of local anesthesia (LA) is that the soft tissue anesthesia (STA) typically lasts for 3 to 5 hours while most routine dental procedures are completed in less than an hour. Pediatric patients particularly may accidently bite on their lips. OBJECTIVES: The study was conducted to evaluate the effectiveness of phentolamine mesylate (PM) on the reduction of the incidence of self-inflicted soft tissue injury (STI) and its effect on the time of return of normal function, after inferior alveolar nerve block anesthesia. MATERIALS AND METHODS: The study is a blinded randomized controlled parallel group clinical trial with a 1:1 allocation ratio. A total of eighty pediatric patients, with an age range of 5-8 years, selected from the Pediatric Dentistry out-patient clinic, Faculty of Dentistry, Alexandria University, after obtaining necessary consents. Inferior alveolar nerve block anesthesia (2 percent lidocaine with 1:100,000 epinephrine) was administered in the recommended dose. After completion of the operative procedure, participants were randomly allocated into 2 groups: study and control group. The experimental group received a PM injection using the same technique employed for administration of LA, in a cartridge ratio of 1:1. The control group did not receive any reversal agent. The incidence of self-inflicted STA and return to normal function were recorded post-operatively and STI was followed up after 24 hours. RESULTS: There were no significant differences in the incidence of self-inflicted STI between the PM and control group except for the occurrence of ulcers after 24 hours (P=0.04). Phentolamine mesylate accelerated the median time of return to normal function (P =0.001). CONCLUSION: Phentolamine mesylate was efficacious in reducing the incidence of self-inflicted soft-tissue ulceration and accelerated the time of return to normal function after LA.