Inferior Alveolar Nerve Block Injection Research Articles

Facial Blanching after Local Anesthesia Injection: Clinico-anatomical Correlation-Review of Literature.

Facial blanching as a complication of local anesthesia is reported in dentistry. Inadvertent arterial penetration and subsequent vasospasm has been accepted as the mechanism of this phenomenon. Most cases occur after inferior alveolar nerve block injection. In this article, five cases are reported after Gow-Gates injection, maxillary nerve block via greater palatine foramen, inferior alveolar nerve block, and maxillary buccal infiltration. It is the largest case series in this topic. Also, clinico-anatomical correlation between facial–mucosal blanching and the site of intra-arterial injection is explained. To the best of our knowledge, partial blanching of the face subsequent to buccal infiltration is reported for the first time in this article. Cutaneous surgeon should be aware of this complication and should not carry out unnecessary treatment.

Buffered versus unbuffered local anesthesia for inferior alveolar nerve block injections in children: a systematic review.

BackgroundThe present study aimed to evaluate and compare the efficacy of buffered and unbuffered local anesthesia solutions during inferior alveolar nerve block (IANB) administration in children.MethodsPubMed, Ovid SP, and Cochrane databases were searched separately by two independent reviewers for potential papers published between 1980 and April 2020 using relevant MeSH terms and pre-specified inclusion and exclusion criteria. T Studies of IANB administration in children comparing buffered and unbuffered local anesthesia solutions were evaluated. The primary outcome evaluated was pain (perception and reaction), while the secondary outcome was the onset of anesthesia.ResultsA total of five articles were included in a qualitative analysis; among them, four qualified for quantitative analysis of the primary outcome and three for quantitative analysis of the secondary outcome. A fixed-effects model was used to perform the meta-analysis.Pain perception (child-reported pain): Significantly lower pain scores were reported with buffered local anesthesia solution than with unbuffered solution (P = 0.006, MD: −0.32, 95% CI: −0.55 to −0.09).Pain reaction (observer-reported pain reaction in child): No significant difference was found between buffered and unbuffered solution in terms of observer-reported pain behavior in the child (P = 0.09, MD: −0.21, 95% CI: −0.46 to 0.04).Onset of anesthesia: A significantly lower duration of anesthesia onset was reported with buffered local anesthesia solution than with unbuffered solution (P = 0.00001, MD: −12.38, 95% CI: −17.64 to −7.13].ConclusionBuffering local anesthesia solution may reduce discomfort due to IANB injection administration and lower the initial onset time of anesthesia. More randomized control trials with adequate sample sizes should be carried out to validate the accuracy of these results.

Determination of Anesthetic Efficacy of Lidocaine Versus Bupivacaine in Single Visit Root Canal Treatment.

Objective:To compare the anesthetic efficacy of 2% Lidocaine with 1:80,000 epinephrine and 0.5% Bupivacaine with 1:200,000 epinephrine in one-visit root canal treatment in patients with symptomatic irreversible pulpitis.Methods:A total of 60 patients presenting with symptomatic irreversible pulpitis with normal periapical tissues on periapical radiography of mandibular 1st and 2nd molars, reporting moderate to severe pain as assessed by visual analogue scale (VAS) for at least 24 hours were included in this study. All patients received local anesthesia via the inferior alveolar nerve block technique by the investigator. These patients were randomly allocated into two groups in which first group received 2% lidocaine with 1:80,000 epinephrine and the second group received 0.5% bupivacaine with 1:200,000 epinephrine. Patients were instructed to rate the intensity of pain during root canal treatment which was then noted on visual analogue scale (VAS).Results:The average age of the patients was 34.15±9.49 years, in which 32 (53.3%) were male and 28 (46.7%) were female. The anesthetic efficacy was significantly high in bupivacaine as compared to lidocaine local anesthesia group (76.7% versus 40%; P=0.004).Conclusion:The administration of bupivacaine anesthetic agent for inferior alveolar nerve block (IANB) injections can be a better and appropriate pain management aid as compared to lidocaine during root canal treatment of patient with symptomatic irreversible pulpitis.

Needle Gauge Influences Pain Perception During Intrapulpal Anaesthesia - A Randomized Clinical Trial.

Objective:The purpose of this randomized trial was to assess the pain perception during intrapulpal anesthesia (IP) using thinner gauge needles and syringes with or without topical anaesthesia as an adjunct.Methods:One hundred patients, on whom the inferior alveolar nerve block and intraligamentary injections failed, were recruited for the trial. Block randomization was performed and the patients were allocated into 4 groups based on the needle gauge and topical application of anaesthesia prior to IP injection. In two groups (27GN, 31GN) the patients received IP injection with 27 gauge or 31 gauge needles. The patients of other two groups received topical lignocaine-prilocaine mixture prior to the IP injection with 27 or 31 gauge needles, respectively (27GT, 31GT). The visual analogue scale (VAS) was used to assess the pain immediately after IP injection and after cleaning and shaping by a blinded outcome assessor. The Kruskal-Wallis test for overall comparisons followed by the post-hoc analysis using the Conover’s test (P<0.05) was done. Chi-square and Fischer exact test was used to assess the proportion of patients who were comfortable during IP anaesthesia.Results:The intensity of pain during IP administration with 31GN and 31GT (3.7 and 2.3 respectively) was significantly less in comparison to 27GN and 27GT (5.6 and 5.7 respectively). The proportion of patients who were significantly comfortable with IP injections in the groups 31GN and 31GT (52% and 80% respectively) were more (VAS<4) when compared to 27GN and 27GT (12% and 8% respectively). Topical application of lignocaine-prilocaine reduced the pain on IP injection significantly when used as an adjunct with 31 gauge needles. The anaesthetic success of IP anaesthesia was comparable and 100% (VAS scoring <4) in all the groups.Conclusion:Thinner gauge needles (31 gauge) significantly reduce pain perceived during IP anaesthesia. Topical anaesthesia with lignocaine-prilocaine acts as an effective adjunct only with 31gauge needle.

Anesthetic Efficacy of Lidocaine/Ketorolac in Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis: A Randomized Clinical Trial.

Objective:The purpose of this randomized, double-blind study was to evaluate the anesthetic efficacy of lidocaine-ketorolac administration by Inferior Alveolar Nerve Block (IANB) in patients with irreversible pulpitis.Methods:Eighty-eight adult patients received a combination of either one cartridge of “2% lidocaine with 1:80.000 epinephrine” (Li) plus one cartridge of a mixture of 0.8 mL of the same solution and 1mL ketorolac tromethamine (KT)(30 mg/mL), or one cartridge of Li solution plus one cartridge of a mixture of the same solution and saline. Endodontic access was prepared after fifteen minutes. Anesthetic success was defined as no or mild pain [less than 54 mm on the Heft-Parker visual analog scale (HP-VAS)] during access cavity preparation and initial file insertion. Chi-square test was used for data analysis, and the level of significance was set at 0.05 (P=0.05).Results:Results showed that the success rates were 34.1% and 27.3% for Li-KT and Li-Saline groups, respectively, with no significant difference between the two groups (P=0.48). However, significant decrease of baseline mean VAS pain score of the participants in both groups was found during access cavity preparation or initial file insertion (P<0.05).Conclusion:Mixed Li-KT solution did not increase the success rate of IANB injection significantly.

Effectiveness of two-stage versus one-stage injection in reducing discomfort during inferior alveolar nerve block in children

Background: Inferior alveolar nerve block (IANB) anesthesia is a painful procedure & many attempts are made to render the injection painless, especially in children. Aim: To assess discomfort expressed during modified two-stage IANB injection versus one-stage injection in 8-10 years old children. Subjects & Methods: Sixty children were randomly & equally allocated to either intervention group (two-stage) or control group (one-stage). For all patients, topical anesthesia gel was applied. Intervention group: A short needle was used for the initial piercing & deposition of the local anesthesia (LA), the needle was inserted for 4mm & 0.4ml of the solution was deposited, then withdrawn. After 5 min, a long needle (gauge 27) was advanced till the point of LA drug deposition & bone touching & the rest of the LA solution was deposited. Control group: A long needle was inserted, dropping 0.4 ml of the solution incrementally till the point of LA drug deposition & bone touching & the rest of the LA solution was deposited. The overall patients’ levels of discomfort were assessed using Face Legs Activity Cry Consolability scale (FLACC) & Facial Image Scale (FIS). Results were tabulated & statistically analyzed. Results: For FLACC scale, the post-anesthetic values recorded a median=1 (range=0-3) in two-stages group, & a median=2 (range=0-4) in one-stage group; with statistically significant difference between them (p=0.00). For FIS, a median=2 (range=1-4) in the two-stage group & a median = 3 (range=1-5) in one-stage group; the difference between groups was statistically significant (p=0.017). Conclusion: The two-stage IANB injection technique is a simple & an effective method of reducing the overall discomfort in children.

Trial provides very low-quality evidence of similar outcomes between inferior alveolar nerve block and intrapapillary injection when extracting mandibular premolars

Wongpang D, Makeudom A, Sastraruji T, Khongkhunthian S, Krisanaprakornkit S, Supanchart C. Anesthetic efficacies of intrapapillary injection in comparison to inferior alveolar nerve block for mandibular premolar extraction: a randomized clinical trial [published online ahead of print May 21, 2019]. Clin Oral Investig. https://doi.org/10.1007/s00784-019-02954-5.

Avoidance of Anesthesia Needle Tip Barb Formation to Reduce Risk of Injury during Inferior Alveolar Nerve Block Injection

Permanent nerve damage after receiving an inferior alveolar nerve block is a rare but well-documented phenomena for which the exact mechanism involved is still unknown. The current technique calls for the practitioner to advance the needle until bone is contacted to ensure proper deposition of the anesthetic. Potentially dangerous barbs can develop on the needle tip after contact with bone and cause direct trauma to nerve fascicles upon withdrawal or second use, which may lead to intraneural bleeding, hematoma, and scarring within the perineurium.

Prevalence of Failed Inferior Alveolar Nerve Block (IANB) in Achieving Pulpal Anaesthesia in Mandibular Molars with Symptomatic Irreversible Pulpitis

Introduction: Patient comfort during root canal treatment is immense for patient cooperation and endodontist efficiency. Establishing the high prevalence of failure of IANB injections in providing pulpal anaesthesia, will most likely support the investigation of supplemental techniques to ensure patient comfort. Objectives: The study aimed to evaluate the prevalence of failed Inferior Alveolar Nerve Block (IANB) injections in achieving pulpal anaesthesia in mandibular molars diagnosed with symptomatic irreversible pulpitis when administered alone. Methods: This study involved fifty patients, diagnosed with symptomatic irreversible pulpitis in their mandibular first and second molars. IANB injection using 2% lidocaine with 1:100,000 epinephrine was administered to anesthetize the acutely inflamed teeth before commencing root canal treatment. Lip and tongue numbness was checked subjectively after injection to ensure successful IANB injection. Objectively, cold test was performed after 15 minutes and pain level was recorded using Visual Analogue Scale (VAS). Success was defined as no pain response by (VAS) during cavity preparation, endodontic access, or initial instrumentation. Results: Although, majority of patient (96%) expressed surrounding soft tissue numbness, only 73% did not feel any pain during initiating root canal treatment. Conclusions: IANB injection alone is not enough to provide profound pulpal anaesthesia in acutely inflamed mandibular molars; therefore, supplemental injections are required to achieve patients comfort during treatment.

Pain perception and efficacy of local analgesia using 2% lignocaine, buffered lignocaine, and 4% articaine in pediatric dental procedures.

BackgroundThe purpose of this study was to compare the pain perception and anesthetic efficacy of 2% lignocaine with 1:200,000 epinephrine, buffered lignocaine, and 4% articaine with 1:200,000 epinephrine for the inferior alveolar nerve block.MethodsThis was a double-blind crossover study involving 48 children aged 5–10 years, who received three inferior alveolar nerve block injections in three appointments scheduled one week apart from the next. Pain on injection was assessed using the Wong-Baker Faces pain scale and the sound eye motor scale (SEM). Efficacy of anesthesia was assessed by subjective (tingling or numbness of the lip, tongue, and corner of mouth) and objective signs (pain on probing).ResultsPain perception on injection assessed with Wong-Baker scale was significantly different between buffered lignocaine and lignocaine (P < 0.001) and between buffered lignocaine and articaine (P = 0.041). The onset of anesthesia was lowest for buffered lignocaine, with a statistically significant difference between buffered lignocaine and lignocaine (P < 0.001). Moreover, the efficacy of local analgesia assessed using objective signs was significantly different between buffered lignocaine and lignocaine (P < 0.001) and between lignocaine and articaine.ConclusionBuffered lignocaine was the least painful and the most efficacious anesthetic agent during the inferior alveolar nerve block injection in 5–10-year-old patients.

Student-to-Student Dental Local Anesthetic Preclinical Training: Impact on Students' Confidence and Anxiety in Clinical Practice.

Effective dental local anesthetic administration forms the basis of pain-free dentistry; therefore, the application of theoretical knowledge and the ability to deliver injections safely and competently are vital aspects of student learning. Student- to-student administration of the first local anesthetic injection has been a traditional method for preclinical training. The aim of this study was to evaluate oral health students' perceived value of such practice and the impact on their level of anxiety and confidence in giving their first injections to patients. A sequential mixed-methods cohort study design was used. After their local anesthesia training, all 42 second-year students in the oral health program at the Sydney Dental School, University of Sydney, Australia, in 2016-17 were asked to complete five short questionnaires. All 42 students completed each questionnaire, after which seven of them participated in a voluntary focus group. The students reported that they valued the one-on-one feedback from the educators during student-to-student preclinical training. The students' primary concern was the possible pain and discomfort that may arise when they perform the first infiltration or inferior alveolar nerve block injections on patients. Most students reported they felt "a little nervous" and experienced a similar level of confidence in administering the two types of injections. The oral health students valued the experiential learning of student-to-student preclinical dental local anaesthetic training. Students' level of anxiety and confidence was affected by the age of patients and type of local anesthetic injections. The level of anxiety students experienced was negatively correlated with their confidence in giving first local anesthetic injections to patients. Further investigation is needed to determine if this level changes with more clinical experience.

Using Gagne's Theory and Peyton's Four-Step Approach to Teach Inferior Alveolar Nerve Block Injection

Developing skills in performing inferior alveolar nerve block injection is an essential element of the dentistry undergraduate curriculum. As a dental faculty staff member working in the conservative dentistry department, I provide preclinical and clinical teaching for dental students. This study presents a lesson plan for this injection technique using a combination of Gagne's nine events of instruction and Peyton's four-step approach. Gagne's nine events of instruction identified the mental conditions of learning that are necessary for effective learning when adult students are presented with various stimuli. This model is based on the nine instructional events used during a teaching session. These are gaining attention, defining learning objectives, stimulating recall of prerequisite learning, presenting the stimulus material, providing learning guidance, practice, providing feedback, assessing the performance, and enhancing retention and transfer. Peyton's four-step approach is a model for teaching practical skills. These are demonstration, deconstruction, explanation, and performance. Each step in this lesson plan is carefully arranged with relevant activities to suit learners with various learning styles using Gagne's theory, while Peyton's approach is incorporated to teach the actual skill. This lesson plan is particularly relevant for tutors designing injection techniques teaching for undergraduate dental and medical students and fresh graduates. In all, this lesson plan also serves as a template on which many other practical skill teachings can be subsequently modeled. The flexible adoption of Gagne's nine events of instruction in combination with other instructional models such as Peyton's approach facilitates the planning of effective clinical teaching sessions.

Success Rate of 3 Injection Methods with Articaine for Mandibular First Molars with Symptomatic Irreversible Pulpitis: A CONSORT Randomized Double-blind Clinical Trial

IntroductionPrevious studies have reported that it is difficult to obtain proper anesthesia in mandibular molars with symptomatic irreversible pulpitis, and supplemental injections are usually unavoidable. The aim of the present study was to determine the anesthetic efficacy of articaine in mandibular first molars with symptomatic irreversible pulpitis with 3 injection methods: an inferior alveolar nerve block (IANB), an IANB with an intraligamentary injection, and an IANB with buccal infiltration before initiating the endodontic treatment. MethodsNinety-six patients (54 women and 42 men) with a diagnosis of symptomatic irreversible pulpitis in mandibular first molars were selected and randomly assigned into 3 groups (n = 32) according to the injection method as follows: group 1, a conventional IANB injection; group 2, an IANB injection, and after profound lip numbness after the IANB (after 15 minutes), buccal infiltration was administered; and group 3, an IANB injection, and after profound lip numbness after the IANB (after 15 minutes), an intraligamentary injection was performed, and after 20 minutes from the IANB, the endodontic treatment was initiated. The anesthetic solution was articaine 4% with 1:100,000 epinephrine. Success was defined as no or mild pain on the basis of the visual analog scale recording upon access cavity preparation or initial instrumentation. Data were statistically analyzed using the chi-square and Mann-Whitney U tests, and P < .05 was set as significant. ResultsThe success rate for IANBs with an intraligamentary injection was 75%, and for IANBs with a buccal injection, it was 65.6%. For IANBs alone, the success rate was 28.1%. ConclusionsConsidering the limitations of the present study, in can be concluded that the success rate of IANBs increased with intraligamentary injections and buccal infiltrations with articaine that were performed before initiating treatment. Also, none of the injection methods showed complete success in anesthesia in all patients.

Anesthetic efficacy of an inferior alveolar nerve block in soft tissue and correlation between soft tissue and pulpal anesthesia.

This study was aimed at evaluating the anesthetic success rates in various regions of soft tissue after inferior alveolar nerve (IAN) block and comparing the success rates of soft tissue anesthesia with those of pulpal anesthesia to find correlations. Fifty-nine dental students received an IAN block injection. A total of four test sites were used for soft tissue anesthesia using a pressure algometer (PA): the corner of the lower lip vermilion border (LL); the buccal-attached gingiva of the lateral incisor (BGI), the molar (BGM), and the lingual gingiva (LG). The lateral incisor (LI) and the first molar (M1) were evaluated for pulpal anesthesia using an electric pulp tester. To evaluate whether soft tissue anesthesia can be an indicator of pulpal anesthesia, the positive predictive value (PPV) and negative predictive value (NPV) were calculated. The highest success rate for soft tissue anesthesia was seen on the LG (93.9%), followed by LL (79.6%), BGI (53.1%), and BGM (14.3%). The PPVs of LL for the M1 and Ll were 74.4 and 59.0%. The NPVs for the M1 and LI were much higher in the LL (90.0 and 100%, respectively) than in the BGI (56.5 and 69.6%, respectively). The highest success rate was found in the LG. Lip numbness was not an indicator of pulpal anesthesia of M1 and LI. However, if the LL was not anesthetized, the probabilities of failed pulpal anesthesia were very high in the LI and M1. The clinicians need to consider not doing an additional lingual nerve block after IAN block.

Inferior alveolar nerve block by intraosseous injection with Quicksleeper® at the retromolar area in mandibular third molar surgery.

BackgroundThere are many techniques of inferior alveolar nerve block injection (IANBI); one among them is the computer-assisted intraosseous injection (CAIOI). Here we aim to evaluate the effectiveness of CAIOI with Quicksleeper® in mandibular third molar surgery.MethodsThis study is a clinical, single-blind, randomized, split-mouth, controlled trial including 25 patients (10 males and 15 females, mean age 21 years). The patients underwent surgical removal of bilateral mandibular third molars with two different IANBI techniques. One side was injected using Quicksleeper®, and the other side was injected using a conventional IANBI. Both techniques used one cartridge (1.7 ml) of 1:100,000 epinephrine 4% articaine. A supplementary injection was used if necessary. All volumes of anesthetic agent used were recorded. Statistical analysis was performed using paired t-test and Wilcoxon test.ResultsThis research showed that CAIOI has faster onset and shorter duration of action than IANBI (P < 0.05). The pain was similar in both techniques. In the CAIOI group, one-third of the cases could be completed without additional anesthesia. The remaining two-thirds required minimal supplementary volume of anesthesia. The success rates were 68% for CAIOI and 72% for IANBI, respectively.ConclusionCAIOI is an advantageous anesthetic technique. It can be used as an alternative to conventional IANBI for mandibular third molar surgery.

Correlation of Mandibular Foramen to Occlusal Plane as a Clinical Guide for Inferior Alveolar Nerve Block in Children: A Digital Panoramic Radiographic Study.

Aim:The study aimed to correlate the position of mandibular foramen with occlusal plane as a clinical guide for inferior alveolar nerve block (IANB) injection in children from 3 to 13 years of age.Materials and Methods:The study was carried out on 180 children visiting our department and required orthopantomogram as a routine diagnostic aid. Mandibular casts were obtained and radiographs were digitally analyzed to obtain linear and angular measurements.Statistical Analysis:The measurements were correlated with the position of mandibular foramen with Karl Pearson's correlation test.Results:The results of the study suggest that the needle for IANB should be placed below the occlusal plane in 3–4-year-old children (1.26 mm approximately), almost at the level of occlusal plane in 5–7 years (0.33 mm), above the occlusal plane in 7–9 years (1.54 mm), 9–12 years (1.64 mm), 11–12 years (1.98 mm), and 12–13 years (2.9 mm), respectively. The distance of the mandibular foramen from anterior border of mandible was greater than that from posterior border. The gonial angle values decrease with increasing age.Conclusion:The bony landmarks within the jaws keep changing their relative positions along with the skeletal growth. It is therefore necessary to modify the placement of needle during local anesthesia techniques with advancing age.

Inferior Alveolar Nerve Block Injection Pain Using a Computer-Controlled Local Anesthetic Device (CCLAD): A Prospective, Randomized Study

There is evidence that the Computer-Controlled Local Anesthetic Device (CCLAD) decreases the pain of oral injections. The purpose of this study was to evaluate injection pain of the inferior alveolar nerve block (IANB) using the CCLAD in an upright position versus a supine position. Additionally, we evaluated solution deposition pain with the CCLAD when compared to previous studies using a traditional syringe. One hundred ten asymptomatic subjects were randomly given IANBs using 2% lidocaine with 1:100,000 epinephrine while in an upright sitting position and supine position, at 2 different appointments, spaced at least 2 weeks apart. Each subject rated the pain for needle insertion, needle placement, and solution deposition on a Heft-Parker visual analogue scale. Pain ratings were compared between the upright and supine positions using a repeated-measures analysis of variance with post hoc testing using the Tukey-Kramer procedure. Moderate to severe pain was reported by 10% to 13% of the patients for needle insertion, 74% to 75% for full needle placement, and 8% to 10% for solution deposition. There was no significant difference between groups for phases of the injection. When comparing the injection phases within the groups, the needle placement phase of the injection was statistically more painful than both the needle insertion phase and solution deposition phase ( p = .0001). Using the CCLAD, IANB injection pain of the supine and upright positions was not statistically different. Needle placement was the most painful phase of the injection. Solution deposition pain was less with the CCLAD when compared to other studies of the IANB using a traditional syringe.

Anesthetic Efficacy of Gow-Gates Nerve Block, Inferior Alveolar Nerve Block, and Their Combination in Mandibular Molars with Symptomatic Irreversible Pulpitis: A Prospective, Randomized Clinical Trial

IntroductionThe purpose of this prospective, randomized clinical trial was to evaluate the anesthetic efficacy of the Gow-Gates nerve block (GGNB), the inferior alveolar nerve block (IANB), and their combination for mandibular molars in patients with symptomatic irreversible pulpitis. MethodsOne hundred fifty patients diagnosed with symptomatic irreversible pulpitis of a mandibular molar were selected. The patients randomly received 2 GGNB injections, 2 IANB injections, or 1 GGNB injection plus 1 IANB injection of 1.8 mL 2% lidocaine with 1:80,000 epinephrine. Access cavity preparation was initiated 15 minutes after injections. Lip numbness was a requisite for all of the patients. Success was specified as no or mild pain on the basis of Heft-Parker visual analog scale recordings during access cavity preparation or initial instrumentation. Data were analyzed with the chi-square, Kruskal-Wallis, and analysis of variance tests. ResultsThe success rates of anesthesia were 40%, 44%, and 70% for the GGNB, IANB, and GGNB + IANB groups, respectively. There was no statistically significant difference in the success rate of anesthesia between the GGNB and IANB groups (P > .05). The anesthesia success rate for the GGNB + IANB group was significantly different from those of the GGNB and IANB groups (P < .05). ConclusionsA combination of GGNB and IANB could improve the efficacy of anesthesia in mandibular molars with symptomatic irreversible pulpitis, but it would still require supplemental anesthesia. Further research may be needed to confirm the results of this study.

Efficacy of transcutaneous electronic nerve stimulation in alleviating pain during inferior alveolar nerve block injections in pediatric dentistry

Aim: This study was carried out with the aim of comparing the efficacy of Transcutaneous electrical nerve stimulation (TENS) and 20% benzocaine gel prior to inferior alveolar nerve block (IANB) injections in alleviating pain in children of 8–12 years of age. Materials and Methods: The sample included fifty children in whom TENS application was done and fifty children in whom benzocaine topical application was done prior to administration of IANB injections for the extraction of mandibular posterior teeth. Pain perception was evaluated using Wong–Bakers Facial Pain Rating Scale in both the groups. ANOVA test was used to evaluate the differences in mean pain scores between the groups. Results: The patients demonstrated significant reduction in pain during IANB when TENS was used with a mean pain score of 3.36 as compared to topical application of local anesthetic agent with a mean pain score of 4.76, indicating higher efficacy of TENS. Conclusion: Application of TENS was more comfortable and significantly reduced pain. TENS is a safe, reliable, and practical alternative to be used in pediatric dentistry.

Is Inferior Alveolar Nerve Block Sufficient for Routine Dental Treatment in 4- to 6-year-old Children?

IntroductionPain control is one of the most important aspects of behavior management in children. The most common way to achieve pain control is by using local anesthetics (LA). Many studies describe that the buccal nerve innervates the buccal gingiva and mucosa of the mandible for a variable extent from the vicinity of the lower third molar to the lower canine. Regarding the importance of appropriate and complete LA in child-behavior control, in this study, we examined the frequency of buccal gingiva anesthesia of primary mandibular molars and canine after inferior alveolar nerve block injection in 4- to 6-year-old children.Study designIn this descriptive cross-sectional study, 220 4- to 6-year-old children were randomly selected and entered into the study. Inferior alveolar nerve block was injected with the same method and standards for all children, and after ensuring the success of block injection, anesthesia of buccal mucosa of primary molars and canine was examined by stick test and reaction of child using sound, eye, motor (SEM) scale. The data from the study were analyzed using descriptive statistics and statistical software Statistical Package for the Social Sciences (SPSS) version 21.ResultsThe area that was the highest nonanesthetized was recorded as in the distobuccal of the second primary molars. The area of the lowest nonanesthesia was also reported in the gingiva of primary canine tooth.ConclusionAccording to this study, in 15 to 30% of cases, after inferior alveolar nerve block injection, the primary mandibular molars’ buccal mucosa is not anesthetized.How to cite this article: Pourkazemi M, Erfanparast L, Sheykhgermchi S, Ghanizadeh M. Is Inferior Alveolar Nerve Block Sufficient for Routine Dental Treatment in 4- to 6-year-old Children? Int J Clin Pediatr Dent 2017;10(4):369-372.