Dental Local Anesthesia Research Articles

Topical anesthetics methods used to reduce needle pain/discomfort prior to local anesthesia in children and adolescents: a scoping review.

The aim of this study was to review the most effective topical anesthetic methods for reducing pain/discomfort prior to dental local anesthetic needle puncture for dental procedures in children and adolescents. A scoping review was conducted. Individual search strategies were developed for each of the bibliographic databases (Cochrane, Embase, LILACS, LIVIVO, Pubmed, Scopus, PsyINFO, Web of Science), and in the gray literature (Google Scholar, Open Gray), comprehensively, without restrictions on language, publication data, or level of socioeconomic development of the country in which the study was conducted. The search was conducted on April 21, 2021 and the updates on May 24, 2024. Randomized controlled studies conducted in patients up to 18 years of age were included. Variables collected: characteristics of the included studies, topical anesthetics evaluated, time and the mode of application. Initially, 8579 studies were retrieved. Then 3127 were identified as eligible, of which (n = 3127), 52 studies were included in the narrative synthesis. The most commonly observed anesthetic methods with the most favorable outcomes were lidocaine, benzocaine, ice cooling, and EMLA. Spray, gel or patch were used, with application times ranging from 1 to 10 min. Mucosal cooling an ice stick was analyzed by eight studies. Only one showed a smaller reduction in pain perception scores than others. Cooling is a technique with numerous clinical advantages from the clinical point of view, for reduction of pain/discomfort prior to needle puncture of dental local anesthesia in children and adolescents. It is an accessible, inexpensive and pleasant method that does not resemble needles or unpleasant tastes, nor involves systemic toxicity and complications that may be associated with others anesthetics agents. Future randomized controlled studies in accordance with the Consort Statement are needed to further investigate the topic.

Auxillary aids for pain and anxiety reduction during dental local anesthesia in pediatric patients: a systematic review.

This systematic review aimed to evaluate the effectiveness of auxiliary aids-Transcutaneous Electrical Nerve Stimulation (TENS), vibrotactile devices, and Low-Level Laser Therapy (LLLT) in reducing pain and anxiety during dental local anesthesia in pediatric patients. The review followed PRISMA guidelines, employing a comprehensive search strategy across multiple databases (PubMed, Cochrane, EBSCO, LILACS, Google Scholar, and Embase) from 2014 to July 2024. Eligibility criteria were based on the PICOS framework, focusing on randomized clinical trials and clinical studies involving pediatric patients undergoing dental procedures with local anesthesia. The interventions included TENS, vibrotactile devices, or LLLT. Pain and anxiety were assessed using validated scales such as the Wong-Baker Faces Pain Rating Scale and physiological measures like heart rate. Nineteen studies with a total of 1094 pediatric patients aged 4-12 were included. TENS and vibrotactile devices consistently showed significant reductions in pain and anxiety compared to standard methods. LLLT results were more variable, with some studies reporting significant pain reduction while others showed no significant difference. Meta-analysis was not possible due to heterogeneity among the studies. Overall, TENS and vibrotactile devices were more effective in alleviating injection-related pain, especially when combined with cold applications or topical anesthetics. The findings highlight the potential of these auxillary aids as non-invasive and effective adjuncts for reducing pain and anxiety in pediatric dental procedures. LLLT showed mixed outcomes, likely due to variability in application protocols, suggesting a need for standardized methods. While all interventions demonstrated promise, inconsistencies in study designs and subjective measures limit the generalizability of the results. TENS and vibrotactile devices are effective auxiliary aids for reducing pain and anxiety during dental local anesthesia in children. Further research is required to optimize LLLT protocols and standardize intervention applications to achieve consistent results across studies.

Schwann cells exposed to articaine display distinct toxic pathways compared to lidocaine

Articaine (ATC) has emerged as one of the most popular local anesthetics (LA) in dental clinics, despite its relatively recent introduction to the market. As a member of the amino-amide class of LA, ATC possesses unique features, including a thiophene ring and an ester group, which allow for its use at higher clinical concentrations. However, reports have indicated a higher incidence of paresthesia associated with ATC, though the underlying cause of this effect remains unclear. To investigate this further, we conducted an extracellular metabolic flux analysis and an NMR-based metabolomics study of ATC effects on Schwann cells - a type of glial cell found in the peripheral nervous system - in comparison to lidocaine (LDC), the "gold standard" LA in dentistry. The results showed that ATC had a more significant impact on Schwann cell oxygen consumption compared to LDC. Metabolomics profiling of Schwann cells revealed distinct metabolic alterations between the two treatments. Notably, ATC triggered elevated intracellular levels of various amino acids, including leucine, isoleucine, valine, phenylalanine, methionine, histidine, tyrosine, and glycine, which were not observed in LDC-treated Schwann cells. This was consistent with signs of endoplasmic reticulum stress and apoptosis in ATC-treated cells, as detected by protein expression analysis. These findings offer insights into the metabolic and cellular responses elicited by the two anesthetics in Schwann cells, that may help explain the differential toxicity and higher incidence of paresthesia associated with ATC.

Perception of the value of simulation models by dental anesthesia teachers and implementation of simulation models for teaching.

A dental anesthesia simulation model (DASM) is a tool for the teaching and learning of local dental anesthesia techniques. We investigated how dental anesthesia teachers (DATs) perceive the value of those tools. The objective of this study was to investigate the following: the characteristics of the dental anesthesia curriculum used by DATs in Mexico; the DATs' opinion of ethical issues in the teaching of local dental anesthesia; the DATs' perception of the value of using a DASM to teach local dental anesthesia; and the characteristics of the implementation of a DASM by DATs. Dental anesthesia teachers in Mexico answered an online questionnaire with 34 items. The questionnaire had five sections that explored the objective of the study. The results were analyzed with a chi-square test (p<0.05) or with the Tau-c test (p<0.05). One hundred twenty dental anesthesia teachers participated in the study. A total of 37.5% perceived a very high value of using a DASM to teach local dental anesthesia. No significant statistical differences were found when the level of perception was analyzed using the variable of whether the participants used a simulation model for teaching. Half of the participants had access to a simulation model, but only 29.2% used a simulation model for teaching. Most of the participants did not know how to use a DASM for teaching. Dental anesthesia teachers had a positive perception of simulation models. However, they did not use them, nor were they prepared to use them.

Development and application of a quantitative LC-MS/MS assay for the analysis of four dental local anesthetics in human plasma and breast milk

Local anesthetics (LAs: articaine, lidocaine, bupivacaine, and mepivacaine) are essential for dental pain management. However, there are concerns that the lipophilic LAs could cross into breast milk causing toxicity to the infant. Our objective was to establish a multi-analyte LC-MS/MS method for the concurrent quantification of local anesthetics (LAs) in human plasma and breast milk, clarifying the transfer of LAs from plasma to breast milk, thereby offering crucial data for the safe assessment of LAs during the nursing period. Sample preparation for plasma and breast milk involved protein precipitation and a single dilution step. The chromatographic analysis was conducted using an ACQUITY UPLC BEH C18 column. Detection was facilitated by a triple quadrupole mass spectrometer employing positive electrospray ionization. The method demonstrated excellent linearity for articaine, mepivacaine, and bupivacaine across the range of 0.5 to 500ng/mL, and for lidocaine from 1.0 to 1000ng/mL in both plasma and breast milk, with correlation coefficients (R2) of 0.99 or higher. The method was effectively utilized in the analysis of samples from three nursing mothers who received dental treatment involving LAs. Articaine and lidocaine excretion in milk was confirmed, but it presented no significant safety risks to the breastfed infants.

Allergic clinical symptoms and distribution of stimulation index of drug lymphocyte stimulation test for local anesthetics.

The Drug Lymphocyte Stimulation Test (DLST), recognized for its safety as an allergy diagnostic modality, has been acknowledged for its utility in diagnosing drug-induced pathological conditions. However, reports elucidating DLST outcomes concerning local anesthetics are notably scarce. An exhaustive analysis was conducted on the DLST results pertaining to local anesthetics derived from 571 patients presenting with suspected allergies to these specific agents. Remarkably, Stimulation Index (SI) > 1.8 was discerned in 11.4% and 7.8% of patients exhibiting hives or swelling subsequent to the administration of local anesthetics, surpassing the incidence observed in those experiencing post-injection discomfort. Additionally, SI > 3.0 was observed in 3 cases with lidocaine, 3 cases with prilocaine, and 1 case with mepivacaine. The distribution of SI exhibited a non-normal pattern for all three tested local anesthetics. Noteworthy is the case of a singular patient registering an SI of 1.84, who also yielded a positive challenge test, conclusively confirming an allergy to lidocaine. The DLST, holding promise as a potentially invaluable tool in identifying the causative factors behind adverse reactions to dental local anesthetics, lacks sufficient evidence to substantiate its efficacy definitively at present. DLST, coupled with intradermal testing and challenge testing, may be elucidated in patients exhibiting indicators of suspected local anesthetic allergy.

Considerations in dental local anaesthesia for the patient with cleft lip and palate

Patients who have had a history of surgical repair of cleft lip and palate can often develop scar tissue post-operatively that can make it more difficult for dentists to achieve sufficient local anaesthesia. In addition, the presence of a cleft can result in anatomical variation of nerve supply to the maxillary region, which can result in further complications for achieving sufficient anaesthesia. This article reviews the anatomical variations that can occur, and posits a technique to allow for more predictable and successful local anaesthesia in this cohort of patients. CPD/Clinical Relevance: GDPs may have difficulty in achieving sufficient local anaesthesia for patients with a cleft lip and palate.

Effect of Different Approaches of Delivering Local Dental Anesthesia on Pain Perception in Children. A Double Blinded Randomized Controlled Clinical Trial.

Effect of Different Approaches of Delivering Local Dental Anesthesia on Pain Perception in Children. A Double Blinded Randomized Controlled Clinical Trial.

Comparative Analysis of Different Variables on Complications of Local Anesthesia in Dentistry

Background: With continuous progress in medicine and treatments, anesthetists will more often have to treat risk patients in dental surgeries. Therefore there is a need to compare the rate of incidence of complications with risk factors so we can minimize the drug-related complications in patients undergoing dental anesthesia. The study aimed was to evaluate the incidence rate of local anesthetic complications in dentistry and also to analyze the effect of different risk factors on the incidence of local anesthetic complications. Methods: It was an observational cross-sectional study conducted at the Maxillofacial Department in Sardar Begum Dental College and Hospital. Once the patient signed a consent form, Performa was used to collect patient data. The patients were given lidocaine 2% with 1:100,000 epinephrine by either infiltration or inferior alveolar nerve block (IANB) injection or by both techniques to induce anesthesia, then underwent different dental procedures. We focused on six complications and six different risk factors regarding the total population in our study Performa. Results: Our study included 207 dental patients in total, of which 45% were men and 55% were women. The overall complications observed during the study were 11.5% of patients receiving dental local anesthesia in which non-risk factor patients were 6.7% and risk factor patients were 4.8%. Conclusion: The current study reports a high incidence of dental local anesthetic complications, including bleeding, tachycardia, and salivation. In addition, this study also reports the high incidence of bleeding and tachycardia in diabetic and hypertensive patients. Hence study recommends that dentists should take medical history before each procedure to reduce risk of complications associated with dental anesthesia.

Adrenaline dilution in dental local anesthesia for patients with underlying disease.

Adrenaline dilution in dental local anesthesia for patients with underlying disease.

Dexmedetomidine as an additive to local anesthesia in dentistry.

Leki znieczulenia miejscowego to najczęściej stosowane leki w gabinecie stomatologicznym. Pozwalają one na bezbolesne przeprowadzanie zabiegów w obrębie jamy ustnej. Niesie to korzyści dla pacjenta, który nie musi obawiać się bólu, ale i dla lekarza, którego komfort i efektywność pracy zwiększa się, dzięki współpracy ze strony pacjenta. Mimo dużej dostępności leków znieczulenia miejscowego, cały czas poszukiwane są nowe, lepsze rozwiązania. Ostatnio badaną nowością jest dodatek deksmedetomidyny do leków znieczulenia miejscowego. Deksmedetomidyna to agonista receptora alfa2- adrenergicznego o działanieu przeciwbólowym, przeciwlękowym oraz sedującym. Powszechnie jest ona stosowana w anestezjologii i instensywnej terapii do sedacji pacjentów w ramach oddziałów intensywnej terapii, jako koanalgetyk oraz jako dodatek do leków znieczulenia miejscowego w czasie wykonywania blokad obwodowych oraz centralnych. Badania przeprowadzane na pacjentach zakwalifikowanych do ekstrakcji stomatologicznych pokazują, że dodanie deksmedetomidyny do lidokainy, powszechnie stosowanego leku znieczulenia miejscowego, potęguje jej działanie znieczulające. Antagonista receptora alfa2- adrenergicznego wydłuża czas działania analgetycznego i przyspiesza jego początek. Dodatkowo zmniejsza dolegliwości pozabiegowa i przyspiesza gojenie. Równocześnie nie odnotowuje się negatywnego wpływu na parametry ogólne. Jest to obiecujący zamiennik innych dodatków do leków znieczulenia miejscowego, takich jak np. adrenalina, szczególnie u pacjentów, u których isnieją przeciwwskazania do jej stosowania.

Effect of Dental Local Anesthetics on Reactive Oxygen Species: An In Vitro Study.

Introduction Oxidative stress, an imbalance between reactive oxygen species (ROS) production and antioxidant defenses, plays an important role in various dental diseases. Local anesthetics are frequently used in dentistry. The potential antioxidant activity of dental local anesthetics can contribute to dental practice. Therefore, this study aimed to investigate the ROS-scavenging activities of three commonly used dental local anesthetics, lidocaine, prilocaine, and articaine, focusing on their effects on hydroxyl radicals (HO•) and superoxide anions (O2 •-). Materials and methods The electron spin resonance (ESR) spin-trapping technique was employed to specifically measure the ROS-scavenging activities of these local anesthetics at varying concentrations. Results Lidocaine, prilocaine, and articaine exhibited concentration-dependent HO•-scavenging activities, with IC50 values of 0.029%, 0.019%, and 0.014%, respectively. Lidocaine and prilocaine showed concentration-dependent O2 •--scavenging activity, with IC50 values of 0.033% and 0.057%, respectively. However, articaine did not scavenge O2 •-. Conclusions The proactive use of dental local anesthetics may mitigate oxidative injury and inflammatory damage through direct ROS scavenging. However, further research is needed to elucidate the specific mechanisms underlying the antioxidant effects of these dental local anesthetics and their potential impact on the dental diseases associated with oxidative stress.

The Effect of Mandibular Shape on the Response to Dental Local Anesthesia: A Prospective Study

The Effect of Mandibular Shape on the Response to Dental Local Anesthesia: A Prospective Study

Pain during primary molar local anaesthesia with SleeperOne5 computerized device versus conventional syringe: A randomized, split-mouth, crossover, controlled trial.

Because of controversial results from clinical studies comparing different dental local anesthesia methods in children, the primary objective of this randomized, split-mouth, crossover, controlled trial was to compare pain intensity during local anaesthesia (LA) performed with a computer-controlled LA delivery system (C-CLADS) versus a conventional syringe (CONV). Secondary objectives included comparisons during dental treatment. Participants (4-8 years) with tooth pair requiring similar treatment were recruited from five French hospitals. The right primary molar, which was treated at the first visit, was randomly allocated to one of the anaesthesia groups (either intraosseous with C-CLADS or infiltration with CONV), whereas the contralateral molar (treated at the second visit) was assigned to the other group. Pain intensity and behaviour outcomes, assessed with the Faces Pain and Venham revised scales, respectively, were compared between groups using Proc mixed. Stratified analyses were performed on dentition and location. Among 107 participants, the analysis revealed reduced pain perception during LA in the C-CLADS group compared with the CONV group (-0.72, 95% CI: -1.43, -0.006), but not during dental treatment. Stratified analyses showed that this effect was observed only in primary dentition (p = .006) and mandibular molars (p = .005). Behavioural issues were fewer in the C-CLADS group than in the CONV group (p = .05) only during injection. C-CLADS emerged as the preferable system in primary dentition.

Pharmacokinetic Profiling and Optimization of Local Anesthetic Delivery Techniques in Dental Procedures a Prospective Cohort Study

The optimization and pharmacokinetic profile of dental local anesthetics are the subjects of this prospective cohort study. Using Chi-square testing, the study analyzes and evaluates cohort data. Various study participants must undergo dental procedures under the influence of a local anesthetic. Local anesthetics may be administered intravenously, orally, or topically. The pharmacokinetic profile assesses a local anesthetic’s transit time, distribution, metabolism, and elimination. The Chi-square test evaluates the efficacy, duration, patient satisfaction, and adverse effects of various ways of administering analgesics. This statistical analysis looks at the impact of distribution technique and other categorical variables on the final product. This study aims to identify the best local anesthetic delivery technique for dental procedures in terms of efficacy, safety, and convenience. The results will enhance dental offices and the way patients feel about their visits. Find out how the variables are related by using the Chi-square test. The optimal delivery strategy may be determined by identifying statistically significant variations between delivery modalities. For the purpose of improving patient care, this prospective cohort study used the Chi-square test to learn more about the distribution of local anesthetics during dental procedures.

Functional neurologic disorder as a rare complication of dental local anaesthetics: two contrasting cases.

Adverse reactions to dental local anaesthetics are fortunately rare. However, when they occur, they can be severe and debilitating to the patient. Adverse reactions may be either prolonged anaesthesia, with or without dysaesthesia, or systemic reactions. Although these systemic reactions are commonly thought to be allergies, this is rarely the case. Much more commonly, these adverse systemic reactions are either cardiovascular or from the central nervous system. This paper describes two contrasting cases of functional neurologic disorder which illustrates the consequences and appropriate management. The responsibilities of the dentist who injected the local anaesthetic are outlined.

Pharmacokinetics of Local Anesthetics in Dentistry: The Example of Articaine-Containing and Mepivacaine- Containing Anesthetics

Aim. To analyze current data on the pharmacokinetics of drugs used for local anesthesia in dental practice, with particular emphasis on articaine-containing and mepivacaine-containing anesthetics. Materials and Methods. The study of up-to-date information from the Cyberleninka, Elibrary, Google Scholar and PubMed electronic databases was carried out during a systematic review of the literature. Selected and included articles, the content of which concerns the pharmacokinetics of local anesthetics articaine and mepivacaine. Results. 55 publications were reviewed. After analyzing the literature for inclusion criteria, the total number of publications has become 42. Conclusions. According to the analyzed data, the choice of local anaesthetic solution should be made individually for each patient and be based on the pharmacokinetics of the drug.

Anatomical features of the structure of the mandibular retromolar triangle as a target point for local anesthesia in dentistry and maxillofacial surgery

Anatomical features of the structure of the mandibular retromolar triangle as a target point for local anesthesia in dentistry and maxillofacial surgery

Adrenaline dilution in dental local anesthetic: a preliminary study to prevent coring in cartridges.

Many patients with underlying medical conditions are treated with local anesthetics in dental clinics. Dental local anesthetic cartridges contain the vasoconstrictor adrenaline, which can affect the cardiovascular system. For this reason, the adrenaline in the cartridge (2% lidocaine + 1:80,000 adrenaline) is sometimes diluted in order to avoid hemodynamic changes in these patients. However, at the same time, considerations have to be made for coring. Coring is a process in which a piece of rubber is scraped off when a needle is inserted into a rubber stopper, and the rubber is mixed with the drug solution. Particles generated during the coring process contaminate local anesthetic solutions. In this study, we closely observed the puncture site of a 33G dental needle inside a cartridge to investigate a safe dilution method that considers coring. The puncture site was located within 1.50 ± 0.08 mm (mean ± SD) of the diameter from the center of the rubber stopper of the cartridge head. Punctures were made with a 0.75-mm outer diameter metal needle outside the 1.50-mm diameter range from the center of the rubber stopper to reduce the overlap between puncture sites and minimize the risk of coring. After discarding half of the cartridge, 2% lidocaine without adrenaline was injected by piercing the end of the rubber stopper at the cartridge head with a 22-27G metal needle (outer diameter approximately 0.4-0.7 mm). This method minimizes the risk of rubber displacement and coring while ensuring a safe and effective dilution process. Providing a safer method for adrenaline dilution reduces the risk of coring and contamination in dental anesthetic cartridges.

Novel dental anesthetic and associated devices: a scoping review.

The efficient management of pain and discomfort is essential for successful dental treatment and patient compliance. Dental professionals are commonly evaluated for their ability to perform treatment with minimal patient discomfort. Despite advancements in traditional local dental anesthesia techniques, the pain and discomfort associated with injections remain a concern. This scoping review aims to provide a comprehensive overview of the literature on novel dental anesthetics and associated devices designed to alleviate pain and discomfort during dental procedures. The Joanna Briggs Institute and the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews guidelines were used to prepare the review. Six databases and two sources of gray literature were searched. This review analyzed 107 sources from 1994 to 2023. Local anesthesia devices were grouped into computer-controlled local anesthetic delivery (CCLAD) systems, intraosseous anesthesia (IOA), vibratory stimulation devices, and electronic dental anesthesia (EDA). CCLAD systems, particularly the Wand and Single-Tooth Anesthesia, have been the most researched, with mixed results regarding their effectiveness in reducing pain during needle insertion compared to traditional syringes. However, CCLAD systems often demonstrated efficacy in reducing pain during anesthetic deposition, especially during palatal injections. Limited studies on IOA devices have reported effective pain alleviation. Vibrating devices have shown inconsistent results in terms of pain reduction, with some studies suggesting their primary benefit is during needle insertion rather than during the administration phase. EDA devices are effective in reducing discomfort but have found limited applicability. These findings suggest that the CCLAD systems reduce injection pain and discomfort. However, the evidence for other devices is limited and inconsistent. The development and research of innovative technologies for reducing dental pain and anxiety provides opportunities for interdisciplinary collaboration and improved patient care in dental practice.