Soft Tissue Anesthesia Research Articles

Knowledge, Awareness, and Practice Regarding the Use of Phentolamine Mesylate: A Soft-tissue Local Anesthesia Reversal Agent among Dental Professionals – A Cross-Sectional Questionnaire Study

Abstract Background: One of the drugs that is most frequently used in dentistry is local anesthetics. They are decisive while performing any dental procedure. The average length of a dental procedure is 47 min, but the local anesthetics used in standard dental procedures last between 1 and 3 h, with the most common inadequacy being the persistence of soft-tissue anesthesia (the numbness of the lips, cheeks, and tongue), which can persist for at least 3–5 h. This extended soft-tissue anesthetic in children can result in self-inflicted wounds like biting of the lips, tongue, or cheek. Aim: The study’s aim was to evaluate dental practitioners’ knowledge, awareness, and usage of phentolamine mesylate, a soft-tissue local anesthetic reversal agent. Materials and Methods: Two hundred and two dentists and graduate students participated in the study by filling out a validated questionnaire. The data obtained were entered into an Excel sheet and statistically analyzed using SPSS software version 22.0. It was observed that 66.50% of the participants had knowledge scores that were lower than the mean, 81.07% had awareness scores that were lower than the mean, and 91.26% had practice scores that were lower than the mean. With a very statistically significant P = 0.0001 (P = 0.05), Karl Pearson’s correlation coefficient revealed a positive correlation between knowledge, awareness, and practice. Conclusion: There was a general lack of knowledge about the drug phentolamine mesylate leading to lesser attitude, thereby leading to lesser use of the drug.

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.

Comparative efficacy of low-volume retrobulbar anesthesia using three commercial local anesthetics in adult horses.

To compare the efficacy of low-volume (5-mL) locoregional retrobulbar anesthesia ("retrobulbar block") by use of 3 commercial local anesthetic formulations. 8 healthy adult mares. A block-randomized, masked, controlled design was used. A single ultrasound-guided retrobulbar block was performed with 2% lidocaine, 2% mepivacaine, or 0.5% bupivacaine (n = 5 eyes/group). Contralateral eyes served as untreated controls. End points performed at baseline and time intervals up to 24 hours postblock included the following: assessment of neurophthalmic reflexes/responses, intraocular pressure, and vertical pupil diameter measurement, corneal and periocular esthesiometry, and observation for adverse effects. Low-volume block did not result in increased intraocular pressure or other adverse effects at any time point in any treatment group. Statistically significant corneal anesthesia (P < .001) was observed 1 minute after block in all groups, persisting through 4 hours after lidocaine or mepivacaine block and through 24 hours after bupivacaine block. Clinically significant periocular anesthesia was not observed in any group. Significant vertical pupil diameter increase (P < .05) was observed for up to 4 hours after lidocaine or mepivacaine block and 6 hours after bupivacaine block. Low-volume retrobulbar block with any of the 3 local anesthetic drugs evaluated was not associated with adverse effects. In terms of efficacy, mepivacaine block showed no clinical advantage over lidocaine block. However, bupivacaine block induced comparatively rapid and sustained corneal anesthesia. In comparison to published findings using a larger injection volume, low-volume retrobulbar block with lidocaine produced clinically comparable corneal anesthesia. However, periocular soft tissue anesthesia was not achieved with any local anesthetic drug at low volume.

Inferior alveolar nerve block anesthesia in children: The effect of ibuprofen and phentolamine mesylate on pain perception.

For successfully managing pediatric dental patients, local anesthesia is essential to eliminate pain during or after the operative period. An early recovery from soft-tissue anesthesia after an inferior alveolar nerve block (IANB) should benefit a young child patient by avoiding the risk of inadvertently biting the soft tissues. Hence, the purpose of the study was to (1) evaluate and compare the efficacy of pre- and postoperative ibuprofen on pain perception in children who undergo IANB anesthesia with or without the use of PM and (2) evaluate the average time required for reversal of anesthesia symptoms using phentolamine mesylate. The present study was a randomized, clinical trial performed among 60 children between 6 and 8 years of age using a convenient sampling method. The children were randomly assigned into four equal groups of 15 each using the computer-generated randomization sequence. IANB anesthesia was performed using 2% lignocaine with 1:100,000 epinephrine, and a mandibular primary molar pulpotomy was performed on each group. Group 1: the ibuprofen tablet was taken 1 h before the onset of the procedure. Group 2: ibuprofen tablet 30 min after the pulpotomy procedure. Group 3: the ibuprofen tablet was taken 1 h before the onset of the procedure, and the Phentolamine mesylate (PM) injection was administered. Group 4: immediately after the pulpotomy, the PM injection was administered, and an ibuprofen tablet was taken 30 min after the pulpotomy procedure. All children were assessed for the duration of soft-tissue anesthesia, their behavior scores and pain rating, as well as the incidence of postoperative self-inflicted injuries. A one-way ANOVA was used to compare the average time needed for the reversal of anesthetic symptoms between groups. The effects of phentolamine, local anesthetics, and ibuprofen on the child's behavior and pain scores were compared using the Student's t-test. For the study, P < 0.05 was accepted as statistically significant. The time needed for the full reversal of anesthetic symptoms to manifest on the tongue and lip was substantially reduced by the injection of phentolamine (P < 0.001). The use of phentolamine for reversal or the intake of ibuprofen pre- or postoperatively did not exhibit any significant variation in the behavior, pain experience, or incidence of self-inflicted injuries in the child. It is evident that although phentolamine injections shorten the duration of anesthesia, the adjunctive use of pre- or postoperative ibuprofen did not significantly alter pain scores.

Phentolamine Mesylate in Dental Practice: Efficacy and Safety for Reversing Soft Tissue Anesthesia - A Systematic Review

Phentolamine Mesylate in Dental Practice: Efficacy and Safety for Reversing Soft Tissue Anesthesia - A Systematic Review

Efficacy of Maxillary Buccal Infiltration of Articaine for Palatal Anesthesia: A Prospective, Randomized, Crossover Study

Objective Although there are conflicting data, several authors have proposed that articaine’s molecular properties suggest improved perfusion capabilities over other amide anesthetics. The purpose of this prospective, randomized, crossover study was to evaluate the anesthetic efficacy of palatal soft-tissue anesthesia following a buccal infiltration of 1.8 and 3.6 mL of 4% articaine with 1:100,000 epinephrine. Methods One hundred eighteen adults received 1.8 or 3.6 mL of 4% articaine with 1:100,000 epinephrine as a buccal infiltration of the maxillary first molar at 2 separate appointments. Palatal soft-tissue anesthesia was evaluated with a dental explorer. Anesthetic success was defined as the absence of pain with an explorer stick. For the subjects who achieved palatal anesthesia, mapping was conducted over 70 minutes, and the overall area of palatal anesthesia was calculated. The data were analyzed using chi-square tests. Results The highest percentage of palatal anesthetic success was 20% for the 1.8-mL volume and 32% for the 3.6-mL volume both at 30 minutes. A statistically significant difference between the 1.8- and 3.6-mL volumes was seen at 40 minutes. There was high variability in area measurements for subjects who achieved palatal anesthesia. The highest area measurements were 92 mm2 for the 1.8-mL volume at 20 minutes and 113 mm2 for the 3.6-mL volume at 10 minutes. Conclusion Because of the low success rates (20%–32%) and the high variability of the area anesthetized for the subjects who achieved palatal anesthesia, the clinical efficacy of 1.8 or 3.6 mL of articaine via buccal infiltration for palatal anesthesia is of questionable value.

Evaluation of the onset of pulpal, soft tissue anesthesia, and pain using buffered lidocaine in children: a randomized-controlled trial

The American Academy of Paediatric Dentistry (AAPD) has recently released guidelines that highlight the importance of conducting further research on the effects of buffered local anesthesia in children. Adjusting the pH of local anesthetics may reduce pain and reduce the onset time of anaesthesia. In this study, we evaluated the onset of pulpal, soft tissue anesthesia and pain during inferior alveolar nerve block injection to treat pulpally involved mandibular primary molars with buffered lidocaine in comparison with non-buffered lidocaine. We conducted a prospective, randomized, triple-blind, crossover trial involving 40 children aged 7 to 10 years. The onset time of soft tissue anaesthesia was assessed by probing the gingiva after ensuring numbness of the tongue, the lower lip, and the angle of the mouth, while the onset time for pulpal anaesthesia assessed using Endo-ice. We identified a significant difference between buffered lidocaine and non-buffered lidocaine in the onset time of pulpal and soft tissue anesthesia (p &lt; 0.001). Analysis also identified a showed a significant difference between the two groups for the Wong-Baker Faces pain rating scale (p &lt; 0.006) and the Sound, Eye and Motor scale (p &lt; 0.043). In conclusion, buffered lidocaine reduced the onset time for anaesthesia in pulpal and soft tissue, and reduced pain during the administration of inferior alveolar nerve block injections in children. According to the findings of this study, buffered lidocaine can be utilized as an alternative to non-buffered lidocaine in children.

Comparison of Anesthetic Efficacy between 2% Lignocaine and 2% Mepivacaine in Inferior Alveolar Nerve Blocks during Extractions and Pulpotomies of Primary Molars in Children

ABSTRACT Context: There are few studies reported in children comparing local anesthetic agents for their efficacy during extraction and pulpotomy procedures, as well as how they affect the patient’s comfort, pain management, and postoperative outcomes. The current study was planned to assess the local anesthetic effectiveness of 2% lignocaine and 2% mepivacaine in inferior alveolar nerve blocks (IANBs) during pediatric primary molar extractions and pulpotomies. Subjects and Methods: A randomized, double-blind clinical trial was carried out among 60 healthy children between the ages of 6 and 12 years who needed pulpotomies or tooth extractions of their mandibular primary molars. Traditional IANBs were performed either using 2% lignocaine or 2% mepivacaine, both with 1:100,000 epinephrine. The efficacy of local anesthesia was determined by an independent, trained operator after the procedures of local anesthesia, pulpotomy, and extraction. The pain experienced and the behavior of the child were recorded. The parameters, such as the onset and duration of anesthesia, between the groups were compared using an unpaired t-test. The pain rating by the child and the behavior rating by the operator were analyzed by an independent t-test and a Mann–Whitney U-test, respectively. The associated discomfort due to local anesthesia among groups was analyzed by the Fisher’s exact test and the Spearman’s correlation coefficient test. A value of P &lt; 0.05 was considered to be statistically significant. Results: The onset of anesthesia was significantly earlier for the lignocaine group (104.93 s) than the mepivacaine group (138.13 s) while performing pulpotomy (P &lt; 0.001) and extraction (P &lt; 0.001) procedures. The duration of action of lignocaine (173.06 min) was longer than that of mepivacaine (139.96 min). However, this comparison was statistically significant only for the extraction group (P = 0.015) but not for the pulpotomy group (P = 0.057). There was no statistically significant difference in the pain rating, their behavior, or the incidence of self-inflicted injury or discomfort between the anesthetic groups. Conclusions: The time taken for the onset of soft-tissue anesthesia was significantly shorter, and its duration was longer for 2% lignocaine when compared to 2% mepivacaine, when both the agents were given along with 1:100,000 adrenaline. Both agents were similarly effective for pulpotomy and extraction of primary molar teeth with respect to pain control and the behavior displayed by the child, which resulted in similar minor postoperative complications.

Efficacy of 7.5% Sodium Bicarbonate Buffered 2% Lidocaine with 1:80,000 Epinephrine in Exodontia

Objectives: The present study examined the efficacy and acceptability of buffered lidocaine (7.5% sodium bicarbonate and 2% lignocaine with 1:80,000 adrenaline) injection for pain management in dental extractions. Materials and Methods: A hundred patients aged between 20-60 years, according to the recommendations of the American Society of Anesthesiologists (ASA), who required teeth extraction either in maxillary or mandibular arch were considered. Routine exodontia was performed immediately after mixed sodium bicarbonate buffered lidocaine was administered. Simultaneously, the onset time of anesthesia was recorded using a stop clock, whereas pain perceived by the patient during injection and extraction was scored using a visual analog scale. The duration of anesthesia was assessed by the feeling of numbness and the first sign of pain. Results: One hundred patients were administered buffered lidocaine (pH 7.2). They had demonstrated a rapid onset (average of 41.20 sec) of anesthesia, a prolonged duration of anesthesia for soft tissues (average of 3.5 hrs), and low discomfort during injection (62%) and extraction (60%). Conclusion: Buffering lidocaine with sodium bicarbonate reduces the discomfort during the injection and hastens the onset of anesthesia for infiltrations and maxillary blocks when compared to mandibular block with an immersive action that prolongs the duration of soft tissue anesthesia up to 4-5 hrs. It is a simple, economical procedure that a dentist can efficiently perform before local anesthetic administration, making oral surgical operations more comfortable for patients.

Efficacy of intraseptal anesthesia obtained by computer-controlled articaine with epinephrine delivery in scaling and root planing.

The primary aim of this study was to compare the anesthetic efficacy of the intraseptal anesthesia (ISA) obtained with three doses of 4% articaine with 1:100,000 epinephrine (4%Ar + Ep) for scaling and root planing (SRP), using a computer-controlled local anesthetic delivery system (CCLADS). The secondary aims were to compare the clinical anesthetic parameters in relation to different jaw regions and examine the possible influence of sex and smoking habits on them. SRP under ISA obtained with different doses (0.1ml, 0.2ml, and 0.3ml) of 4%Ar + Ep was performed in 360 patients. The success rate, onset, duration of soft tissue anesthesia, and the anesthetic field widths were recorded by pinprick testing. The anesthesia success was high (90-95%). The onset was immediate. The duration and anesthetic field widths showed a dose-related significance, however, without a consistent sex-related or smoking-related significance. The multiple logistic regression analysis revealed a twofold higher chance of anesthesia success by increasing the dose and increased bleeding on probing-related and female sex-reduced probability of anesthesia success. ISA obtained with 0.3ml of 4%Ar + Ep delivered by a computer-controlled local anesthetic delivery system provided a high anesthetic success and the adequate clinical anesthetic parameters for SRP in all regions of both jaws. ISA obtained with 4%Ar + Ep provides an effective anesthesia for SRP. The anesthetic success rate may be reduced in the presence of gingival inflammation and in females as well. The study was registered in a Clinical Trials database (NCT04392804, registration date May 9, 2020).

The injectable local anaesthetics in the prevention of intraoperative pain in paediatric dentistry – practical remarks on agent choice and methods. Possible complications of local anaesthetic administration in paedodontics

In paedodontics, as in general dentistry, causal treatment plays a fundamental role in the management of pain present before the appointment, but the therapeutic procedures performed are often associated with the occurrence of acute pain. It is currently being accepted, that effective dental treatment of children is possible after obtaining the appropriate level of local anaesthesia. Local anaesthesia is one of the most delicate and difficult procedures in paediatric dentistry. Fear of anaesthesia and the accompanying pain is clearly marked in paediatric patients; therefore, the right attitude of a dentist plays a crucial role, while psychological strategies and pharmacological approach may be a valuable help. In the case of intraoperative pain prevention in paedodontics, injectable aminoamide derivatives-mainly lidocaine, articaine and mepivacaine in Polish conditions – are of fundamental importance. The success of the procedure is the result of the precision of the injection and administration of the solution, dependent on the practitioner, the reaction of the tissues into which the drug is deposited, their anatomical structure and the patient's stress level. The article discusses the clinically significant features distinguishing paediatric patient population and the impact of this specificity on the choice of methods of effective dental local anaesthesia. The agents used have been characterized, taking into account the dosage, the latency period and the resulting anaesthesia time for the dental pulp and soft tissues. Pulp anaesthesia allows for painless intervention within the tooth tissues, while soft tissue anaesthesia is necessary to undertake a therapeutic action requiring soft tissue disruption in dental surgery. Soft tissue anaesthesia, especially in the inferior alveolar nerve block, with long-acting local anaesthetics, is associated with a higher risk of self-injury in children with loss of sensation and proprioception in mucosa of the cheeks, lips and tongue. Local and general complications of dental anaesthesia in children were presented, along with their prevention and management.

The Comparative Evaluation of the Anesthetic Efficacy of 4% Articaine With 1:100,000 Adrenaline and 0.75% Ropivacaine for Inferior Alveolar Nerve Block in the Extraction of Impacted Lower Third Molar.

Introduction Postoperative pain management is a major concern in lower third molar surgery. Various local anesthetic agents are studied for the same. Articaine and ropivacaine are recently studied for pain control intra- and postoperatively in minor oral surgical procedure. However, there is sparse literature that compares thesetwo agents. Therefore, the present study was designed to compare 4% articaine with 1:100,000adrenaline and 0.75% ropivacainefor inferior alveolar nerve block in lower impacted third molarsurgery. Materials and method A prospective, randomized controlled, split-mouth, double-blind study was performed. A total of 60healthy patients requiring extraction of lower impacted third molar with similar difficulty index were included in the study. Patients were administered 4% articaine with 1:100,000adrenaline and 0.75% ropivacaine on either side by random allocation. The procedure was performed at an interval of 14 days. Parameters assessed were time of onset of anesthesia, profoundness of anesthesia, hemodynamic parameters (heart rate and blood pressure), duration of soft tissue anesthesia, duration of postoperative analgesia, and postoperative symptom severity (PoSSe) scale. Results The time of onset of articaine was faster (69.20 + 20.13 seconds) compared to ropivacaine (104.06 + 17.66 seconds). No significant difference was observed in hemodynamic parameters. There was significant difference in duration of soft tissue anesthesia, postoperative analgesia, and PoSSe scale between the two groups. Conclusion Within the limitations of the study,0.75% ropivacainewas effective in providing prolonged soft tissue anesthesia, postoperative analgesia, and better PoSSe scale with hemodynamic stability compared to 4% articaine.

Bupivacaine for Root Canal Treatment - Practitioner Behaviors and Patient Perspectives: Survey Studies.

Introduction and ObjectivesLocal anesthesia is essential in dentistry in providing intraoperative analgesia and anesthesia. However, knowledge related to its use for management of post-operative pain is limited. Perioperative pain management is especially important for root canal treatment (ie, endodontic therapy), performed by endodontists. In this study, we sought to better understand endodontists’ attitudes regarding the use of long-lasting anesthetic, namely 0.5% bupivacaine HCl with 1:200,000 epinephrine, for the management of post-endodontic pain. Additionally, we aimed to understand the perspectives of dental patients about receiving longer lasting anesthesia for endodontic therapy and to determine factors that affect their anesthetic preferences within the orofacial region.MethodsAn email invitation to participate in an anonymous online survey was sent to members of the American Association of Endodontists. Also, 82 patients attending an in-person visit to an endodontic clinic were recruited to the study.ResultsData from 474 endodontic practitioners and 82 patients included in analysis. Among practitioners, the majority reported to either never (33.31%) or rarely (34.84%) using bupivacaine. Most chose “I don’t think I need it” (47%) and “patient discomfort because of longer duration of soft tissue anesthesia” (30.81%) as reasons for not preferring the use of bupivacaine. Of the practitioners who reported at least rare use, most chose bupivacaine for post-operative pain management (78.02%). Conversely, 52% of patients reported that they were likely/most likely to request long-lasting anesthetics for post-operative pain control.ConclusionBupivacaine is rarely used as a post-operative pain management strategy for endodontic therapy. Specifically, bupivacaine is not preferred not because of adverse events, toxicity, or slow onset concerns, but rather, because of longer duration of soft tissue anesthesia. However, our data suggest that patients may be willing to receive long-lasting anesthesia. Further patient-centered research should investigate the use of long-lasting anesthetic agents for management of post-endodontic pain.

Hyaluronidase following buccal infiltrations of articaine with epinephrine for anesthesia of mandibular first molars: A split-mouth, double-blind, placebo-controlled randomized clinical trial.

Adjunctive hyaluronidase has been widely used for ophthalmic anesthesia; however, in Dentistry, very few studies are available so far. Thus, the present study aimed to evaluate anesthetic outcomes of adjunctive hyaluronidase administration following buccal infiltration of articaine with epinephrine for anesthesia of mandibular first molars. Twenty-eight patients received a buccal supraperiosteal infiltration of 4% articaine with 1:100,000 epinephrine for anesthesia of the mandibular first molars, in a split-mouth approach. Afterward, randomly and using the same technique, they received either 1.0 mL of hyaluronidase (150 UTR/mL) or a placebo solution. Considering patients' pain perceptions provoked by electric and mechanical stimulations, as well as using a pain scale, success rate, action onset time, duration of both pulpal and soft tissue anesthesia, and pain immediately after both punctures and on the 2nd day were assessed. The pulpal anesthetic success rate was 85.7% for hyaluronidase and placebo groups. Soft tissue anesthesia showed a shorter action onset time and a longer duration when hyaluronidase was used; however, there was no difference between the groups regarding action onset time and duration of pulpal anesthesia. Pain at the puncture sites did not differ between the groups, regardless of the time point evaluated. Adjunctive hyaluronidase following buccal infiltration of articaine with epinephrine for mandibular first molars seems not to provide any advantage in anesthetic outcomes in which the nerve fibers are intraosseous (i.e., pulpal anesthesia). On the other hand, soft tissue anesthesia may be improved substantially by using this pharmacological strategy. Key words:Hyaluronidase, local anesthesia, dentistry.

Twin Mixed Local Anesthesia in Third Molar Surgery - Randomized Controlled Trial

The aim of this study was to compare the clinical efficacy of injection of 2 long-acting amide local anesthetic agents - bupivacaine and ropivacaine with and without 4 mg dexamethasone in patients undergoing third molar extraction. A prospective randomized double blind controlled trial was conducted among 68 patients with impacted mandibular third molars. Group A and B were the control groups and received 1.8 mL of 0.5% bupivacaine hydrochloride and 0.75% ropivacaine hydrochloride, respectively. Group A1 and B1 were experimental groups and received modified twin mixes which were 1.8 mL of 0.5% bupivacaine hydrochloride+1mL/4mg dexamethasone and 0.75% ropivacaine hydrochloride+1 mL/4mg dexamethasone, respectively. Visual analog pain scale, mouth opening measurement and facial swelling were assessed at the time of injection and postoperative days 1, 3, and 7. The mean visual analogue scale score for pain on local anesthesia injection was found to be less in both experimental groups- Group A1 (2.94) and B1 (2.41) as compared to control groups- Group A (3.59) and B (3.06). The durations of soft tissue anesthesia were higher as compared to their respective controls for both Group A1 and B1. Patients in both control groups A and B had an increased postoperative swelling, pain and trismus. Intraoperative and postoperative comfort in both the experimental groups were higher than those for control groups, thereby establishing the clinical efficacy of both modified twin mixes for use in surgical extraction of mandibular third molars.

Local anesthesia reversal— A review

Local anesthetic agents are widely used in dentistry. It has major role in all field of dentistry especially in oral surgery, Pediatrics, Endodontics, Periodontics etc. The only drawback associated with LA is that occurrence of soft tissue anaesthesia can persist for three to five hours, while the procedure itself usually lasts for less than an hour. Patients experience limitation of function in terms of speech difficulty, drinking neating etc. All these events leave negative impact on minds of patients; hence they avoid visiting dental offices. In order to reverse these events, a new drug named OraVerse (phentolamine mesylate) is available to us. This drug is known for its LA reversal ability and effects of local dental anaesthetic.

Use of bufferized dental anesthetics in dental surgery

Introduction and objective: The addition of epinephrine to the anesthetic solution reduces the pH of the solution to a range between 2.9 and 4.4.The acidity of the anesthetic may delay onset and contribute to injection pain. Objective: to determine the intensity of pain during a mandibular third molar surgery after using buffered 4% articaine with epinephrine 1:100000 in the inferior alveolar nerve block with buccal infiltration. Materials and methods: an observational and descriptive clinical study was performed. The buffered solution was alkalinized with 8.4% sodium bicarbonate with a ratio of 9:1, using a hand-mixing methodology, the sample were patients who required a mandibular third molar surgery. After standardizing the anesthetic technique, it was used the inferior alveolar nerve block followed by buccal infiltration. Results: 32 patients (20 female - 62.5% and 12 male - 37.5%), with an average age of 21.12 years (mean ± standard deviation [SD]: 21.12 ± 3.61) were admitted to the study. When assessing the pain puncture and during the injection, 94% of patients classified it as mild pain according to VAS. When evaluating the latency period, the average time was less than two minutes and the perioral soft tissue anesthesia was 62%. Only a small percentage of patients required complementary anesthesia. Conclusion: buffered 4% of articaine with epinephrine in the inferior alveolar nerve block with buccal infiltration significantly decreased onset time, injection pain and need for complementary anesthesia in third molar surgery.

The effect of single buccal infiltration anesthesia of 4% articaine with either 1:100,000 or 1:200,000 epinephrine on pulpal blood flow and anesthesia of maxillary first molars and second premolars in humans.

The aim of this study was to determine the effect of single buccal infiltration of 4% articaine with either 1:100,000 (EP100) or 1:200,000 (EP200) epinephrine on pulpal blood flow (PBF), pulpal anesthesia and soft tissue anesthesia of maxillary first molars and second premolars in human subjects. Fifteen healthy volunteers with intact maxillary first molars and second premolars received an infiltration of 4% articaine with either EP100 or EP200 at buccal aspect of maxillary first molars. The PBF, pulpal anesthesia and soft tissue anesthesia were assessed with a laser Doppler flowmeter (LDF), an electric pulp tester (EPT) and Aesthesiometer II, respectively. Articaine (4%) with either EP100 or EP200 produced PBF reduction in maxillary first molars (injected teeth) by 68.09 and 69.83%, and produced PBF reduction in second premolars (adjacent teeth) by 76.81 and 75.02%, respectively at 15min post injection. Duration of PBF returned to baseline was 159.00 ± 21.06 (EP100) and 159.00 ± 31.97 (EP200) min in the molars, and 161.00 ± 20.02 (EP100) and 159.00 ± 25.86 (EP200) min in the premolars. The onset of pulpal anesthesia was 2.80 ± 1.26 (EP100) and 3.07 ± 1.28 (EP200) min in the molars, and 2.13 ± 0.52 (EP100) and 2.40 ± 0.83 (EP200) min in the premolars; the duration of pulpal anesthesia was 74.53 ± 24.16 (EP100) and 76.27 ± 34.03 (EP200) min in the molars, and 82.53 ± 31.03 (EP100) and 75.60 ± 37.17 (EP200) min in the premolars. Buccal tissue anesthesia was found in both teeth (100%), but palatal anesthesia was achieved by 13.33% in the premolars and 6.67% in the molars for each solution. Single buccal infiltration to maxillary first molar produced PBF reduction and successful pulpal anesthesia, evaluated by EPT, in both first molar and second premolar. This anesthetic technique also produced high success of buccal tissue anesthesia, but demonstrated very low success for palatal tissue anesthesia. Single buccal infiltration to maxillary first molar is potent enough for pulpal and buccal tissue anesthesia, except palatal tissue anesthesia, in both first molar and second premolar.

Comparação da Eficácia Anestésica da Articaína 4% Associada a Epinefrina 1:100.000 e 1:200.000 na Técnica Infraorbitária

Objective: To compare the anesthetic efficacy of 4% articaine associated with epinephrine concentrations of 1:100,000 and 1:200,000, using the infraorbital nerve block approach. Material and Methods: This is a double-blind cross-sectional study conducted with 40 volunteers. Pulpal anesthetic parameters such as latency, duration, and success rates were evaluated using a pulp tester device, which emits electrical discharges ranging from 0 to 80 ?A in 20 seconds. Soft tissue anesthesia (vestibular gum) was evaluated by pressing a wooden toothpick into the gingival region used in the approach. Finally, parameters related to pain after anesthesia were evaluated. Results: We found no statistically significant differences between anesthetic solutions for pulp and soft tissue regarding latency period. The anesthetic solution containing 1:100,000 epinephrine presented a significantly longer effect duration than 1:200,000 epinephrine regarding pulpal anesthesia of maxillary central incisors, first maxillary premolar, and second maxillary premolar. As for vestibular gum, we found no statistically significant differences between the solutions. Regarding pain at injection, the two anesthetic solutions showed no statistically significant differences. Conclusion: 4% articaine with 1:100,000 epinephrine presented significantly longer pulpal anesthesia duration in some dental elements when compared to 1:200,000 epinephrine