This randomized placebo-controlled crossover trial evaluated if nanostructured lipid nanocarriers (NLC) could improve the topical anaesthetic efficacy of lidocaine and prilocaine (L+P) incorporated ...in a xanthan-hydrogel applied in the oral cavity. There were no differences among topical formulations regarding the primary endpoints of pain intensity during needle insertion or local anaesthetic injection. Nonetheless, exploratory analyses indicate that individuals with low mechanical pain sensitivity were more susceptible to placebo effects which could also interfere with the anaesthetic effects of the topical formulations. Thus, mechanical pain sensitivity can be an interesting approach to increase assay sensitivity in clinical trials of topical anaesthesia.
This textbook presents basic principles of local anesthesia and exodontia for undergraduate dental program students and dental surgeons in training. Readers will understand key concepts and points ...that prepare them for daily oral and maxillofacial surgery
Early childhood caries (ECC) is the single most common chronic childhood disease. In the treatment of ECC, children are often given moderate sedation or general anesthesia. An estimated 100 000 to ...250 000 pediatric dental sedations are performed annually in the United States. The most common medications are benzodiazepines, opioids, local anesthetics, and nitrous oxide. All are associated with serious adverse events, including hypoxemia, respiratory depression, airway obstruction, and death. There is no mandated reporting of adverse events or deaths, so we don't know how often these occur. In this article, we present a case of a death after dental anesthesia and ask experts to speculate on how to improve the quality and safety of both the prevention and treatment of ECC.
To determine whether the permeation capacity and analgesic efficacy of articaine (ATC) could be increased and cytotoxicity decreased by encapsulation in poly(ɛ-caprolactone) nanocapsules (ATCnano), ...aiming at local or topical anesthesia in dentistry. Cellular viability was evaluated (using the MTT test and fluorescence microscopy) after 1 h and 24 h exposure of HaCaT cells to ATC, ATCnano, ATC with epinephrine (ATCepi), and ATC in nanocapsules with epinephrine (ATCnanoepi). The profiles of permeation of 2% ATC and 2% ATCnano across swine esophageal epithelium were determined using Franz-type vertical diffusion cells. Analgesic efficacy was evaluated with a von Frey anesthesiometer in a postoperative pain model in rats, comparing the 2% ATC, 2% ATCnano, 2% ATCepi, and 2% ATCnanoepi formulations to 4% ATCepi (a commercially available formulation). We show that use of the nanocapsules decreased the toxicity of articaine (P<0.0001) and increased its flux (P = 0.0007). The 2% ATCepi and 4% ATCepi formulations provided higher analgesia success and duration (P<0.05), compared to 2% ATC, 2% ATCnano, and 2% ATCnanoepi. Articaine-loaded poly(ɛ-caprolactone) nanocapsules constitute a promising formulation for intraoral topical anesthesia (prior to local anesthetic injection), although it is not effective when injected in inflamed tissues for pain control, such as irreversible pulpitis.
Lidocaine is the most commonly used local anesthetic worldwide, known for its rapid onset and moderate duration of anesthesia. However, it is short-lived and does not effectively promote effective ...topical anesthesia in the oral cavity when used alone. Our aim was to investigate whether an approximate 50% encapsulation of lidocaine in poly(ε-caprolactone) nanocapsules (LDC-Nano) would be able to increase its permeation and analgesic efficacy and reduce cytotoxicity. In this study, we characterized LDC-Nano and conducted MTT tests with HaCaT cells to assess their in vitro cytotoxicity. Additionally, in vitro permeation assays across the pig esophageal epithelium and the anesthetic efficacy of the hind paw incision model in rats were performed. Plain lidocaine (LDC) was compared with LDC-Nano and lidocaine hydrochloride plus epinephrine (LDC-Epi). The physicochemical characteristics of LDC-Nano were satisfactory (pH: 8.1 ± 0.21; polydispersity index: 0.08 ± 0.01; mean diameter (nm): 557.8 ± 22.7; and encapsulation efficiency (%): 51.8 ± 1.87) and remained stable for up to 4 months. LDC-Nano presented similar in vitro cytotoxicity to LDC but was higher than LDC-Epi (LD
: LDC = 0.48%; LDC-Nano = 0.47%; and LDC-Epi = 0.58%;
< 0.0001). Encapsulation increased the permeability coefficient about 6.6 times and about 7.5 the steady-state flux of lidocaine across the mucosal epithelium. Both encapsulation and epinephrine improved anesthesia duration, with epinephrine demonstrating superior efficacy (100% of animals were anesthetized up to 100, 30, and 20 min when LDC-Epi, LDC-nano, and LDC were used, respectively). Although LDC-Epi demonstrated superior in vivo anesthetic efficacy, the in vitro permeation and cytotoxicity of LDC-Nano indicate promising avenues for future research, particularly in exploring its potential application as a topical anesthetic in the oral cavity.
Aim: This study was carried out to identify differences in the parameters for locating mandibular foramen (MF) in the central Indian population and the recommended guidelines for the administration ...of inferior alveolar nerve block (IAN) as mentioned in the dental literature.
Methods: Eighty high-resolution full volumes cone-beam computed tomography (CBCT) scans were randomly selected from the radiology database and the scans were rendered, viewed, and measured using the on-demand volumetric imaging software (Anatomage, San Jose, CA). The parameters used in locating the MF/IAN complex were the horizontal distance from the mandibular notch to the midpoint of MF (H); vertical distance from the level of the mandibular occlusal plane to the center of MF (V) and the angle from the contralateral premolar contact area to the MF.
Results: Paired t-test was applied. The mean horizontal distance from the mandibular notch to MF was 22.36 ± 2.60 mm in males and 21.05 ± 3.57 mm in females. The mean vertical distance to the occlusal plane was 10.23 ± 4.57 mm in males and 7.42 ± 4.96 mm in females, with a significant difference between the genders (P < 0.05). The mean value for the angulation for the occlusal plane was 39.28° ±5.23° and 37.35° ±3.72° in males and females, respectively.
Conclusion: Ethnicity and gender influence the location of the MF/IAN complex. The utilization of long needles, orienting the syringe barrel at an angulation slightly <45° and approximately 10 mm above the mandibular occlusal plane can aid in successfully administering the IAN block.
Background: In dentistry, needles are the most feared and anxiety-causing tool, making anesthetic injection a worrying practice for patients. Aim: To evaluate the effect of intraosseous anesthesia ...(IOA) and needle-free dental anesthesia (NFA) on pain levels in systemically healthy 8-10-year-old patients. Patients and Methods: Twenty patients aged 8-10 years were included in this cross-over study. Specifically, the pain was measured by Wong Baker, pulse rate (PR), and salivary opiorphin levels (SOL). In addition, the Frankl Behavioral scale was used to measure behaviors and face, legs, activity, cry, consolability (FLACC) was utilized to measure pain and discomfort. To determine the patients' anxiety levels Spielberger State-Trait Anxiety Scale (SSAS-SAAS) was used. The Friedman and Wilcoxon signed-rank tests were used. P < 0.05 was considered significant. Results: According to FLACC scores, IOA and NFA exhibited significantly pain alteration patterns in during local and topical anesthesia, respectively (p = 0.004, 0.001; P < 0.01). Also, only NFA showed significantly decreased SOL values in 5- and 10-min after local anesthesia periods compared to the before levels (p = 0.004, P = 0.001; P < 0.01). Conclusion: Patients feel similar pain perceptions during local anesthesia application in both injection systems. According to the SOL values, NFA may provide more higher anesthetic efficiency than IOA.
Anesthetic techniques play an important role in the outcome of the therapeutic procedures in dentistry. Although inferior alveolar nerve block (IANB) anesthesia is currently the most often used, ...there are situations that imply the need of an alternative anesthesia technique to overcome the potential risks and complications. The aim of the study was to evaluate the efficacy of the retromolar triangle anesthesia technique in achieving the desired nerve block, while evaluating the duration of the anesthesia for the included cases. Methods: The present prospective study included 50 subjects that had indication of inferior molar extraction. The performed anesthesia technique for these cases was the retromolar triangle approach, and the analyzed parameters for evaluating the efficacy of this anesthesia technique were the positive nerve block of the branches involved in the area (inferior alveolar, buccal, and lingual nerves) and the duration of the anesthesia. Results: The efficiency of the retromolar triangle anesthesia technique was positive in 64% of the cases for the inferior alveolar nerve, 46% of the cases for the lingual nerve, and 22% of the cases for the buccal nerve. The duration of the anesthesia revealed a mean value of 72.4 min, suggesting that the duration is an essential factor in its effectiveness. Conclusions: Retromolar triangle anesthesia can be a viable option for clinicians, offering a simple and easy approach for the management of clinical cases.
Dental procedures under general anesthesia (DGA) was found to improve the oral health-related quality of children's life. However, some parents and pediatricians expressed concern about the ...neurotoxicity of general anesthesia. The purpose of this trial was to whether DGA in children has an adverse effect on neurocognition.
In this prospective, assessor-masked, controlled, equivalence trial, we recruited 340 children younger than 7 years who were undergoing caries treatment between Feb 1, 2019, and Aug 31, 2019, without factors affecting neurodevelopment. They received either sevoflurane-based general anesthesia or awake-local anesthesia. The Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition was used to evaluate the neurocognitive function of children at 6 months after surgery, and the Full-Scale IQ (FSIQ) was selected as the primary outcome. The predefined clinical equivalence margin was 5 (1/3 SD of FSIQ score). If the 95% CI of the difference between the average FSIQ score of the two groups is within - 5 to + 5, then the two groups are equivalent.
The outcome data were obtained from 129 children in the general anesthesia group and 144 in the local anesthesia group. The median length of general anesthesia was 130 min (IQR 110-160). The mean FSIQ score in the general anesthesia group was 103·12 (SD 8.94), and the mean of the local anesthesia group was 103·58 (SD 8.40). There was equivalence in means of FSIQ score between the two groups (local minus general anesthesia 0.46, 95% CI - 2.35 to 1.61). There was no significant difference in FSIQ scores between different age groups and different anesthesia durations. Only the mother's education could affect the primary outcome.
In this trial, prolonged DGA with a sevoflurane-only anesthetic in preschool children, does not adversely affect neurocognitive function at 6 months after surgery compared with awake-local anesthesia.
Chinese Clinical Trial Registry, ChiCTR1800015216 . Registered Mar 15 2018.
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