COVID-19 Vaccine Uptake Among Residents and Staff Members of Assisted Living and Residential Care Communities-Pharmacy Partnership for Long-Term Care Program, December 2020-April 2021.

OBJECTIVES: In December 2020, CDC launched the Pharmacy Partnership for Long-Term Care Program to facilitate COVID-19 vaccination of residents and staff in long-term care facilities (LTCFs), including assisted living (AL) and other residential care (RC) communities. We aimed to assess vaccine uptake in these communities and identify characteristics that might impact uptake. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: AL/RC communities in the Pharmacy Partnership for Long-Term Care Program that had ≥1 on-site vaccination clinic during December 18, 2020-April 21, 2021. METHODS: We estimated uptake using the cumulative number of doses of COVID-19 vaccine administered and normalizing by the number of AL/RC community beds. We estimated the percentage of residents vaccinated in 3 states using AL census counts. We linked community vaccine administration data with county-level social vulnerability index (SVI) measures to calculate median vaccine uptake by SVI tertile. RESULTS: In AL communities, a median of 67 residents [interquartile range (IQR): 48-90] and 32 staff members (IQR: 15-60) per 100 beds received a first dose of COVID-19 vaccine at the first on-site clinic; in RC, a median of 8 residents (IQR: 5-10) and 5 staff members (IQR: 2-12) per 10 beds received a first dose. Among 3 states with available AL resident census data, median resident first-dose uptake at the first clinic was 93% (IQR: 85-108) in Connecticut, 85% in Georgia (IQR: 70-102), and 78% (IQR: 56-91) in Tennessee. Among both residents and staff, cumulative first-dose vaccine uptake increased with increasing social vulnerability related to housing type and transportation. CONCLUSIONS AND IMPLICATIONS: COVID-19 vaccination of residents and staff in LTCFs is a public health priority. On-site clinics may help to increase vaccine uptake, particularly when transportation may be a barrier. Ensuring steady access to COVID-19 vaccine in LTCFs following the conclusion of the Pharmacy Partnership is critical to maintaining high vaccination coverage among residents and staff.

The Endodontic Complexity Assessment Tool (E-CAT): A digital form for assessing root canal treatment case difficulty.

AIMS: To develop an evidence-based, valid and reliable assessment tool that educational establishments and dental practitioners may use to assess the complexity of root canal treatment (RCT) utilizing digital advancements. The study also aimed to provide a more objective definition of the term 'uncomplicated' root canal treatment as described by the Association for Dental Education in Europe (ADEE) and the European Society of Endodontology (ESE) undergraduate curriculum guidelines for Endodontology. METHODOLOGY: The development process involved a narrative review of the literature to identify the complexity factors associated with root canal treatment on permanent teeth; an iterative development and analysis process to assess the weighting of these factors; and the programming of digital software to enhance the efficiency and user interface of the assessment form. Validation of the tool was sought with a panel of 35 specialist endodontists to assess clinical scenarios and assess the consensus inter-examiner agreement with the outcomes provided by the E-CAT. The inter-user and intra-user reliability studies were conducted with 15 dentists to evaluate the same clinical cases and by repeating the experiment 9 months later. The ease of use of the form was also assessed. RESULTS: The E-CAT was successfully developed with a total of 19 complexity criteria and hosted on a secure server under the domain of www.e-cat.uk. The tool provides a smart interactive filtering mechanism and automatic background calculation of the risk scores. Three levels of complexity were defined: class I (uncomplicated), class II (moderately complicated) and class III (highly complicated). The consensus of the panel of endodontists had excellent agreement with the outcome of the E-CAT. The inter-user and intra-user reliability was found to be 0.80 and 0.90, respectively. The average time to assess a case was 1:36 min. CONCLUSION: The E-CAT gave promising results providing an efficient and reliable platform to assess the complexity of cases undergoing root canal treatments. The study design allowed the formulation of a more objective definition to describe 'uncomplicated' root canal treatment as referred to by the ESE and ADEE guidelines. This study is advantageous for educational, public health and referral pathways.

Characterization of COVID-19 in Assisted Living Facilities - 39 States, October 2020.

The coronavirus disease 2019 (COVID-19) pandemic has highlighted the vulnerability of residents and staff members in long-term care facilities (LTCFs) (1). Although skilled nursing facilities (SNFs) certified by the Centers for Medicare & Medicaid Services (CMS) have federal COVID-19 reporting requirements, national surveillance data are less readily available for other types of LTCFs, such as assisted living facilities (ALFs) and those providing similar residential care. However, many state and territorial health departments publicly report COVID-19 surveillance data across various types of LTCFs. These data were systematically retrieved from health department websites to characterize COVID-19 cases and deaths in ALF residents and staff members. Limited ALF COVID-19 data were available for 39 states, although reporting varied. By October 15, 2020, among 28,623 ALFs, 6,440 (22%) had at least one COVID-19 case among residents or staff members. Among the states with available data, the proportion of COVID-19 cases that were fatal was 21.2% for ALF residents, 0.3% for ALF staff members, and 2.5% overall for the general population of these states. To prevent the introduction and spread of SARS-CoV-2, the virus that causes COVID-19, in their facilities, ALFs should 1) identify a point of contact at the local health department; 2) educate residents, families, and staff members about COVID-19; 3) have a plan for visitor and staff member restrictions; 4) encourage social (physical) distancing and the use of masks, as appropriate; 5) implement recommended infection prevention and control practices and provide access to supplies; 6) rapidly identify and properly respond to suspected or confirmed COVID-19 cases in residents and staff members; and 7) conduct surveillance of COVID-19 cases and deaths, facility staffing, and supply information (2).

Is articaine more effective than lidocaine in patients with irreversible pulpitis? An umbrella review.

BACKGROUND: Pain management can be challenging during root canal treatment of teeth with irreversible pulpitis. AIM: To identify whether articaine or lidocaine is the most appropriate local anaesthetic solution for teeth with irreversible pulpitis undergoing root canal treatment. DATA SOURCE: The protocol of this umbrella review is registered in the PROSPERO database (CRD42019137624). PubMed, EBSCHO host and Scopus databases were searched until June 2019. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: Systematic reviews published in English comparing the effectiveness of local anaesthesia following administration of articaine or lidocaine in patients undergoing root canal treatment of teeth diagnosed with irreversible pulpitis were included. Two independent reviewers selected the studies and carried out the data extraction and the appraisal of the included reviews. Disagreements were resolved in consultation with a third reviewer. STUDY APPRAISAL AND SYNTHESIS METHODS: The quality of the included reviews was appraised by two independent reviewers using the AMSTAR tool (a measurement tool to assess systematic reviews). Each of the 11 AMSTAR items was given a score of 1 if the specific criterion was met, or 0 if the criterion was not met or the information was unclear. RESULTS: Five systematic reviews with meta-analyses were included. The AMSTAR score for the reviews ranged from 8 to 11, out of a maximum score of 11, and all reviews were categorized as 'high' quality. Two reviews scored 0 for item 8 in AMSTAR because the scientific quality of the clinical trials included in these reviews was not used in the formulation of the conclusions. LIMITATIONS: Systematic reviews published only in the English language were included. Only a small number of studies were available to assess pain intensity during the injection phase, the time until the onset of anaesthesia and the occurrence of adverse events. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Articaine is more effective than lidocaine for local anaesthesia of teeth with irreversible pulpitis undergoing root canal treatment. There is limited evidence that injection of articaine is less painful, has more rapid onset and has fewer adverse events compared with lidocaine.

Evidence for changing nerve growth factor signalling mechanisms during development, maturation and ageing in the rat molar pulp.

AIM: To examine rat molar pulp innervation and identify complex cellular signalling systems involving nerve growth factor (NGF) and its p75 receptors (NGFR) at different stages of development, maturation and ageing. METHODOLOGY: Decalcified mandibular first molar mesial cusps from Wistar rats of ages 0 day; 1, 2, 3, 4, 6, 9, 12 and 24 weeks (n = 5 per group) were sectioned (10 µm) and incubated with antibodies for NGF, NGFR, calcitonin gene-related peptide (CGRP) and neurofilament. Nerve densities in worn and intact regions of 3- to 24-week-old rats were compared by anova, Bonferroni and t-tests. RESULTS: During odontogenesis, differences in NGF and NGFR expression were observed, with no evidence of nerve fibres, suggesting a signalling mechanism controlling cellular differentiation and dentine formation. Tooth wear in 4-week rats was associated with reduced NGF expression and significantly decreased CGRP axons within affected odontoblast regions. The underlying subodontoblasts started expressing NGF which continued until 9 weeks. This may promote a significant increase in CGRP nerve density in affected regions. Nerve density in intact odontoblast regions increased gradually and reached significant levels in 12-week rats. Reduction in nerve densities within worn and intact regions of cusps was observed at 24 weeks. CONCLUSIONS: Age-related changes and responses to tooth wear may be controlled by the NGF signalling mechanism, with roles in odontoblast/subodontoblast communication and control of sensory innervation at different stages of tooth development, maturation and ageing. Greater understanding of cellular and nerve regulation in the injured pulp may promote therapeutic strategies for pulp survival.

The tactile receptive fields of freely moving Caenorhabditis elegans nematodes.

Sensory neurons embedded in skin are responsible for the sense of touch. In humans and other mammals, touch sensation depends on thousands of diverse somatosensory neurons. By contrast, Caenorhabditis elegans nematodes have six gentle touch receptor neurons linked to simple behaviors. The classical touch assay uses an eyebrow hair to stimulate freely moving C. elegans, evoking evasive behavioral responses. This assay has led to the discovery of genes required for touch sensation, but does not provide control over stimulus strength or position. Here, we present an integrated system for performing automated, quantitative touch assays that circumvents these limitations and incorporates automated measurements of behavioral responses. The Highly Automated Worm Kicker (HAWK) unites a microfabricated silicon force sensor holding a glass bead forming the contact surface and video analysis with real-time force and position control. Using this system, we stimulated animals along the anterior-posterior axis and compared responses in wild-type and spc-1(dn) transgenic animals, which have a touch defect due to expression of a dominant-negative α-spectrin protein fragment. As expected from prior studies, delivering large stimuli anterior and posterior to the mid-point of the body evoked a reversal and a speed-up, respectively. The probability of evoking a response of either kind depended on stimulus strength and location; once initiated, the magnitude and quality of both reversal and speed-up behavioral responses were uncorrelated with stimulus location, strength, or the absence or presence of the spc-1(dn) transgene. Wild-type animals failed to respond when the stimulus was applied near the mid-point. These results show that stimulus strength and location govern the activation of a characteristic motor program and that the C. elegans body surface consists of two receptive fields separated by a gap.

Evidence for programmed odontoblast process retraction after dentine exposure in the rat incisor.

OBJECTIVE: To re-examine the morphology and potential functions of odontoblasts in intact rat incisors and after cavity preparation into dentine. DESIGN: Intact incisors were fixed, decalcified, snap frozen and sectioned (10µm), before staining with rhodamine phalloidin or antibodies for cyto-skeletal proteins: vimentin and actin, ion transporter: NaK-ATPase, and dendritic cell marker: OX6. Samples with cavity were processed similarly and stained for actin and vimentin before comparing the lengths of odontoblast processes (OP) at baseline, 3h and 24h (n=5 for each group). RESULTS: Actin was expressed through the full length of OP, while vimentin immunoreactivity was not uniform, with 4 distinct regions. OP showed morphological complexity with fine branches emanating within different regions of dentine. Novel actin-positive tree-like OP were identified within predentine which reduced in intensity and length toward the incisal portion of the tooth. Specimens with cavities showed time-dependant pulpal retraction of OP. CONCLUSIONS: Differences in structural antibody expression suggest functional variations in OP within different regions of dentine. The role of actin positive OP in predentine is not known, but could be related to dentine deposition, cellular stability or sensing mechanisms. Cavity preparation into dentine was followed by programmed retraction of OP which could be controlled either mechanically by the spatial limitation of the OP within dentinal tubules or structurally by the presence of vimentin, in addition to actin, in the mid-dentine.

Complex cellular responses to tooth wear in rodent molar.

The arrangement and roles of the odontoblast and its process in sensing and responding to injuries such as tooth wear are incompletely understood. Evidence is presented that dentine exposure by tooth wear triggers structural and functional changes that aim to maintain tooth integrity. Mandibular first molars from freshly culled 8 week Wistar rats were prepared for light microscopy ground-sections (n=6), or fixed in 4% paraformaldehyde, decalcified in 17% EDTA, sectioned and stained with antibodies to cyto-skeletal proteins (vimentin (vim), α-tubulin (tub) and α-actin), cellular homeostatic elements (sodium potassium ATPase (NaK-ATPase) and sodium hydrogen exchanger (NHE-1)), and sensory nerve fibres (CGRP) (n=10) for fluorescence microscopy of worn and unworn regions of the mesial cusp. Immunoreactivity (IR) to vim, actin, NaK-ATPase and CGRP was confined to the pulpal third of odontoblast processes (OPs). IR to tub and nhe-1 was expressed by OPs in full dentine thickness. In areas associated with dentine exposure, the tubules contained no OPs. In regions with intact dentine, odontoblasts were arranged in a single cell layer and easily distinguished from the sub-odontoblast cells. In regions with open tubules, the odontoblasts were in stratified or pseudo-stratified in arrangement. Differences in structural antibody expression suggest a previously unreported heterogeneity of the odontoblast population and variations in different regions of the OP. This combined with differences in OPs extension and pulp cellular arrangement in worn and unworn regions suggests active and dynamic cellular responses to the opening of dentinal tubules by tooth wear.

The role of sustained release isosorbide mononitrate on corticosteroid-induced hypertension in healthy human subjects.

There is evidence implicating abnormalities in the nitric oxide (NO) pathway in the development of glucocorticoid-induced hypertension (GC-HT). In humans, a reduction in NO availability during cortisol treatment has been observed. This study examined whether the NO donation may reverse the elevated blood pressure (BP) observed with cortisol treatment. A randomised double-blind, placebo-controlled, crossover study was undertaken in eight healthy men to address the effect of co-administration of isosorbide mononitrate (ISMN, 60 mg single dose, day 5) with cortisol (200 mg per day, days 1-6) and then compared with placebo (single dose, day 5) with cortisol. After a 2-week washout period, subjects crossed over to the alternate treatment. BP measurements were obtained using a mercury sphygmomanometer. Tonometry was used to estimate central pressures. There was a significant rise in mean arterial pressure with cortisol: 80 ± 3 vs 89 ± 3 mm Hg (day 1 vs day 5, cortisol+ISMN phase, P < 0.001) and 81 ± 3 vs 89 ± 3 mm Hg (day 1 vs day 5, cortisol+placebo phase, P < 0.01). ISMN significantly decreased aortic augmentation index: -17.3 ± 3.2 vs 1.8 ± 3.5%, (differences calculated from day 5-day 1, cortisol/ISMN vs cortisol+placebo, P < 0.001). These results demonstrated that GC-HT can be modified by co-administration of exogenous NO donors, consistent with the hypothesis that GC-HT is accompanied by reduced NO activity in humans.

Factors affecting direction and strength of patient preferences for treatment of molar teeth with nonvital pulps.

AIM: To elicit the factors affecting willingness to pay (WTP) values for the preferred options of participants for dealing with a molar tooth with a nonvital pulp, a common but difficult problem. METHODOLOGY: A total of 503 patients were recruited from dental practices in the North East of England and interviewed. Their preferred treatment option for a molar tooth with a nonvital pulp (endodontics, extraction and various prosthetic restorative options) and WTP for this preferred option were elicited. Factors affecting preferred option and WTP were analysed using econometric modelling. RESULTS: Overall, 53% of the sample wished to save the tooth with a mean WTP of £373. The variance in WTP was high. Of those opting for extraction, the majority chose to leave a gap or have an implant. The preferred option was influenced by previous treatment experience. WTP was only influenced by having a low income. CONCLUSIONS: The high level of variance in WTP and its relatively unpredictable nature pose difficult questions for policy makers trying to ensure the delivery of an equitable service. For dentists, it is important not to make assumptions about patient preference and strength of preference when making decisions. Ideally, WTP values should be considered alongside effectiveness data, and those on costs, in policy making.

Polymerization kinetics of resin cements after light activation through fibre posts: an in vitro study.

AIM: To measure the polymerization of light-cured (Variolink Veneer, VLV) and dual-cured (Variolink II, VLII) resin luting cements after light activation through different lengths of fibre post ex vivo. METHODOLOGY: Degree of conversion after prolonged direct light activation (PLA) [12 min after LED light activation for 3 min] was determined using ATR-FTIR. Models were then produced to allow samples of VLV and VLII (n = 5 each group) to be light-activated through 3, 6 and 9 mm lengths of fibre post (Fiber Lux). Degree of conversion was assessed by ATR-FTIR and expressed as a percentage of the degree of conversion achieved after PLA. Data were analysed using anova and Tukey's test (P < 0.05). RESULTS: Mean [SD] degree of conversion for VLV and VLII after PLA was 57.97% [1.51] and 54.71% [3.77], respectively. Light activation of VLV through a 3 mm post produced 81.62% of the PLA value, compared with 71.03% for the 6 mm and 46.04% for the 9 mm post. Conversion after activation through 9 mm posts was significantly less than through 3 mm and 6 mm posts (P < 0.05). For VLII, activation through a 3 mm post produced 66.51% of the PLA value, compared with 54.38% for the 6 mm and 41.56% for the 9 mm post. A significant decrease in degree of conversion was noted for VLII as post length increased (P < 0.05). CONCLUSIONS: The degree of conversion for VLV reduced after light activation through 9 mm posts when compared to 3 mm and 6 mm posts, whilst the degree of conversion for VLII decreased with every increase in post length.

Complete genomic characterization of a potato mop-top virus isolate from the United States.

Potato mop-top virus (PMTV; family Virgaviridae) was reported recently in the Pacific Northwestern USA. To better understand the genetic diversity of this virus, the complete genome of an isolate from Washington State (WA), USA, was characterized. Sequence comparisons of the WA isolate with other known sequences revealed that the RNA-Rep-encoded RdRp protein and the RNA-CP-encoded coat protein displayed >99 % amino acid sequence identity to those of two Nordic (RdRp) and several European and North American isolates (CP), respectively. The RNA-TGB-encoded TGB 1 and TGB 3 protein sequences had >99 % amino acid sequence identity to the corresponding proteins of Czech and Danish isolates, whereas the TGB 2 protein is identical to those of Colombian isolates. Phylogenetic analysis of the viral genes of the WA isolate reflected the close relationship between WA and European isolates. RFLP analysis of corresponding DNA of RNA TGB and RNA CP revealed that the WA isolate has the RNA TGB-II and RNA CP-B types, which are prevalent in Europe and other parts of world. This is the first report of the complete genome characterization of PMTV from the Americas.

Effect of massage on the efficacy of the mental and incisive nerve block.

The purpose of this trial was to assess the effect of soft tissue massage on the efficacy of the mental and incisive nerve block (MINB). Thirty-eight volunteers received MINB of 2.2 mL of 2% lidocaine with 1 : 80,000 epinephrine on 2 occasions. At one visit the soft tissue overlying the injection site was massaged for 60 seconds (active treatment). At the other visit the crowns of the mandibular premolar teeth were massaged (control treatment). Order of treatments was randomized. An electronic pulp tester was used to measure pulpal anesthesia in the ipsilateral mandibular first molar, a premolar, and lateral incisor teeth up to 45 minutes following the injection. The efficacy of pulp anesthesia was determined by 2 methods: (a) by quantifying the number of episodes with no response to maximal electronic pulp stimulation after each treatment, and (b) by quantifying the number of volunteers with no response to maximal pulp stimulation (80 reading) on 2 or more consecutive tests, termed anesthetic success. Data were analyzed by McNemar, Mann-Whitney, and paired-samples t tests. Anesthetic success was 52.6% for active and 42.1% for control treatment for lateral incisors, 89.5 and 86.8% respectively for premolars, and 50.0 and 42.1% respectively for first molars (P = .344, 1.0, and .508 respectively). There were no significant differences in the number of episodes of negative response to maximum pulp tester stimulation between active and control massage. A total of 131 episodes were recorded after both active and control massage in lateral incisors (McNemar test, P = 1.0), 329 (active) versus 316 (control) episodes in the premolars (McNemar test, P = .344), and 119 (active) versus 109 (control) episodes respectively for first molars (McNemar test, P = .444). Speed of anesthetic onset and discomfort did not differ between treatments. We concluded that soft tissue massage after MINB does not influence anesthetic efficacy.

Detection of Potato mop top virus (Furovirus) on potato in southeast Idaho.

In February 2012, commercially produced potato (Solanum tuberosum) tubers, cv. Modoc, grown in southeast Idaho, were observed with internal necrotic arcs and lines. Samples were obtained from potatoes that had been washed and packaged. No external symptoms were evident. Multiple samples were collected from the packing line and cut to check for internal defects as part of the normal grading procedure. The incidence of symptomatic tubers from these samples was determined by personnel at the packaging facility to be approximately 3%. Initially, one symptomatic and one asymptomatic tuber were tested. Total RNA extracted from these tubers were tested by RT-PCR at Aberdeen, Idaho, with primers specific for Potato mop top virus (PMTV) (1) and Tobacco rattle virus (TRV) (4). RT-PCR results showed that the symptomatic tuber produced a band at 416 bp with the PMTV primers, which was also present in the PMTV-positive control. No amplification was observed with the TRV primers. The asymptomatic tuber was negative for both PMTV and TRV. Subsequently, total RNA from four additional symptomatic tubers from the same lot were tested at USDA-ARS in Prosser, WA, by RT-PCR for TRV (4) and with a different set primers for PMTV (2). The tests included two PMTV-positive controls from cv. Alturas tubers (1), a healthy cv. Russet Burbank control, and a water control. Results showed that amplified products of 460 bp were obtained with the PMTV primers for the four symptomatic tubers and the same tubers were negative for TRV. In addition, symptomatic tissue from the four tubers tested positive for PMTV by ELISA using a commercially available kit (Adgen, Ayr, Scotland). Symptomless Russet Burbank tubers and water controls were negative in RT-PCR and ELISA tests. The 460 bp PMTV amplicon from two symptomatic Modoc tubers were cloned and sequenced. The sequences were identical and the sequence (GenBank Accession No. JX239990) was 100% identical to the corresponding sequences of PMTV isolates from North Dakota (HM776172) and Finland (AM503632). There was one nucleotide difference from the corresponding sequence of a PMTV isolate from Washington (JN132117). To our knowledge, this is the first published report of PMTV in Idaho and confirms that PMTV exists in southeast Idaho. A previous report made by Canada in 2004 (Plant Dis. 88:363) indicates that PMTV was found in multiple states and provinces, but no specific locations were identified. This report follows reports of PMTV in commercial potatoes in Washington (1), North Dakota (2), and Maine (3). In 2011, 129,000 hectares of potatoes were grown in Idaho, representing 29% of the fall grown potatoes in the United States. PMTV can cause quality problems and as evidenced by these samples with no external symptoms, problems may be compounded because of internal symptoms that may go undetected. The confirmation of PMTV alerts growers and processors to the presence of this virus in this important potato-producing state. References: (1) J. M. Crosslin. Plant Dis. 95:1483, 2011. (2) N. David et al.Plant Dis. 94:1506, 2010. (3) D. H. Lambert et al.Plant Dis. 87:872, 2003. (4) D. J. Robinson. J. Virol. Methods 40:57, 1992.

Buccal versus lingual articaine infiltration for mandibular tooth anaesthesia: a randomized controlled trial.

AIM: To compare the effectiveness of buccal and lingual local anaesthetic injections in the mandibular first molar region in obtaining pulpal anaesthesia in mandibular teeth. METHODOLOGY: Twenty healthy volunteers received 1.8 mL of 4% articaine with 1 : 100,000 epinephrine as a buccal or lingual infiltration in the mandibular first molar region in a randomized double-blind cross-over design. The responses of the first molar, a premolar and the lateral incisor teeth were assessed using an electronic pulp tester over a 47-min period. Successful anaesthesia was defined as no response to maximum stimulus from the pulp tester on two or more consecutive tests. Success between techniques was analysed using the McNemar test and variations between teeth were compared with Chi-square. RESULTS: The number of no responses to maximum stimulation from an electronic pulp tester was significantly greater for all test teeth after the buccal injection compared with the lingual approach (P < 0.001). Successful anaesthesia was more likely following the buccal infiltration compared with the lingual method for molar (65% and 10%, respectively) and premolar (90% and 15%, respectively) teeth. There was no difference in anaesthetic success for the lateral incisor. CONCLUSION: Buccal infiltration at the first mandibular molar is more effective than lingual infiltration in the same region in obtaining anaesthesia of the mandibular first molar and premolar teeth.

The efficacy of infiltration anaesthesia for adult mandibular incisors: a randomised double-blind cross-over trial comparing articaine and lidocaine buccal and buccal plus lingual infiltrations.

AIM: To compare the efficacy of 2% lidocaine and 4% articaine both with 1:100,000 adrenaline in anaesthetising the pulps of mandibular incisors. METHODS: Thirty-one healthy adult volunteers received the following local anaesthetic regimens adjacent to a mandibular central incisor: 1) buccal infiltration of 1.8 mL lidocaine plus dummy lingual injection (LB), 2) buccal plus lingual infiltrations of 0.9 mL lidocaine (LBL), 3) buccal infiltration of 1.8 mL articaine plus dummy lingual injection (AB), 4) buccal plus lingual infiltrations of 0.9 mL articaine (ABL). Pulp sensitivities of the central incisor and contralateral lateral incisor were assessed electronically. Anaesthetic efficacy was determined by two methods: 1) Recording the number of episodes with no responses to maximal electronic pulp tester stimulation during the course of the study period, 2) recording the number of volunteers with no response to maximal pulp tester stimulation within 15 min and maintained for 45 min (defined as sustained anaesthesia). Data were analysed by McNemar, chi-square, Mann-Whitney and paired t-tests. RESULTS: For both test teeth, the number of episodes of no sensation on maximal stimulation was significantly greater after articaine than lidocaine for both techniques. The split buccal plus lingual dose was more effective than the buccal injection alone for both solutions (p <0.001). 4% articaine was more effective than 2% lidocaine when comparing sustained anaesthesia in both teeth for each technique (p <0.001), however, there was no difference in sustained anaesthesia between techniques for either tooth or solution. CONCLUSIONS: 4% articaine was more effective than 2% lidocaine (both with 1:100,000 adrenaline) in anaesthetising the pulps of lower incisor teeth after buccal or buccal plus lingual infiltrations.