Dentapen versus traditional syringe infiltration - which LA technique is preferred by patients?

Design Single-blind randomised cross-over trial.Intervention The study compared solution deposition pain of a maxillary lateral incisor infiltration between a computer-controlled local anaesthesia delivery device (Dentapen) and traditional syringe. The Dentapen was given with a slow flow rate of 1.8 mL/162 sec and ramp-up mode, and the traditional syringe infiltration was delivered at a flow rate of 1.8 ml/60 sec. Patients were randomly assigned to a sequence to receive both interventions at two separate appointments, with each participant acting as their own control. Patients rated the pain of each intervention using a Heft-Parker visual analogue scale and completed a preference survey at the conclusion of the second appointment.Case selection A total of 130 adult patients with ASA I or II were included in the study. Criteria for exclusion were patients under 18 years of age or older than 65, allergies to local anaesthetics or sulphites, pregnant or nursing, history of significant medical conditions (ASA III or higher), taking any medications that may affect pain assessment, active pathosis at the injection site, or inability to give informed consent.Data analysis Differences in pain of solution deposition for the Dentapen and traditional infiltration techniques were analysed using paired t-tests and odds ratios. Interactions between study groups, gender and anxiety were analysed using a linear mixed-effect model with a P value <0.05.Results Solution deposition pain was significantly less (P <0.001) with the Dentapen infiltration than the traditional infiltration. The preference survey revealed that 75% of patients preferred the Dentapen infiltration over the traditional technique.Conclusions The findings of this clinical trial suggest that pain during maxillary lateral incisor infiltrations can be reduced by using the Dentapen with a slow flow rate and ramp-up mode compared with the traditional syringe technique.

Climate-conscious sedation: how can we sustainably manage dental anxiety using inhalation sedation?

Climate change represents an urgent global threat. Without action, rising temperatures resulting from human activity will increasingly affect our health and wellbeing through changing patterns of disease, extreme weather events and availability of resources. Expedient decarbonisation of the UK economy is an ambitious goal to which we must all contribute.The NHS aims to be the world's first net-zero health service and reach carbon-neutral status by 2040. Dental services are particularly resource-intensive. Some dental anxiety management techniques have a disproportionately high impact on the environment relative to their usage. Inhalation sedation with nitrous oxide is one such example.Nitrous oxide is a greenhouse gas almost 300 times more potent than carbon dioxide, but its utility to facilitate dental treatment for anxious and vulnerable patients is well-documented. This paper balances the health utility with environmental and social harm of continuing to use nitrous oxide and suggests evidence-based methods we can apply to limit the environmental impact of sedation services.

'Sustainability in the NHS': a novel method for teaching sustainable dentistry and quality improvement to dental core trainees.

The practice of dentistry contributes to 3% of the carbon footprint of the NHS. As awareness and concern about climate change increases, all dental care professionals must play their part in reducing the environmental impact of the care they provide. This paper aims to describe a novel method of teaching, both the theory and practical application of sustainable dentistry, by integrating sustainable quality improvement methods into the existing management and leadership requirements of dental core training.

Sustainable oral healthcare: what is it and how do we achieve it?

In recent years, there has been an increase in interest in what environmental sustainability means for healthcare, including oral health and dentistry. To help facilitate discussions among key stakeholders in this area, the Scottish Dental Clinical Effectiveness Programme held a workshop in November 2022. The purpose of this workshop was to explore current thinking on the subject of sustainability as it relates to oral health and to help stakeholders identify how to engage with the sustainability agenda. This paper presents an overview of the presentations and discussions from the workshop and highlights potential avenues for future work and collaboration.