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.

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.

Creating a patient-based condition-specific outcome measure for Temporomandibular Disorders (TMDs): Oral Health Impact Profile for TMDs (OHIP-TMDs).

The aim of this study was to generate a putative patient-based outcome measure specifically for Temporomandibular Disorders (TMDs) using a mixed-method approach. A combined quantitative-qualitative methodology was used to identify the most relevant items in the Oral Health Impact Profile (OHIP-49) for TMDs. The quantitative study involved 110 patients with TMDs diagnosed using the Research Diagnostic Criteria for TMDs (RDC/TMD) and 110 age- and sex-matched controls. All subjects completed the OHIP-49. The qualitative study involved semi-structured interviews with a separate sample of patients with TMDs (n = 29). The two resultant data sets were analysed blinded and separately. Each data set used predetermined rules to select candidate items for the putative OHIP for TMDs. The two sets of selected items were then compared using a priori rules to make a final item selection for OHIP TMDs. Eighteen pre-existing items were selected through the quantitative process and fourteen by the qualitative process. On comparison of the two selections all but two of the items selected by the qualitative process had also been selected by the quantitative process. Two new candidate items emerged from the qualitative data that were not covered by OHIP-49. A 22 item putative OHIP-TMDs outcome measure emerged from the final selection process. A putative OHIP-TMDs outcome measure has been generated which requires further testing especially in relation to its responsiveness to change.

Articaine buccal infiltration enhances the effectiveness of lidocaine inferior alveolar nerve block.

AIM: To compare mandibular tooth pulpal anaesthesia and reported discomfort following lidocaine inferior alveolar nerve block (IANB) with and without supplementary articaine buccal infiltration. METHODOLOGY: In this prospective randomized double-blind cross-over study, thirty-six healthy adult volunteers received two IANB injections of 2 mL lidocaine 2% with epinephrine 1 : 80,000 over two visits. At one visit, an infiltration of 2 mL of articaine 4% with epinephrine 1 : 100,000 was administered in the mucobuccal fold opposite a mandibular first molar. At the other visit, a dummy injection was performed. Injection discomfort was recorded on 100 mm visual analogue scales. Pulpal anaesthesia of first molar, premolar, and lateral incisor teeth was assessed with an electronic pulp tester until 45 min post-injection. A successful outcome was recorded in the absence of sensation on two or more consecutive maximal pulp tester stimulations. Data were analysed using McNemar and Student's t-tests. RESULTS: The IANB with supplementary articaine infiltration produced more success than IANB alone in first molars (33 volunteers vs. 20 volunteers respectively, P < 0.001), premolars (32 volunteers vs. 24 volunteers respectively, P = 0.021) and lateral incisors (28 volunteers vs. 7 volunteers respectively, P < 0.001). Buccal infiltration with articaine or dummy injection produced less discomfort than IANB injection (t = 4.1, P < 0.001; t = 3.0, P = 0.005 respectively). CONCLUSIONS: The IANB injection supplemented with articaine buccal infiltration was more successful than IANB alone for pulpal anaesthesia in mandibular teeth. Articaine buccal infiltration or dummy buccal infiltration was more comfortable than IANB.

Aspirations and solutions--a 20 year journey through dental local anaesthetics.

This paper describes clinical and laboratory investigations concerned with the delivery, comfort, systemic effects and efficacy of dental local anaesthesia. Factors influencing the aspirating ability of dental local anaesthetic delivery systems are discussed. The effects of adrenaline in dental local anaesthetic solutions on plasma potassium levels and on the transplanted heart are described. The use of an infiltration technique as an alternative to the inferior alveolar nerve block in the mandible is discussed.

A comparison of the aspirating abilities of re-usable and partly disposable dental cartridge syringes in vitro.

OBJECTIVES: To compare the ability of re-usable and partly disposable dental cartridge syringes to aspirate in vitro. METHODS: A laboratory investigation comparing two re-usable (Astra and Rotor) and one partly disposable (Ultra Safety-plus) dental cartridge syringes. Forces needed to move the cartridge plunger and forces required to produce aspiration of Bonney's Blue dye were measured using an Instron testing machine. RESULTS: There were significant differences in the forces needed to produce aspiration in the different systems (F = 194, p<0.001). The Astra system needed the least force to produce aspiration. The forces required to aspirate in the Rotor and Ultra Safety-plus systems did not differ. Each system aspirated effectively in vitro at the initial aspiration manoeuvre. The forces available for subsequent aspiration attempts varied with the speed of cartridge plunger movement. The volume of local anaesthetic cartridge used did not affect the force needed to produce aspiration in the Ultra Safety-plus syringe. The method of testing free-flow of solution through the needle affected the force generated at subsequent plunger movements. CONCLUSIONS: The re-usable and partly disposable syringes investigated aspirated effectively at the initial aspiration manoeuvre. The force available to produce aspiration at subsequent attempts varies with the speed of injection. The method of testing free-flow of solution through the needle in a loaded syringe affects the force available at the first aspiration manoeuvre.

Recent advances in local anaesthesia.

This paper describes developments in the field of dental local anaesthesia. Recently introduced injectable agents, advances in the field of topical anaesthesia and new delivery systems are discussed.

A survey of local anaesthetic use among general dental practitioners in the UK attending postgraduate courses on pain control.

OBJECTIVE: The aim of this study was to identify which local anaesthetic solutions were used by general dental practitioners in the United Kingdom and to determine selection criteria. In addition, differences in anaesthetic choice between recent graduates (< or = 5 years) and more experienced practitioners were investigated. MATERIAL AND METHODS: Five hundred and six general dental practitioners attending postgraduate courses on pain control in dentistry completed a questionnaire. Participants were asked to indicate year and place of qualification, anaesthetic solutions available in their surgeries and criteria used in the choice of anaesthetic. In addition, the respondents were asked to indicate choice of local anaesthetic in a number of common medical conditions. Questionnaires were distributed and collected immediately prior to the start of the course presentation and participants were not asked to indicate whether the selection decisions were teaching, experience or evidence based. Data were analysed by using the Chi-square test. RESULTS: Lidocaine with epinephrine was the most widely available solution among this group of practitioners (94%), the second most common solution was prilocaine with felypressin (74%). The majority of practitioners had two or more solutions available. Practitioners who qualified within the last five years (14%) were more likely to have articaine available, the most recently introduced local anaesthetic into the UK (p = 0.04, one degree of freedom). Common medical conditions lead to a modification in anaesthetic selection: the use of prilocaine/felypressin increases in the majority of circumstances, although it is avoided in pregnant females by recent graduates. CONCLUSIONS: Lidocaine/epinephrine continues to be the most common anaesthetic solution used by this group of UK general practitioners. The primary criterion for selection of an anaesthetic agent was perceived efficacy. Prilocaine/felypressin is commonly selected as an alternative solution in the presence of common medical conditions.

Differences between men and women regarding attitudes toward dental local anesthesia among junior students at a United Kingdom dental school.

The aim of this study was to assess the attitudes of junior dental students at a United Kingdom dental school regarding the administration and receipt of a local anesthetic injection. The effect of teaching on these attitudes was also evaluated. Data were collected by questionnaire. Previous experience with local anesthesia in a dental office did not affect students' attitudes toward administration and receipt of a local anesthetic injection from a classmate. Female students were more anxious about giving and receiving local anesthetic injections than male students. Didactic teaching decreased anxiety in relation to administration and receipt of a local anesthetic injection. The results showed that male and female students in a United Kingdom dental school differed in their attitudes toward local anesthesia.

Factors influencing the discomfort of intraoral needle penetration.

This study with 24 volunteers compared the discomfort produced by needle penetration in different parts of the palatal mucosa. In addition, comparing a fresh needle to one that was used for a previous penetration in the same patient, we assessed the influence of the status of the needle on insertion discomfort during buccal mucosal penetration. The results showed that needle penetration in the anterior hard palate was more uncomfortable than in the posterior palate. Although men could not differentiate between fresh and used needles for a second buccal mucosal penetration, women reported a significant increase in discomfort with used needles.

Why does local anaesthesia not work everytime?

This paper describes the reasons why local anaesthesia may fail. It offers strategies to help overcome failure of local anaesthesia in dentistry.

Recent advances in local anaesthesia.

This paper describes developments in the field of dental local anaesthesia. Recently introduced injectable agents, advances in the field of topical anaesthesia and new delivery systems are discussed.

Intra-oral topical anaesthetics: a review.

OBJECTIVE: This review considers the use of topical anaesthetics in the mouth to reduce the discomfort of local anaesthetic injections and intra-oral operative procedures. DATA SOURCES: Electronic literature search using Pub Med, manual search of references within papers found by the primary search and manual searching of abstracts from scientific meetings. STUDY SELECTION: The articles selected for this review investigate or used topical anaesthesia in dental procedures. CONCLUSIONS: The use of topical anaesthetics does not guarantee pain-free dental local anaesthesia. Efficacy is dependent upon the duration of application and the gauge of needle used. Evidence is available that the use of topical anaesthesia alone is sufficient to perform some intra-oral procedures including periodontal manipulations, operative dentistry and oral surgery.

Intraligamentary anaesthesia.

The introduction of specialized syringes in the late 1970s and early 1980s has led to an increase in the use of intraligamentary anaesthesia as a means of pain control in dentistry. This paper reviews the technique and its efficacy and considers the advocated advantages and disadvantages of the method in the light of the published scientific evidence. It is concluded that intraligamentary anaesthesia has a role to play in modern dental local anaesthesia but it does not fulfil all the requirements of a primary technique.

A laboratory investigation of a new design of self-aspirating syringe.

A new design of dental cartridge syringe which incorporates a double self-aspirating mechanism has been investigated under controlled conditions in the laboratory. The new design was compared to two self-aspirating syringes which have been available for some time, namely the Astra and Aspiject syringes. The new syringe aspirated as effectively as the Astra design and was better in this respect than the Aspiject. The method used to examine the syringes involved tests which might be of value in creating standards for dental local anesthetic cartridges.

Does beta 2 adrenergic agonism affect local anaesthetic efficacy?

It is theoretically possible that adrenaline might increase local anaesthetic efficacy by a specific beta 2 adrenergic agonistic mechanism by which nerve cell membranes are hyperpolarized. This study compares the anaesthetic efficacy of a local anaesthetic containing the beta 2 adrenergic agonist salbutamol to adrenaline-containing and plain local anaesthetic solutions following intradermal injections. The findings indicate that beta 2 adrenergic agonism did not affect local anaesthetic efficacy in the model employed.

Effect of different storage methods on the performance of dental local anaesthetic cartridges.

Self-aspirating dental local anaesthetic syringe systems rely on deformation of rubber diaphragms contained in the anaesthetic cartridges to produce the aspirating force. A test has been developed which can examine the performance of these rubber diaphragms under functional conditions. This method could be useful in the production of standards for dental local anaesthetic cartridges. The test has been used to determine the influence of storage conditions on the performance of dental local anaesthetic cartridges. The results show that, with the cartridges investigated, storage at 37 degrees C increased the amount of distortion per unit force of the aspirating diaphragms in comparison with storage at room temperature. However recovery of the diaphragms was unaffected. Storage at the higher temperature decreased the amount of force required to initiate movement of the cartridge rubber bung during injection. Soaking cartridges in alcohol did not affect the distortion of the aspirating diaphragms or the force needed to move the bung during injection, but did increase the degree of recovery of the diaphragm in the bung of self-aspirating cartridges.

The use of patient-controlled transcutaneous electronic nerve stimulation (TENS) to decrease the discomfort of regional anaesthesia in dentistry: a randomised controlled clinical trial.

OBJECTIVE: To compare the use of topical anaesthesia and transcutaneous electronic nerve stimulation (TENS) as means of reducing the discomfort of inferior dental block injections. METHODS: One hundred adult dental patients received 2% lignocaine with 1:80,000 adrenaline for long buccal and inferior dental block anaesthesia. The long buccal injections were given first with no prior mucosal preparation. Patients received inferior dental blocks after one of the following mucosal preparations: (1) no pretreatment; (2) a 2 min application of 20% benzocaine topical anaesthetic; (3) application of patient-controlled TENS at the injection site. Patients scored injection discomfort after each administration on a 100 mm visual analogue scale. RESULTS: The discomfort of the long buccal injection did not differ between the three groups of patients (F2,97 = 1.0). There were significant differences in the pain scores for the inferior dental block injections (F2,97 = 5.3; p < 0.01). Injection discomfort following TENS was less than that following no pretreatment (p < 0.01) and after topical anaesthetic application (p < 0.05). The use of topical anaesthesia did not produce a significant change in injection discomfort compared with no pretreatment. CONCLUSION: The use of TENS reduces injection discomfort during inferior dental block anaesthesia.

Clinical experience in oral surgery with 2 different automatic aspirating syringes.

The efficacy of 2 designs of automatic aspirating syringe was investigated in 440 patients receiving regional block anaesthesia in the mandible. The incidence of positive aspiration was significantly different between operators and between syringes. Positive aspiration was achieved in 18.9% of patients at some stage during administration of the local anaesthetic solution.

Local anaesthesia and dry socket. A clinical investigation of single extractions in male patients.

1533 single intra-alveolar permanent tooth extractions in males were investigated in a study to determine if the type and technique of local anaesthesia influenced the occurrence of dry socket. The results show that the incidence of dry socket was significantly greater after the use of Xylocaine compared to Citanest and that the use of repeated injections or intraligamental techniques increased the likelihood of this painful post-extraction condition.