Student training in administering inferior alveolar nerve block anesthesia with a simple manufactured simulation model.

OBJECTIVE: To compare the effectiveness of administering inferior alveolar nerve blocks (IANB) for the first time with or without a previous practical lesson using a simple manufactured simulator. METHODS: This was a study designed to compare students' first administration of IANB anesthesia during 2022, with or without a previous practical lesson. Students were randomized into two groups. The experimental group attended both theoretical lessons and a practical lesson with a simulator device, while the control group attended only theoretical lessons. The theoretical lesson included usual contents such as anatomy, physiology, technical maneuvers for administering anesthesia, tips, and complications, and the practical lesson consisted of the administration of anesthesia using a simple manufactured simulator. After students applied their first IANB, its efficacy, and their answers to a questionnaire on a 5-point Likert scale were recorded. Statistical analysis consisted of the Chi-square test (p < 0.05). RESULTS: The study recorded 60 anonymous surveys. The main difference observed was in instrument handing (p < 0.05), and there was a tendency in the ease of recognition of the anatomical marks used for the technique-pterygomandibular raphe and coronoid notch of the mandible (p = 0.08 and 0.11, respectively). No difference in success was observed (p > 0.05). Self-confidence and personal feelings did not differ statistically. All students agreed strongly or partially that training with the simulator model was helpful. CONCLUSION: Students who used simple manufactured simulators achieved better outcomes for instrument handling, and possibly for identification of anatomical landmarks, than those who received only theoretical lessons.

A comparative assessment of efficacy and preference between needleless device INJEX and insulin syringe for anesthetizing primary maxillary teeth in children aged 4-9 years: A split-mouth crossover randomized clinical study.

insulin syringe for anesthetizing primary maxillary teeth in children aged 4-9 years. Materials and Methods: This randomized clinical study included 46 children aged 4-9 years. The patients were digitally allotted to receive 4% articaine for extractions of primary maxillary teeth, either using needleless device INJEX or insulin syringe on each side of the maxillary arch, in two different appointments after a 1-week washout period. Pain perception was measured by the subjective (Faces Pain Scale-Revised [FPS-R]) and objective pain scores (Face, Legs, Activity, Cry, and Consolability [FLACC]) and hemodynamic parameters (heart rate and oxygen saturation) during LA administration and during extractions. After the second appointment, children were asked about their preference between needleless device INJEX and insulin syringe. Results: On evaluating subjective pain scores with FPS-R, intergroup differences between the INJEX and insulin syringe groups were found statistically insignificant, both during LA administration (P = 0.101) and extraction (P = 0.080). However, on assessing pain objectively during extraction using FLACC, the mean pain score was less with insulin syringe (2.78) as compared to INJEX (4.72) and the difference was statistically significant (P = 0.000). There was no significant difference in patient preference between the two methods. Conclusion: Pain perception was minimal during local anesthesia administration using needleless device INJEX; however, its clinical efficacy during extractions was reported to be lower than insulin syringe. Background: Managing pain in children is the most challenging task as it forms the foundation for instilling positive behavior toward dental treatment. Adequate local anesthesia (LA) is the cornerstone of pain management. However, the fear of needles, particularly in young children, can result in complete avoidance and refusal of treatment. Aim: This study aimed to evaluate and compare the efficacy and preference between needleless device INJEX and.

Evaluation of maximum dose intravenous midazolam used in dental intravenous sedation: a West of Scotland regional audit.

Background Intravenous (IV) midazolam sedation is commonly used in the delivery of dentistry for phobic patients. There is currently no guidance on a maximum dose for use specifically in dentistry. Dentists practise with the British National Formulary recommended maximum dose of 7.5 mg; however, anecdotally, this is often exceeded. We aim to evaluate prescribing and propose recommendations for a maximum dose for dentists.Method Data was collected from ten dentists across four Scottish health boards regarding their last 20 IV sedation patients, giving a total of 200. Data obtained from standard Dental Sedation Teachers Group IV logbooks included: dose of midazolam administered; justification for doses over 7.5 mg; flumazenil or supplemental oxygen usage; significant medical/social factors; and the Ramsay Sedation Score.Results Mean midazolam dose was 6.1 mg with a range of 14 mg. The recommended maximum dose of 7.5 mg was exceeded in 28% of cases. The mean sedation score was 2.7 and there were no reported adverse events or use of flumazenil.Conclusion IV midazolam is an effective way to achieve conscious sedation in dentistry. Acknowledgement of current off-label prescribing is important; however, 7.5 mg as a recommended maximum dose is too conservative as it is regularly exceeded without adverse events. Further investigation and expert opinion is required to set a maximum dose specifically for dentistry.

Comparative Assessment of Pain during Infiltration by a Two-stage Infiltration Technique: A Double-blind Clinical Trial.

AIM: The aim of this study was to assess and compare the pain during infiltration by a modified two-stage local anesthetic infiltration technique under topical anesthesia (TA). MATERIALS AND METHODS: In this cross-over double-blind study, 30 volunteers participated, where two groups were given single-stage infiltration and the other two had two-stage infiltrations. Depending upon the infiltration technique (one- or two-stage) and the use of TA, the patients were randomly divided into four groups. Local anesthesia (LA) was administered by infiltration into the mucobuccal fold of the maxillary central incisor, and the pain perceived during the infiltration in each group was recorded. The volunteers were recalled after 24 hours to assess the tenderness at the injection site. The volunteers were recalled 2 weeks after infiltration for the subsequent groups to assess the pain for this cross-over study. RESULTS: A statistically significant difference was observed in the pain perceived when TA was used and when the infiltration was done in two stages. Regarding the pain at the site of injection after 24 hours, no significant difference was observed among the volunteers. CONCLUSION: Topical anesthesia was effective in reducing the pain of injection when compared to placebo. The pain of injection is further reduced with a two-stage infiltration technique after TA application. CLINICAL SIGNIFICANCE: Topical anesthesia can be used routinely before infiltration, and LA infiltration injections are less painful if administered in two stages.

European Society of Anaesthesiology Task Force on Nitrous Oxide: a narrative review of its role in clinical practice.

Nitrous oxide (N2O) is one of the oldest drugs still in use in medicine. Despite its superior pharmacokinetic properties, controversy remains over its continued use in clinical practice, reflecting in part significant improvements in the pharmacology of other anaesthetic agents and developing awareness of its shortcomings. This narrative review describes current knowledge regarding the clinical use of N2O based on a systematic and critical analysis of the available scientific literature. The pharmacological properties of N2O are reviewed in detail along with current evidence for the indications and contraindications of this drug in specific settings, both in perioperative care and in procedural sedation. Novel potential applications for N2O for the prevention or treatment of chronic pain and depression are also discussed. In view of the available evidence, we recommend that the supply of N2O in hospitals be maintained while encouraging its economic delivery using modern low flow delivery systems. Future research into its potential novel applications in prevention or treatment of chronic conditions should be pursued to better identify its role place in the developing era of precision medicine.

Assessment of anesthetic properties and pain during needleless jet injection anesthesia: a randomized clinical trial.

OBJECTIVE: Pain due to administration of local anesthetics is the primary reason for patients' fear and anxiety, and various methods are used to minimize it. This study aimed to measure the degree of pain during administration of anesthesia and determine the latency time and duration of pulpal anesthesia using two anesthetic methods in the maxilla. MATERIALS AND METHODS: A randomized, single-blind, split-mouth clinical trial was conducted with 41 volunteers who required class I restorations in the maxillary first molars. Local anesthesia was administered with a needleless jet injection system (experimental group) or with a carpule syringe (control) using a 30-gauge short needle. The method of anesthesia and laterality of the maxilla were randomized. A pulp electric tester measured the latency time and duration of anesthesia in the second molar. Visual analogue scale (VAS) was used to measure the degree of pain during the anesthetic method. Data were tabulated and then analyzed by a statistician. The t-test was used to analyze the differences between the groups for basal electrical stimulation. Duration of anesthesia and degree of pain were compared using the Mann-Whitney test. A 5% significance level was considered. RESULTS: There was no statistical difference in the basal electrical stimulation threshold (mA) and degree of pain between the two methods of anesthesia (p>0.05). Latency time was 2 minutes for all subjects. The duration of pulpal anesthesia showed no statistical difference (minutes) between the two methods (p<0.001), with a longer duration for the traditional method of anesthesia (median of 40 minutes). CONCLUSIONS: The two anesthetics methods did not differ concerning the pain experienced during anesthesia. Latency lasted 2 minutes for all subjects; the traditional infiltration anesthesia resulted in a longer anesthetic duration compared with the needleless jet injection.

Assessment of anesthetic properties and pain during needleless jet injection anesthesia: a randomized clinical trial

Abstract Pain due to administration of local anesthetics is the primary reason for patients' fear and anxiety, and various methods are used to minimize it. This study aimed to measure the degree of pain during administration of anesthesia and determine the latency time and duration of pulpal anesthesia using two anesthetic methods in the maxilla. Materials and Methods: A randomized, single-blind, split-mouth clinical trial was conducted with 41 volunteers who required class I restorations in the maxillary first molars. Local anesthesia was administered with a needleless jet injection system (experimental group) or with a carpule syringe (control) using a 30-gauge short needle. The method of anesthesia and laterality of the maxilla were randomized. A pulp electric tester measured the latency time and duration of anesthesia in the second molar. Visual analogue scale (VAS) was used to measure the degree of pain during the anesthetic method. Data were tabulated and then analyzed by a statistician. The t-test was used to analyze the differences between the groups for basal electrical stimulation. Duration of anesthesia and degree of pain were compared using the Mann-Whitney test. A 5% significance level was considered. Results: There was no statistical difference in the basal electrical stimulation threshold (mA) and degree of pain between the two methods of anesthesia (p>0.05). Latency time was 2 minutes for all subjects. The duration of pulpal anesthesia showed no statistical difference (minutes) between the two methods (p<0.001), with a longer duration for the traditional method of anesthesia (median of 40 minutes). Conclusions: The two anesthetics methods did not differ concerning the pain experienced during anesthesia. Latency lasted 2 minutes for all subjects; the traditional infiltration anesthesia resulted in a longer anesthetic duration compared with the needleless jet injection.

Comparison of Visual Analog Scale Scores in Pain Assessment during Pulpotomy using Different Injection Materials in Children Aged 6 to 8 and 8 to 10 Years.

AIM: Proper anesthesia and pain management during treatment are most important concerns in dentistry for people of all ages, especially children. This study compared the success rate of lidocaine block with articaine buccal infiltration during anesthesia of the primary mandibular second molars in children aged 6 to 8 and 8 to 10 years. MATERIALS AND METHODS: The present clinical trial was conducted on 40 children aged 6 to 8 and 8 to 10 years who were referred to the Department of Pediatrics of the Faculty of Dentistry at Shahid Sadoughi University of Medical Sciences in Yazd (Islamic Republic of Iran) and needed to be treated with pulpotomy on both primary mandibular second molars. The patients were randomly divided into two groups. At the first session, a group received articaine buccal infiltration and the other group experienced inferior alveolar nerve (IAN) block. At the next visit, this trend was reversed. Visual analog scale (VAS) was used to evaluate the pain during pulpotomy. RESULTS: Data were analyzed by Statistical Package for the Social Sciences (version 17) software using Mann-Whitney test. According to the results of this test, the pain during pulpotomy was significantly lower in the articaine group (p < 0.001). CONCLUSION: Articaine buccal infiltration can be employed for pulpotomy treatment in primary mandibular second molars. CLINICAL SIGNIFICANCE: This research will eliminate block injection of lidocaine in children and utilize infiltration of articaine for pulpotomy treatment of mandibular teeth, hence preventing lingual nerve damage and prolonging paresthesia of IAN, lip, and cheek bite due to IAN block anesthesia.

Minimally-invasive dental anesthesia: Patients' preferences and analysis of the willingness-to-pay index.

AIM: The aim of the present prospective study was to evaluate the impact of a computer-controlled anesthesia on patients' comfort and to investigate, through the willingness-to-pay (WTP) index, and patients' acceptance of this new technology. METHODS: Fifty patients undergoing a class I or II restorative procedure were enrolled. A computer-controlled device for anesthetic delivery was utilized, and a questionnaire on the level of discomfort and WTP was given to all patients. RESULTS: A total of 86% of participants declared less discomfort than that perceived during their last traditional procedure for pain control; 58% of patients were willing to pay an additional fee for a modern anesthesia technique, with a median WTP value of 20$. CONCLUSIONS: Computer-controlled systems for local anesthesia represent a relevant tool for reducing patients' discomfort during dental treatment. The WTP index helps to quantify its relevance.

Assessment of hypoxia, sedation level, and adverse events occurring during inhalation sedation using preadjusted mix of 30% nitrous oxide + 70%oxygen.

PURPOSE: To assess the efficacy of nitrous oxide (N2O)-oxygen (O2) inhalation sedation by rapid induction technique using preadjusted mix of 30% N2O and 70% O2 in children. MATERIALS AND METHODS: Sixty children with a treatment plan which included pulp therapy were recruited for the study. Children categorized 3 and 4 of Frankl behavior rating scale and American Society of Anesthesiologists health status I and II were included for the study. Children were distributed into study group (Group-I) and control group (Group-II) by fishbowl randomization. Children in Group-I were induced inhalation sedation using a preadjusted mix of 30% N2O and 70% O2 through rapid induction technique, and children in Group-II were exposed to inhalation sedation by conventional slow induction technique. Parameters such as least oxygen saturation, sedation levels by Richmond Agitation-Sedation Scale, time taken to achieve ideal sedation, maximum N2O concentrations used, and adverse events were recorded and evaluated for each procedure. Data were analyzed using independent sample t-test and Chi-square tests. RESULTS: Analysis of data showed statistically significant difference between both groups in time taken to achieve ideal sedation (P < 0.001). No significant difference was seen in incidence of hypoxia (P < 0.512), maximum N2O concentrations used (P < 0.118), and occurrence of any adverse events. CONCLUSION: None of the children from both groups exhibited hypoxia. Sense of detachment was seen in one child each from both groups. Rapid induction by preadjusted mix resulted in ideal sedation in 57% children of the Group-I; rest had achieved these levels at 40% N2O. There was a significant difference in the time taken to achieve ideal sedation by rapid induction which was almost half the time taken with slow induction.

Assessment of Thiel-Embalmed Cadavers as a Teaching Tool for Oral Anatomy and Local Anesthesia.

The aim of this study was to determine whether Thiel-embalmed cadavers would provide a useful anatomy teaching tool for topics that cannot be approached using formalin-fixed cadavers such as oral cavity examination and maxillary anesthesia. The suitability of Thiel-embalmed bodies for performing oral examinations was assessed by asking first-year dental and dental hygiene students at a dental school in Ireland to identify oral structures on a classmate and on a Thiel-embalmed body. The study was conducted in 2016. The ease of location was compared in the two settings, and their quality was assessed on the cadavers. The suitability of Thiel-embalmed cadavers to teach maxillary anesthesia was assessed by students' performing mock injections at five adjacent sites daily for five consecutive days, followed by inspection of the gingival surface by experienced anatomists and dentists. Data were obtained from 57 students, but only the 54 forms that were fully completed were analyzed, for an overall response rate of 85.7%. The results showed that most oral structures were more difficult to locate on cadavers. The texture and appearance of features in the cadavers were rated at a midpoint between realistic and unrealistic. The relative inexperience of the participants, the accumulation of fixative in the oral cavity, and discoloration were mentioned as potential confounding factors. Visual analysis of images obtained following repeated injections revealed no deterioration of the tissue. Importantly, the puncture marks appeared to reduce over time, suggesting that the gingival tissue maintains some elasticity following Thiel fixation. These findings suggest that Thiel-embalmed cadavers may be a useful tool to provide students more time to localize and study aspects of the oral cavity. Likewise, the recoiling capacity of gingival tissue suggests that Thiel-embalmed cadavers may provide an ideal tool for teaching injection technique of local anesthetics.

Comparing the Efficiencies of Third Molar Surgeries With and Without a Dentist Anesthesiologist.

Two different anesthesia models were compared in terms of surgical duration, safer outcomes, and economic implications. Third molar surgeries performed with and without a separate dentist anesthesiologist were evaluated by a retrospective data analysis of the surgical operative times. For more difficult surgeries, substantially shorter operative times were observed with the dentist anesthesiologist model, leading to a more favorable surgical outcome. An example calculation is presented to demonstrate economic advantages of scheduling the participation of a dentist anesthesiologist for more difficult surgeries.

[A PhD completed 1. Immediate dental implant placement in the aesthetic zone]. / Hora est 1. Direct plaatsen van implantaat na extractie in de esthetische zone.

When aesthetics play a role in an extraction, the tendency is to place an implant in the extraction socket immediately, preferably in combination with a temporary crown. This tendency is probably related to evolving social factors: demanding patients who want an instant and attactive result. In 2 randomised clinical trials (total 80 patients) the results of clinical treatment involving immediate implants in the aesthetic zone are investigated. Depending on the size of the bone defect (< 5 or ≥ 5 mm) the number of surgical interventions was reduced from 2 to 1 or from 3 to 2. The treatment result was measured by the following outcome variables: survival rate, changes in hard and soft -peri-implant tissues, aesthetic indecees and patient-satisfaction. The most important conclusion is that immediate placements of implants in the aesthetic zone, results in -outstanding short-term (1-year) results with respect to the outcome variables. If this also leads to good long-term results has yet to be investigated.

Assessing the use of the Index of Sedation Need in oral surgery.

OBJECTIVE: This article evaluates the use of the Index of Sedation Need in oral surgery. DESIGN: Service evaluation and audit. SETTING: Oral surgery department of a London dental teaching hospital. SUBJECTS (MATERIALS) AND METHODS: Patients attending for oral surgery procedures with sedation which had been arranged without reference to the IOSN tool completed the IOSN and a patient questionnaire. Operators completed a similar questionnaire. The IOSN was calculated and the questionnaire responses analysed using SPSS. RESULTS: 56% of the patients in this study (n = 105) were receiving sedation appropriately according to the IOSN tool. When the questionnaire responses were analysed depending on sedation need, no statistical difference was found using Fisher's exact test or Pearson Chi-Square (p <0.05). Fifty percent of patients who had no need for sedation according to the IOSN tool were considered by the operator to have been untreatable without it. CONCLUSION: This study raises questions over the validity and reliability of the IOSN tool as a method of defining sedation need.

Airway Assessment for Office Sedation/Anesthesia.

Whenever a patient is about to receive sedation or general anesthesia, no matter what the technique, the preoperative assessment of the airway is one of the most important steps in ensuring patient safety and positive outcomes. This article, Part III in the series on airway management, is directed at the ambulatory office practice and focuses on predicting the success of advanced airway rescue techniques.

Assessment of difficulty in third impacted mandibular molar surgery: the Conti Scale.

AIM: We suggest a numerical method for the preoperative assessment of difficulty in mandibular third molar surgeries. METHODS: This study enrolled 1000 subjects ranging in, age from 17 to 91 years, who presented to the Clinic of Maxillary Facial Surgery at the, University of Florence in Italy, for impacted mandibular third molars removal in 2013. The difficulty of extraction was analyzed for each patient. RESULTS: Comparison of preoperative difficulty assessment scores with the actual difficulty encountered by an operator, confirming the reliability of our protocol. CONCLUSION: Careful preoperative analysis of the extraction difficulties and correct surgical planning can reduce intra and postoperative complications, in the third impacted mandibular molar surgeries. The use of an easy and rapid method for the assessment of difficulty in third molar surgeries, is an efficient clinical methodology for preoperative analysis.

Assessment of buccal aerosolized midazolam for pediatric conscious sedation.

AIM: To assess the acceptance and efficacy of aerosolized midazolam through buccal mucosa for conscious sedation. METHODS: Thirty-five children aged 2-6 years with Grade I and II Frankl behavior rating scale were selected for various dental procedures under local anesthesia. Initially behavior-shaping procedures were used and Houpt behavior scoring was recorded. Thereafter, midazolam was administered using a spray through buccal mucosa and scores for acceptance of drug and behavior after sedation were recorded. The data were compiled and a Wilcoxon signed ranks test was used to assess the difference in behavior before and after the sedation. RESULTS: Eighty-three percent of the patients accepted the drug without any complaint. A statistically significant improvement was seen in the Houpt scores before and after drug administration (P < 0.001). CONCLUSIONS: Buccal aerosolized midazolam can be used successfully for pediatric conscious sedation.

Assessment of patients' awareness and factors influencing patients' demands for sedation in endodontics.

INTRODUCTION: Endodontic therapy is perceived by many as a procedure to be feared. Many studies have reported that fear and anxiety are major deterrents to seeking dental care in general, but only a few deal with the use of sedation in endodontic therapies. The purpose of this study was to assess patients' awareness of and factors influencing the potential demand for sedation in endodontics. We hypothesized that there is an association between demographic factors and the demand for sedation in endodontics. METHODS: A survey consisting of 24 questions was given to patients 18 years and older who presented to the graduate endodontic clinic. Results were collected and statistically analyzed. RESULTS: Thirty-six percent of patients reported that their perception of sedation was being put to sleep, and 27% perceived it as related to or reducing pain. Concerns associated with endodontic therapy were the fear of pain (35%), fear of needles (16%), difficulty getting numb (10%), and anxiety (7%). The 2 major demographic factors that influenced the demand for sedation were cost and the level of anxiety (P < .05). Fifty-one percent showed a positive interest in sedation for endodontic therapy if the option of sedation was available. CONCLUSIONS: The demand for sedation in endodontics is high. Patients' understanding of sedation varies. More patients would consider having endodontic procedures if sedation was available. The provision of sedation by endodontists could result in more patients accepting endodontic therapies.

Oral health status of children with special health care needs receiving dental treatment under general anesthesia at the dental clinic of Taipei Veterans General Hospital in Taiwan.

BACKGROUND: Oral health is crucial to individual growth and development. However, oral health care is often overlooked in children with special health care needs (CSHCN). We investigated current oral health status and unmet dental needs of CSHCN in Taiwan. METHODS: We performed a retrospective study of consecutive CSHCN cases receiving first-time comprehensive dental treatment under general anesthesia at Taipei Veterans General hospital from 2001 to 2010. We retrieved clinical data including age, sex, types, and severity of disability, caries experience index [decayed, extracted, and filled teeth (deft) index for primary dentition/decayed, missing, and filled teeth (DMFT) index for permanent dentition], malocclusion, and treatment modalities from medical charts for analysis. The correlation between different groups of CSHCN regarding the deft/DMFT indices and treatment modalities was analyzed statistically. RESULTS: Our study included 96 children, ranging in age from 2.4 years to 14.3 years (mean age 6.8 ± 3.3 years). The deft/DMFT index was significantly higher in the younger age group (2-6 years; 13.8 ± 4.3) compared with the older group (> 6 years; 10.5 ± 5.3; p < 0.001). The mean number of total treated teeth was 14.2 ± 3.8, and no differences existed among disability groups (p = 0.528) and age groups (p = 0.992). For the treatment modality, the number of pulp therapies with crown restoration was higher in the younger age group than in the older group. At the time of the study, 53 CSHCN had reached their full permanent dentition. We observed significantly more malocclusion of full permanent dentition in the older age group (91%) than in the younger group (35%; p < 0.001). CONCLUSION: Unmet dental needs and caries experience indices remain high in CSHCN, regardless of the types and severity of disability. However, the younger the age at which CSHCN received their first dental treatment, the more effective the dental rehabilitation was. Parental education regarding early dental intervention and a preventive approach for enhanced oral care is mandatory.

Assessment of general pre and postoperative anxiety in patients undergoing tooth extraction: a prospective study.

Our aim was to analyse the amount of anxiety and fear felt before, immediately after, and one week after, dental extraction. We studied 70 patients (35 men and 35 women (mean (SD) age 43 (±10) years), who were listed for dental extraction under local anaesthesia in a private clinic that specialised in oral surgery. Patients were evaluated on 3 consecutive occasions: immediately preoperatively, immediately postoperatively, and 7 days later. Each patient's anxiety was measured using Spielberger's State-Trait Anxiety Inventory (Spanish version), the Modified Corah Dental Anxiety Scale (MDAS) and the Dental Fear Survey. There were significant differences in the STAI-Trait scale between before and 7 days after extraction (p=0.04), and in the MDAS between before and immediately after extraction (p=0.02), and between immediately after and 7 days after extraction (p=<0.001). The DFS also differed between before and immediately after extraction (p=0.002), and between immediately and 7 days after extraction (p<0.001). Dental anxiety immediately after tooth extraction may be influenced by operative techniques (type of anaesthesia, duration of operation, or position of tooth extracted), but anxiety at 7 days after extraction is not.