Intraoral management of odontogenic infection associated with severe trismus under local anesthesia.

Trismus is defined as a tonic contraction of the muscles of mastication. It can also refer to limited mouth opening of any cause. Trismus is a classical symptom of masticatory space infections and it can be a sign of an infection in the anterior compartment of lateral pharyngeal space. Common causes in clinical practice followed by trismus are odontogenic infection which can be periodontal or pericoronal. This article will present a clinical report on intraoral management of mandibular odontogenic infection accompanied by severe trismus under local anesthesia using modified Akinosi technique in an outpatient environment. Treatment and postoperative period were routine. This kind of approach provides access to the infection at an early stage without general anesthesia, it shortens the hospital treatment and it enables faster recovery. KEY WORDS: Local Anesthesia, Odontogenic infection, Trismus.

Split-mouth and parallel-arm trials to compare pain with intraosseous anaesthesia delivered by the computerised Quicksleeper system and conventional infiltration anaesthesia in paediatric oral healthcare: protocol for a randomised controlled trial.

INTRODUCTION: Local anaesthesia is commonly used in paediatric oral healthcare. Infiltration anaesthesia is the most frequently used, but recent developments in anaesthesia techniques have introduced an alternative: intraosseous anaesthesia. We propose to perform a split-mouth and parallel-arm multicentre randomised controlled trial (RCT) comparing the pain caused by the insertion of the needle for the injection of conventional infiltration anaesthesia, and intraosseous anaesthesia by the computerised QuickSleeper system, in children and adolescents. METHODS AND ANALYSIS: Inclusion criteria are patients 7-15 years old with at least 2 first permanent molars belonging to the same dental arch (for the split-mouth RCT) or with a first permanent molar (for the parallel-arm RCT) requiring conservative or endodontic treatment limited to pulpotomy. The setting of this study is the Department of Paediatric Dentistry at 3 University dental hospitals in France. The primary outcome measure will be pain reported by the patient on a visual analogue scale concerning the insertion of the needle and the injection/infiltration. Secondary outcomes are latency, need for additional anaesthesia during the treatment and pain felt during the treatment. We will use a computer-generated permuted-block randomisation sequence for allocation to anaesthesia groups. The random sequences will be stratified by centre (and by dental arch for the parallel-arm RCT). Only participants will be blinded to group assignment. Data will be analysed by the intent-to-treat principle. In all, 160 patients will be included (30 in the split-mouth RCT, 130 in the parallel-arm RCT). ETHICS AND DISSEMINATION: This protocol has been approved by the French ethics committee for the protection of people (Comité de Protection des Personnes, Ile de France I) and will be conducted in full accordance with accepted ethical principles. Findings will be reported in scientific publications and at research conferences, and in project summary papers for participants. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT02084433.

Evaluation and clinical use of an intraoral inferior alveolar nerve block in the horse.

REASONS FOR PERFORMING STUDY: Local anaesthesia is often required to facilitate invasive procedures in equine dental patients under standing sedation. OBJECTIVES: To show that an intraoral approach can be used to desensitise the inferior alveolar nerve in horses and report complications seen with this technique. METHODS: The distance of the mandibular foramen from the distal (caudal) edge of the mandibular third molar tooth, rostral edge of the mandibular ramus and ventral margin of the mandible were measured in 26 adult equine skulls of various ages and breeds. Computed tomography (CT) was used to verify the placement of the local anaesthetic with a custom-made device on 4 equine cadaver heads. The technique was applied in 43 clinical cases having procedures performed on the mandibular quadrants using the delivery device. RESULTS: Computed tomography demonstrated that the intraoral approach provided deposition of the local anaesthetic at the mandibular foramen and anatomical localisation of mandibular foramen indicated that anaesthetic solution could be delivered with a 38 mm needle. Clinical patients to lerated invasive dental procedures following the inferior alveolar nerve block with a 5 ml dose of local anaesthetic, without evidence of self-inflicted lingual trauma. CONCLUSIONS: The inferior alveolar nerve was successfully desensitised with the intraoral approach with minimal complications. The reduced volume of local anaesthetic and ability to deposit the local anaesthetic in close proximity to the nerve compared with an extraoral technique may decrease the complication of self-inflicted lingual trauma.

Evidence-based dentistry on laser paediatric dentistry: review and outlook.

AIM: The goal of paediatric dentistry is to provide preventive education to parents and patients as well as interception and therapy of dental diseases in a minimally invasive way using a stress-free approach. Different laser wavelengths are used for different applications following these minimally invasive concepts: argon, KTP, diode, Nd:YAG, and CO2 lasers are used for soft tissue applications and the erbium family is used for both soft and hard tissue procedures. This paper offers a revision and a discussion of the international literature, showing also some clinical procedures. related to these scientific studies. Soft tissues laser applications in Pediatric Dentistry include application in oral surgery as well as in periodontics and orthodontics. Laser applications on hard tissues include caries prevention and detection and application for sealing of pits and fissures. Also application for cavity preparation, carious removal and pulp therapy are discussed.

Lasers in pediatric dentistry.

Pediatric dentistry's mission in delivering care to our young patients is simple: provide optimal preventive, interceptive, and restorative dental care in a stress-free environment. Lasers such as argon, diode, Nd:YAG, CO2, and now the erbium family enable minimally invasive dentistry for hard- and soft-tissue procedures. This article offers an understanding of treatment planning in the pediatric practice and demonstrates the procedures that dental lasers can perform on younger patients.

The effect of tramadol on dento-alveolar surgical pain.

The aim of the study was to assess the analgesic effect of tramadol in the relief of pain after dentoalveolar operations that involve the removal of bone and suturing. Four-hundred and fifty-two patients over the age of 18 years who were to undergo removal of impacted teeth (n = 362), removal of root (n = 79), or alveolectomy, enucleation of cysts, or removal of soft tissue (n = 11) under local anesthesia were studied. Patients were randomly allocated to receive tramadol 100 mg or 50 mg four times daily, or 50 mg twice daily, or placebo. Median pain scores on the day of operation in the three tramadol groups were similar (2 in each group, ranges 1-5, 1-4.8, and 1-5 respectively) and were all significantly lower than that in the placebo group (2.3 range 1-4.2). The median number of Paracetamol tablets taken by patients in the three tramadol groups was 2 (ranges 0-8, 0-12 and 0-8 respectively), and were all significantly less than in the placebo group (4, range 0-12). More patients given tramadol reported complete pain relief than the placebo group. The advantages of tramadol continued over the next 2 days. There were no serious or unexpected adverse effects. It is concluded that tramadol is an effective analgesic after dentoalveolar operations.