Herbal medicines as anxiolytics prior to third molar surgical extraction. A randomized controlled clinical trial.

OBJECTIVES: This study aimed to compare the effects of Passiflora incarnata, Erythrina mulungu, and midazolam in controlling anxiety in patients undergoing mandibular third molar extraction. METHODS: The volunteers underwent extraction of their third mandibular molars in a randomized, placebo-controlled, triple-blind, and parallel clinical trial. Passiflora incarnata (500 mg), Erythrina mulungu (500 mg), or midazolam (15 mg) was orally administered 60 min before the surgery. The anxiety level of participants was evaluated using questionnaires and measurements of physical parameters, including heart rate (HR), blood pressure (BP), and oxygen saturation (SpO2). RESULTS: A total of 200 volunteers were included in this clinical trial. Considering each procedure independently, no significant differences (p > 0.05) in BP, HR, and SpO2 were observed among the protocols. CONCLUSIONS: Passiflora incarnata showed a similar effect to midazolam but differed from placebo and mulungu, which were unable to control anxiety in this situation. Therefore, the results suggest that Passiflora configures an herbal medicine with an anxiolytic effect, adequate to use in third molar extractions. CLINICAL RELEVANCE: The use of Passiflora incarnata may be an alternative to benzodiazepines for controlling anxiety in patients scheduled for oral surgery under local anesthesia. TRIAL REGISTRATION: ClinicalTrials.gov : ANSI-388.427.

Buffered 2% articaine versus non-buffered 4% articaine in maxillary infiltration: randomized clinical trial.

OBJECTIVES: This randomized, triple-blind, crossover clinical trial aimed to evaluate the efficacy, onset, length of pulp and soft tissue anesthesia, and pain during injection of 2% buffered articaine and 4% non-buffered articaine solutions. METHODS: Each volunteer received two maxillary supraperiosteal anesthesia infiltrations in canine area. The infiltrations were performed at two different sessions using a different local anesthetic solution for each session, and the anesthetic injection speed was always 1 mL/min. The assessment of the onset and length of pulpal and soft tissue anesthesia was performed with the pulp electrical test "pulp tester" and the esthesiometer kit, respectively. Volunteers marked pain during injection on a visual analog scale (VAS). The anesthetics solutions pH was evaluated through the pH meter equipment. RESULTS: There was no difference between the two anesthetic solutions (onset of soft tissue anesthesia, p = 0.5386; length of soft tissue anesthesia, p = 0.718; onset of pulpal anesthesia, p = 0.747; length of pulpal anesthesia, p = 0.375), except for pain during the injection which was lower when buffered 2% articaine was used (p = 0.001) and the pH. The pH analysis revealed that the solutions differed from one another (p < 0.01). CONCLUSION: The 2% buffered articaine solution provided the same anesthetic properties then 4% unbuffered articaine with a great reduction in pain during injection. CLINICAL RELEVANCE: The possibility of use 2% buffered articaine solution instead of 4% articaine maintaining the same anesthetic properties with a great reduction in pain during injection and half of the anesthetic salt concentration.

Comparison of two vasoconstrictors on glycemic levels in diabetic patients.

OBJECTIVES: The aim of this study was to evaluate glycemic levels in diabetic patients before, during, and after extractions using 2% lidocaine with 1:100,000 epinephrine (Lido/Epi) and 3% prilocaine with 0.03 IU/mL felypressin (Prilo/Fely). MATERIALS AND METHODS: A double-blind, randomized clinical trial was conducted to evaluate changes in body parameters and glycemic levels in diabetic patients undergoing two anesthetic protocols during dental extractions. During surgery, we evaluated blood pressure (BP), heart rate (HR), saturation (SpO2), and capillary glycemic levels (Gly). These parameters were measured at the following surgical moments: basal, 30 min after medication, incision, tooth removal, suture, and 30 and 60 min after anesthesia. RESULTS: Data analysis showed no differences between the groups considering age, weight, and time spent in surgery. Increased systolic BP and decreased diastolic BP were observed in the lido/epi group. No difference was observed in the prilo/fely group among the surgical moments or between the groups regarding BP. No difference was observed in HR and SpO2 between the groups at any surgical moment. However, differences were found when compared the differences in glycemic and basal levels in both groups with greater decreases in blood glucose values for the lido/epi group. In anxiety level evaluation, there was no difference between the different surgical moments. CONCLUSION: Thus, both lido/epi and prilo/fely (maximum 3.6 mL) can be safely used in controlled diabetic patients CLINICAL RELEVANCE: The use of lidocaine associated with epinephrine did not increase glycemic levels but leads to decrease over time when associated with an anxiety reduction protocol, offering some advantage over prilocaine plus felypressin for diabetic patients.

Estudo da difusão da articaína nos tecidos orais / Articaine diffusion in oral tissues

Objetivo: Avaliar a difusão do anestésico articaína a 4% com adrenalina 1:100.000 em dentes maxilares e mandibulares, injetado através do bloqueio do nervo alveolar superior posterior (NASP). Método: Foram realizados 50 procedimentos anestésicos do bloqueio do NASP em voluntários e avaliou-se a sensibilidade da mucosa através do teste pin-prick e a sensibilidade pulpar através do teste elétrico pulp tester. As estruturas avaliadas foram: mucosa palatal posterior (túber), mucosa palatal anterior, mucosa jugal, mucosa vestibular de molares, língua, lábio inferior, primeiro pré-molar inferior (1PMI), incisivo lateral inferior (ILI), primeiro molar inferior (1MI), primeiro pré-molar superior (1PMS), incisivo lateral superior (ILS), primeiro molar superior (1MS). Resultados: Foi observado que, ao analisar a insensibilidade mucosa, a efetividade da articaína em insensibilizar as estruturas testadas quando administrada através do bloqueio do NASP foi crescente com o decorrer do tempo e que os 1MS e 1PMS tiveram um tempo de latência inferior às demais unidades dentárias testadas. Observou-se que a insensibilidade pulpar foi crescente com o decorrer do tempo e que os 1MS e 1PMS tiveram um tempo de latência inferior às demais unidades dentárias testadas. O ILS e as unidades dentárias inferiores 1MI e 1PMI necessitaram de um tempo de latência de 4 minutos para começarem a apresentar insensibilidade pulpar. Os ILI apresentaram o maior índice de insucesso de anestesia pulpar (74%) e o insucesso da anestesia do 1MS foi de 6%, a menor entre os dentes testados. Conclusões: Os resultados sugerem haver uma difusão da articaína no sentido ântero-posterior na maxila e a difusão vestíbulo-palatal da droga. A articaína quando administrada através do bloqueio do NASP suprime a necessidade da anestesia do palato.

Objective: The purpose of this research was to evaluate the diffusion of 4% articaine with 1:100,000 adrenaline injected through posterior superior alveolar (PSA) nerve block in maxillary and mandibular teeth. Method: Fifty PSA nerve block procedures were performed in volunteers. The sensitivity of the mucosa was evaluated by the pin-prick test and pulp sensitivity was assessed by electric pulp testing. The following structures were evaluated: posterior palatal mucosa (tuber), anterior palatal mucosa, cheek mucosa, molar buccal mucosa, tongue, lower lip, mandibular first premolar (MD1PM), mandibular lateral incisor (MDLI), mandibular first molar (MD1M), maxillary first premolar (MX1PM), maxillary lateral incisors (MXLI) and maxillary first molar (MX1M). Results: The analysis of mucosa numbness and pulp numbness revealed that the efficacy of PSA nerve block with articaine to desensitize the tested structures increased with time and that the MX1M and MX1PM had shorter latency periods than the other tooth groups. The MXLI and MD1M and MD1PM required 4 minutes to start pulp numbness. MDLI showed the highest failure rate of pulpal anesthesia (74%) and MX1M had the lowest failure rate among all test (around 6%). Conclusion: The results suggest an anterior-posterior diffusion of articaine in the maxilla and a bucco-palatal diffusion of the drug. PSA nerve block with articaine eliminates the need for anesthesia of the palate.

Inverted papilloma (Schneiderian papilloma) with involvement of the oral cavity: report of an unusual case.

Inverted Schneiderian papilloma (ISP) is a neoplasm of epithelial lining origin which arises in the respiratory mucosa that lines the nasal cavity and paranasal sinuses. The inverted Schneiderian papilloma frequently appears as a unilateral lesion in the nasal septum and extends secondarily to the nasal and paranasal sinuses. This paper reports an unusual case of this pathology with involvement of the oral cavity in a 61-year-old white man. Clinical evaluation revealed a vegetating mass in the alveolar ridge of the right maxilla that had been present for approximately 4 months. After radiographic evaluation, involvement of the maxillary sinus was detected. Microscopic evaluation, in situ hybridization and immunohistochemical analysis of the specimen led to a diagnosis of ISP moderate dysplasia associated with HPV infection.

Papiloma invertido (Papiloma Schneideriano) com envolvimento da cavidade oral: relato de caso incomum / Inverted papilloma (Schneiderian papilloma) with involvement of the oral cavity: report of an unusual case

O papiloma invertido schneideriano é uma neoplasia de origem no epitélio de revestimento que surge da mucosa respiratória revestindo a cavidade nasal e os seios paranasais. Frequentemente, surge como uma lesão unilateral no septo nasal e estende-se secundariamente para o nariz e os seios paranasais. Este trabalho relata um caso incomum desta patologia, com o envolvimento da cavidade oral em um homem branco, de 61 anos de idade, cuja avaliação clínica revelou uma massa vegetante no rebordo alveolar direito da maxila, com duração de aproximadamente 4 meses. Após avaliação radiográfica, constatouse o envolvimento do seio maxilar. A análise microscópica, hibridização in situ e análise imunoistoquímica da peça cirúrgica levaram a um diagnóstico de displasia moderada em PIS associado à infecção por HPV.

Inverted Schneiderian papilloma (ISP) is a neoplasm of epithelial lining origin which arises in the respiratory mucosa that lines the nasal cavity and paranasal sinuses. The inverted Schneiderian papilloma frequently appears as a unilateral lesion in the nasal septum and extends secondarily to the nasal and paranasal sinuses. This paper reports an unusual case of this pathology with involvement of the oral cavity in a 61-year-old white man. Clinical evaluation revealed a vegetating mass in the alveolar ridge of the right maxilla that had been present for approximately 4 months. After radiographic evaluation, involvement of the maxillary sinus was detected. Microscopic evaluation, in situ hybridization and immunohistochemical analysis of the specimen led to a diagnosis of ISP moderate dysplasia associated with HPV infection.