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1.
BMC Oral Health ; 24(1): 548, 2024 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-38730438

RESUMO

PURPOSE: To evaluate and compare oral health and behavior scores at the first dental visit and dental treatment need using general anesthesia/sedation (GA/S) of children with systemic diseases (SD) and healthy children. METHODS: Data were obtained from healthy children (n = 87) and children with SD (n = 79), aged 4 to 6 years, presenting to a hospital dental clinic for a first dental examination. The total number of decayed, missing and filled teeth (dmft), dental behavior score using Frankl Scale, and dental treatment need using GA/S were recorded. Chi-square / Fisher's exact test and Mann-Whitney U tests were used for statistical analyses. RESULTS: The patients with SD were diagnosed with cardiac disease (61%), renal disease (9%), and pediatric cancers (30%). The median dmft values of the SD group (3.00) were significantly lower than those of healthy children (5.00) (p = 0.02) and healthy children exhibited significantly more positive behavior (90.8%) than children with SD (73.4%) (p = 0.002). The number of patients needing GA/S for dental treatment did not differ significantly between the two groups (p = 0.185). There was no relationship between dental treatment need with GA/S and dental behavior scores of the patients (p = 0.05). A statistically significant relationship was found between the patients' dmft scores and the need for dental treatment using GA/S; and the cut-off value was found to be dmft > 4 for the overall comparisons. CONCLUSION: The presence of chronic disease in children appeared to affect the cooperation negatively at the first dental visit compared to healthy controls, however, it did not affect the oral health negatively. Having a negative behavior score or SD did not necessitate the use of GA/S for dental treatment.


Assuntos
Índice CPO , Humanos , Pré-Escolar , Criança , Feminino , Masculino , Comportamento Infantil , Neoplasias/psicologia , Cardiopatias , Saúde Bucal , Nefropatias , Cárie Dentária , Anestesia Geral , Anestesia Dentária , Estudos de Casos e Controles , Sedação Consciente
2.
Br Dent J ; 236(9): 680-682, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38730155

RESUMO

Nitrous oxide is a widely used and well-established form of inhalation sedation in dentistry. Its properties have a wide margin of safety and allow for anxious, paediatric and adult patients to receive dental treatment with minimal impact upon discharge. Nitrous oxide has drawbacks, however, including its environmental impact and need for specialist equipment. Methoxyflurane is another drug which could prove to be an alternative to nitrous oxide. Methoxyflurane's use has proved popular within emergency medicine in Australia and New Zealand for its potent analgesic effects and recognition of its anxiolytic effect. As a result, its use in invasive outpatient procedures has now become popular. Unfortunately, there is very limited evidence of its use within dentistry as a form of inhalation sedation and analgesic. A wider evidence base should be established, as methoxyflurane could prove to be an effective and environmentally friendly alternative to nitrous oxide.


Assuntos
Anestesia Dentária , Anestésicos Inalatórios , Metoxiflurano , Óxido Nitroso , Humanos , Metoxiflurano/administração & dosagem , Metoxiflurano/uso terapêutico , Metoxiflurano/farmacologia , Óxido Nitroso/administração & dosagem , Anestésicos Inalatórios/administração & dosagem , Anestesia Dentária/métodos , Isoflurano/administração & dosagem , Sedação Consciente/métodos
3.
Stomatologiia (Mosk) ; 103(2): 32-35, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38741532

RESUMO

THE AIM OF THE STUDY: Was to evaluate the use of Ketorol Express as a preventive analgesia to increase the effectiveness of local anesthesia in providing emergency dental care to patients with arterial hypertension. MATERIALS AND METHODS: The study was conducted on the basis of the state autonomous healthcare institution of the Moscow region «Royal Dental Clinic¼ with the participation of 83 people. The patients were divided into two groups. In group 1, Ketorol Express was prescribed as a preventive analgesia in a dosage of 20 mg before local anesthesia. Patients of group 2 underwent dental interventions without the use of preventive analgesia. A 3% solution of mepivacaine was used as a local analgesic solution. For a subjective assessment of the effectiveness of anesthesia, use a visual analog scale. All patients had their blood pressure and heart rate measured before and after the interventions and hemodynamic parameters were continuously monitored during emergency dental care. RESULTS: In group 1, the effectiveness of combined anesthesia with the infiltration method of local anesthetic administration was 93±1.17%, according to the patient, 94±1.47%, according to the doctor, with the conductive method of anesthesia at the mandibular orifice - according to the patient it was 91±1.01%, according to the doctor 92± 1.36%. In group 2, when providing emergency dental care with the infiltration method of administration of 3% mepivacaine the anesthesia was effective in 80±1.97% of cases according to the patient and in 80±1.17% of cases according to the doctor, with the conductive method of anesthesia at the mandibular orifice, the effectiveness of anesthesia according to the patient was 82±1.11%, according to the doctor 85±1.23%. CONCLUSION: The results of the study demonstrated a statistically significant increase in the effectiveness of local anesthesia performed with a 3% solution of mepivacaine in patients with arterial hypertension due to the use of preventive analgesia with Ketorol Express at a dosage of 20 mg (2 tablets of 10 mg) in emergency dental care with registration and analysis of changes in hemodynamic parameters.


Assuntos
Anestesia Dentária , Anestesia Local , Anestésicos Locais , Hipertensão , Mepivacaína , Humanos , Hipertensão/tratamento farmacológico , Anestesia Local/métodos , Masculino , Mepivacaína/administração & dosagem , Feminino , Anestesia Dentária/métodos , Pessoa de Meia-Idade , Anestésicos Locais/administração & dosagem , Adulto , Assistência Odontológica/métodos , Pressão Sanguínea/efeitos dos fármacos
4.
J Dent Child (Chic) ; 91(1): 31-37, 2024 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-38671571

RESUMO

Purpose: To investigate the impact of animal-assisted activity (AAA) involving a dog (play therapy) on reducing the pain experienced by children during the administration of local anesthetic (LA). Methods: Children between the ages of eight and 12 years who required LA administration were randomized into an AAA group and a control group. Baseline data for the simplified Modified Child Dental Anxiety Scale-Faces version (MCDAS[f]) was recorded, followed by the implementation of either AAA with standard care or standard care alone. The conventional protocol was followed for the administration of LA. Procedural pain was evaluated using both the Faces Pain Scale-Revised (FPS-R) and the Faces, Legs, Activity, Cry, and Consolability Scale (FLACC). All variations in pulse were also recorded. After the procedure, a simplified MCDAS(f) was recorded once again. The data were tabulated and statistically analyzed. Results: The children in the AAA group reported lower pain scores, as measured by FPS-R, compared to the control group (P =0.009). Pain, as observed in the FLACC scores, was also low in the experimental group (P <0.001). A notable reduction in anxiety scores (P <0.001) was observed among children assigned to the AAA group. Conclusion: AAA involving a dog led to a reduction in the pain experienced by children undergoing LA administration, subsequently decreasing anxiety.


Assuntos
Anestesia Dentária , Anestésicos Locais , Terapia Assistida com Animais , Ansiedade ao Tratamento Odontológico , Medição da Dor , Percepção da Dor , Criança , Humanos , Ansiedade ao Tratamento Odontológico/prevenção & controle , Animais , Masculino , Feminino , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Cães , Terapia Assistida com Animais/métodos , Anestesia Dentária/métodos , Anestesia Local/métodos , Dor Processual/prevenção & controle
5.
J Dent Child (Chic) ; 91(1): 18-24, 2024 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-38671572

RESUMO

Purpose: To assess oral sedation success using midazolam and hydroxyzine with and without meperidine, and to assess the relationship between child temperament and sedation outcomes. Methods: This study recruited children between the ages of 36 and 95 months who were randomly assigned to receive dental treatment with an oral sedation regimen of midazolam (0.5 mg/kg) and hydroxyzine (1.0 mg/kg) with or without meperidine (1.5 mg/kg). Data were collected from the treatment log and electronic health records. Parents completed the Child Behavior Questionnaire Short Form (CBQ-SF) to assess temperament. Results: The study included 37 participants. The overall treatment success rate was 54 percent. There were no significant differences in sedation outcome with age, sex, insurance status, sedation regimen, isolation method or duration of procedure. Children with high pre-operative Frankl behavioral ratings were more likely to have a successful sedation outcome (P <0.01). Children who displayed high soothability experienced higher rates of success (P =0.04), which was more pronounced in the non-opioid group (P <0.01). Conclusion: The study showed low rates of success for a relatively small sample size. There was no difference in sedation success between the opioid group and non-opioid group. However, pre-procedure behavior and temperament characteristic of sooth- ability may warrant more exploration as predictors of sedation success.


Assuntos
Anestesia Dentária , Sedação Consciente , Hidroxizina , Hipnóticos e Sedativos , Meperidina , Midazolam , Temperamento , Humanos , Feminino , Masculino , Pré-Escolar , Hidroxizina/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , Sedação Consciente/métodos , Meperidina/uso terapêutico , Anestesia Dentária/métodos , Criança , Midazolam/uso terapêutico , Comportamento Infantil/efeitos dos fármacos , Resultado do Tratamento , Analgésicos Opioides/uso terapêutico , Inquéritos e Questionários , Assistência Odontológica para Crianças/métodos
7.
Eur Arch Paediatr Dent ; 25(2): 267-275, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38649631

RESUMO

PURPOSE: Neurotoxicity concerns have been raised over general anesthesia and sedation medication use in children. Such concerns are largely based on animal studies, historical anesthetic agents, and assessment tools, thus warranting further investigations. Blood biomarkers in detecting neuronal inflammation and apoptosis are novel methods for detecting neuronal damage. Therefore, the aim of this feasibility study was to assess the usefulness of the levels of four plasma biomarkers in dental general anesthesia (DGA) as surrogate markers of neurotoxicity in children. The secondary aim was to compare changes in motor manipulative skills pre- and post-anesthetic exposure. METHODS: This single-center prospective observational study included 22 healthy children aged between 3 and 6 years old who underwent DGA. Subclinical neurotoxicity was measured with a panel of four plasma biomarkers: Caspase-3, neuron-specific enolase (NSE), neurofilament light chain, and S100B at three time points (1; at start, 2; end and 3; on recovery from DGA). The Skillings-Mack test was used to identify the difference in the biomarker levels at three time points. Motor manipulative score assessment, prior and two weeks after DGA was also performed. RESULTS: A total of 22 study participants (mean age = 5 ± 1 years) were included with a median DGA duration of 106 ± 28 min. A reduction in Caspase-3 levels was recorded, with pairwise comparison over three time points, reporting a statistical significance between time point 2 vs. 1 and time point 3 vs. 1. Although fluctuations in NSE levels were recorded, no significant changes were found following pairwise comparison analysis. Among other biomarkers, no significant changes over the three periods were recorded. Furthermore, no significant changes in manipulative motor scores were reported. CONCLUSION: Caspase-3 reduced significantly in the short time frames during day-care DGA; this might be due to the relatively short anesthesia duration associated with dental treatment as compared with more extensive medical-related treatments. Therefore, further studies on Caspase-3 as a potential biomarker in pediatric DGA neurotoxicity are required to further ascertain results of this study.


Assuntos
Anestesia Dentária , Anestesia Geral , Biomarcadores , Caspase 3 , Estudos de Viabilidade , Síndromes Neurotóxicas , Fosfopiruvato Hidratase , Subunidade beta da Proteína Ligante de Cálcio S100 , Humanos , Biomarcadores/sangue , Estudos Prospectivos , Anestesia Geral/efeitos adversos , Criança , Pré-Escolar , Caspase 3/sangue , Masculino , Feminino , Fosfopiruvato Hidratase/sangue , Síndromes Neurotóxicas/sangue , Síndromes Neurotóxicas/etiologia , Síndromes Neurotóxicas/diagnóstico , Anestesia Dentária/métodos , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Proteínas de Neurofilamentos/sangue
8.
J Indian Soc Pedod Prev Dent ; 42(1): 52-57, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38616427

RESUMO

BACKGROUND: The term "stereognosis" comes from neurology and describes the capacity to distinguish objects solely by touch. AIM: The aim of this research study was to compare the neuromotor ability of the tongue in patients with malocclusion and tongue dysfunction with and without superficial anesthesia on the tip of the tongue and hard palate. MATERIALS AND METHODS: The study included 132 patients aged 6-13 years. Using a spatula for speech therapy and a visual evaluation while swallowing saliva, all individuals were identified as having swallowing dysfunctions and divided into three groups: study group (children with malocclusions and tongue dysfunctions) - 44 patients, comparator group (children with malocclusions and without tongue dysfunctions) - 44 patients, and control group (children without malocclusions or tongue dysfunctions) - 44 patients. The Koczorowski methods were used for the stereognostic tests. RESULTS: Age, sex, and malocclusion were taken into account during the differential analysis. The study and comparison groups, study and control groups, and the comparator and control groups all showed statistically significant differences from one another. According to the results, tongue dysfunction affects patients' ability to coordinate their movements with their senses at a developing stage. CONCLUSION: Patients with malocclusions that are made worse by tongue dysfunctions have poorer oral stereognostic sensibility. Speech therapy and interdisciplinary specialist orthodontic treatment are required for individuals with impaired oral perception who are still in the developmental stage and have abnormal tongue position and function.


Assuntos
Anestesia Dentária , Má Oclusão , Humanos , Criança , Língua , Tato , Assistência Odontológica , Má Oclusão/diagnóstico
9.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 59(5): 523-527, 2024 May 09.
Artigo em Chinês | MEDLINE | ID: mdl-38637009

RESUMO

With the transition of the medical model from the traditional biomedical model to the biopsychosocial one, there is a growing trend and requirement for oral operations that prioritize comfort, pain management, minimally invasive techniques, and visualization. Consequently, demands for comfortable dental treatments among individuals are increasing. However, initial periodontal therapy is often accompanied by pain, and patients' reactions to pain range from nervousness to dental fear, such as irritability, hyperventilation, even nausea, vomiting, and refusal to cooperate, which make the implementation of initial periodontal therapy difficult or even impossible. This article will focus on three key steps: firstly, the preparation of the clinic, the acquisition of patients' trust and the implementation of preventive sedation before treatment; secondly, the use of comfort operation and nursing, psychological intervention measures, local anesthesia, and sedation techniques during treatment; thirdly, the health education and follow-up after treatment. By addressing these aspects, we aim to clarify how to perform comfortable initial periodontal therapy step by step.


Assuntos
Doenças Periodontais , Humanos , Doenças Periodontais/terapia , Anestesia Local , Ansiedade ao Tratamento Odontológico/prevenção & controle , Educação de Pacientes como Assunto , Confiança , Educação em Saúde Bucal , Anestesia Dentária/métodos
10.
Pediatr Dent ; 46(2): 91-98, 2024 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-38664910

RESUMO

Purpose: To evaluate the impact of multisensory room (MSR) use on preoperative anxiety and postoperative outcomes in children with autism spectrum disorder (ASD) undergoing dental treatment with general anesthesia. Methods: Forty children, ages six to 17 years, with ASD re- quiring general anesthesia for dental treatment, participated in this study. Participants were randomized to either the control group (standard pre- operative waiting room) or intervention group (MSR) for 20 minutes prior to general anesthesia induction. Pre- and post-intervention preoperative anxiety were measured. Following surgery, postoperative emergence delirium was assessed. Short- and long-term postoperative pain and adverse behavioral effects were evaluated six hours, 24 hours, one week, and one month post-surgery. Data analysis employed repeated measures analysis of variance with two groups and either two or four time periods. Results: The sample was predominantly male (62.5 percent) and identified as either White or Black (53 percent) and non-Hispanic (60 percent). Preoperative behavioral anxiety levels increased post-intervention in the control group (P<0.05) and decreased in the MSR group (P<0.001). Following surgery, pain intensity was greater in the control group compared to the MSR group at six hours (P<0.05) and 24 hours (P<0.01), and similar at one and four weeks. Pre- and post-intervention measures of preoperative heart rate, postoperative emergence delirium, and behavioral effects were similar between groups and over time. Conclusion: These findings suggest a novel, nonpharmacologic technique that can be utilized by various health care specialties to reduce preoperative anxiety and improve post- operative outcomes in children with autism spectrum disorder.


Assuntos
Dor Pós-Operatória , Humanos , Criança , Masculino , Feminino , Adolescente , Dor Pós-Operatória/etiologia , Anestesia Geral , Transtorno do Espectro Autista , Ansiedade , Anestesia Dentária/métodos , Delírio do Despertar/prevenção & controle , Cuidados Pré-Operatórios , Ansiedade ao Tratamento Odontológico/prevenção & controle
11.
Medicine (Baltimore) ; 103(12): e37520, 2024 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-38518036

RESUMO

Oral behavior management methods include basic behavior management methods and drug behavior management methods. In many cases, dental treatment that cannot be done simply through basic behavior management is not possible. The uncooperative behavior of children with dental fear in oral treatment has increased the demand for medication based behavior management methods. Drug sedation can provide more effective analgesic and anti-anxiety effects, thereby helping to provide comfortable, efficient, and high-quality dental services. This article will review the drug sedation methods selected in clinical treatment of pediatric dental fear in recent years, as well as the safety and effectiveness of commonly used drugs, in order to provide guidance for dental professionals in clinical practice.


Assuntos
Anestesia Dentária , Anestesia , Ansiolíticos , Criança , Humanos , Ansiedade ao Tratamento Odontológico/tratamento farmacológico , Ansiedade ao Tratamento Odontológico/prevenção & controle , Terapia Comportamental , Sedação Consciente
12.
Clin Oral Investig ; 28(3): 205, 2024 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-38459266

RESUMO

OBJECTIVE: To assess the anesthetic efficacy of articaine with the needle-free/Comfort-in™ method compared to the conventional needle method. To assess pain during anesthesia application, onset of anesthesia and patient`s self-reported quality of life-related to oral health after the dental emergency appointment. MATERIALS AND METHODS: This parallel, randomized clinical trial was conducted by a single operator/dentist in the state of Maranhao, northeast of Brazil. Included participants were adult dental patients with one molar (maxillary) or premolar (maxillary or mandibular) tooth diagnosed with symptomatic irreversible pulpitis. The primary outcome was the anesthetic efficacy, measured using a combination of electrical and cold pulp tests (cold + EPT) and the Numerical Rating Scale (NRS). Secondary outcomes were pain during anesthesia application, onset of anesthesia, and patient`s quality-of-life (measured with the OHIP-14). RESULTS: 62 patients were randomized in the anesthesia needle-free group and Comfort-in group (34.26 ± 10.786 × 33.29 ± 8.399 years old, respectively). The group of patients in the Comfort-in group had 71.0% success. Patients from the Comfort-in group reported statistically lower pain during the anesthesia application than patients from the conventional group (2.13 ± 2.172 × 6.03 ± 3.146 NRS scores, respectively) as well as immediately after the anesthetic procedure. Patients self-reported negative impact in quality of life was similar between groups before (p > 0.05) and after (p > 0.05) the dental emergency. CONCLUSIONS: Comfort-in™ had similar efficacy to the conventional needle method. CLINICAL RELEVANCE: This trial showed that it is possible to anesthetize patients with tooth pulpits without using needles to provide comfort mainly to anxious patients.


Assuntos
Anestesia Dentária , Bloqueio Nervoso , Pulpite , Adulto , Humanos , Adulto Jovem , Carticaína , Pulpite/cirurgia , Anestésicos Locais , Qualidade de Vida , Bloqueio Nervoso/métodos , Anestesia Dentária/métodos , Dor , Método Duplo-Cego , Nervo Mandibular , Lidocaína
13.
Clin Oral Investig ; 28(3): 170, 2024 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-38396049

RESUMO

OBJECTIVES: This in vivo study aimed to assess the impact of needle bevel design on puncture pain, anesthetic success, and mechanical deformations in intraligamentary injection (ILA) cases, comparing a short triple facet cut (STF) to a triple lancet cut (TL) after single or repetitive use. MATERIALS AND METHODS: In a prospective single-blind trial, 200 ILA needles (STF, n = 100; TL, n = 100) were randomly assigned for dental procedures. Patients received ILA either with STF or TL needles, used once (group A; n = 50 each) or repeatedly (group B; n = 50). Puncture pain was assessed using a numerical rating scale (NRS). Anesthetic success was determined via cold spray (yes/no), and scanning electron microscopy (SEM) analyzed needle tip deformations. RESULTS: Puncture pain did not significantly differ between STF and TL, regardless of needle use or injection area. Success rates were comparable in single use (82% STF vs. 79% TL; p > 0.05). For repetitive use, STF exhibited a significantly higher success rate (80% vs. 69%; p = 0.012). Mechanical deformations were prevalent in 97.5% of needles, with TL showing greater deformations than STF after single and repeated uses. Barbs were more common in TL (90/100) than STF (84/100), with a higher relative risk for barbed-like deformation in TL (RR single use: 1.26; p < 0.001; multiple use: 7.87, p < 0.001). CONCLUSIONS: The short triple facet-designed bevel demonstrated significantly less mechanical deformation, suggesting potential advantages in maintaining needle lumen patency. CLINICAL RELEVANCE: The intraligamentary needle bevel design is linked to mechanical deformation and anesthetic success after repetitive use, but not to puncture pain.


Assuntos
Anestesia Dentária , Anestésicos , Humanos , Anestesia , Agulhas , Dor , Estudos Prospectivos , Método Simples-Cego
14.
Clin Oral Investig ; 28(3): 174, 2024 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-38407635

RESUMO

OBJECTIVES: The absolute necessity of a palatal injection for the extraction of primary maxillary molars has never been explored, despite the fact that it is widely known that children do not tolerate local anesthetic injections into the palatal tissue well. The aim of this study was to compare separately the perception of pain in the absence of palatal injection after anesthesia and maxillary primary molar tooth extraction using different anesthetic solutions and different post-anesthetic waiting times. MATERIALS AND METHODS: A single-blinded randomized controlled study was conducted in 78 participants (26 patients with palatal anesthesia (the control groups), and 26 patients with 5 min and 26 patients with 8 min post-anesthetic waiting time without palatal anesthesia (the study groups)). Subjective experiences of pain were evaluated separately after anesthesia and tooth extraction using the Visual Analog Scale (VAS) and the Wong-Baker Faces Pain Rating Scale (WBS). RESULTS: In terms of VAS scores obtained following administration of anesthesia, there was a statistically significant difference between the groups (p<0.05). VAS pain scores were reported to be lower in the groups without palatal anesthesia than in the groups with palatal anesthesia. No statistically significant difference was observed in VAS and Wong-Baker scores after tooth extraction between the groups with and without palatal anesthesia (P>0.05). CONCLUSIONS: While the pain reported following administration of anesthesia was found to be higher in the groups receiving palatal anesthesia, no difference was found between the groups in the pain reported after tooth extraction. CLINICAL RELEVANCE: Extraction of maxillary primary molars is possible without palatal injection by injecting 4% articaine or 2% lidocaine into the buccal vestibule of the tooth with a waiting time of 5 or 8 min.


Assuntos
Anestesia Dentária , Criança , Humanos , Dente Molar/cirurgia , Anestesia Local , Anestésicos Locais , Dor Facial
15.
Stomatologiia (Mosk) ; 103(1): 48-54, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38372607

RESUMO

The article presents a case of a surgical treatment of removing a dermoid cyst of the floor of the oral cavity in a patient with severe hemophilia A. A detailed analysis was carried out of the surgical operation, postoperative management, coagulation factor replacement therapy and accompanying therapy, as well as the features of anesthesia, which allowed a surgical intervention without any hemorrhagic and infectious complications.


Assuntos
Anestesia Dentária , Cisto Dermoide , Hemofilia A , Neoplasias Bucais , Humanos , Neoplasias Bucais/complicações , Neoplasias Bucais/cirurgia , Cisto Dermoide/complicações , Cisto Dermoide/cirurgia , Hemofilia A/complicações , Soalho Bucal/cirurgia
16.
J Endod ; 50(4): 406-413, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38266911

RESUMO

INTRODUCTION: Previous studies on intraosseous (IO) anesthesia as a primary injection have shown high success rates. The TuttleNumbNow (TNN; Orem, UT) is a new primary IO injection technique that has not been scientifically evaluated. Therefore, the purpose of this prospective randomized, crossover study was to evaluate the anesthetic efficacy of the TNN IO technique using the Septoject Evolution needle (Septodont, Saint-Maur-des-Fosses, France) compared with buccal infiltration for pulpal anesthesia in mandibular first molars. METHODS: One hundred four healthy subjects were randomly assigned to 2 treatment groups separated by at least 2 weeks. One set of injections consisted of buccal infiltration of the mandibular first molar using 1.8 mL 4% articaine with 1:100,000 epinephrine followed by a mock TNN injection distal to the mandibular first molar. The other set of injections was a mock buccal infiltration of the mandibular first molar followed by a TNN injection of 1.8 mL 4% articaine with 1:100,000 epinephrine distal to the mandibular first molar. Statistical analyses were performed. RESULTS: For the mandibular first molar, which had a 42% anesthetic success rate (highest 80 reading) with buccal infiltration compared with 49% with the TNN, no statistically significant difference in success was observed (P = .2115). CONCLUSIONS: The TNN technique has been advocated as an IO injection. However, the inability to deliver anesthetic solution to the cancellous bone resulted in an anesthetic success rate of 49%. The success was statistically similar to a buccal infiltration (42%) and would not provide adequate pulpal anesthesia as a primary injection.


Assuntos
Anestesia Dentária , Carticaína , Humanos , Anestésicos Locais , Lidocaína , Estudos Cross-Over , Estudos Prospectivos , Mandíbula , Epinefrina , Anestesia Dentária/métodos , Dente Molar , Método Duplo-Cego , Anestesia Local
17.
Int Endod J ; 57(5): 520-532, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38279778

RESUMO

AIM: The anaesthetic success rate of an inferior alveolar nerve block (IANB) in mandibular molars with irreversible symptomatic pulpitis can be low, and postoperative pain control in teeth with this diagnosis can be challenging. This study aimed to evaluate the influence of preemptive use of dexamethasone and oral potassium diclofenac on the success of IANB. The influence of these drugs on the intensity of postoperative pain was assessed as a secondary outcome. METHODOLOGY: Eighty-four patients with mandibular molars diagnosed with irreversible symptomatic pulpitis recorded preoperative pain intensity using a cold thermal test and a modified Numerical Rating Scale (mNRS). Sixty minutes before the anaesthetic procedure, patients were randomly assigned to one of three groups based on the medication they received: dexamethasone (4 mg), diclofenac potassium (50 mg), or placebo. All patients received IANB with 4% articaine (1:200 000 epinephrine), and 15 min later, they were evaluated for pain intensity using the cold thermal test. Anaesthetic success was analysed. The pain intensity was then recorded, and endodontic treatment and provisional restoration of the tooth were executed in a single session. Patients were monitored for 6, 12, 24, 48 and 72 h using the mNRS to assess the intensity of postoperative pain. RESULTS: There was a statistically significant increase in anaesthetic success when 4 mg dexamethasone (39.3%) or 50 mg diclofenac potassium (21.4%) was used compared to the placebo group (3.6%) (p < .001), with no significant difference between the two drugs. Regarding postoperative pain, dexamethasone was superior to placebo at 6 h (p < .001), with diclofenac having an intermediate behaviour, not differing between dexamethasone and placebo (p > .05). There was no significant difference amongst the groups at 12 h (p > .05). At 24, 48 and 72 h, the effectiveness of dexamethasone and diclofenac were comparable, and both were superior to placebo (p < .001). CONCLUSION: The use of dexamethasone or diclofenac potassium was favourable in terms of increasing the success rate of inferior alveolar nerve block in cases of mandibular molars with irreversible symptomatic pulpitis and decreased the occurrence of postoperative pain when compared to the use of a placebo.


Assuntos
Anestesia Dentária , Anestésicos , Bloqueio Nervoso , Pulpite , Humanos , Anestesia Dentária/métodos , Anestésicos/farmacologia , Anestésicos Locais , Anti-Inflamatórios/farmacologia , Dexametasona/farmacologia , Diclofenaco/farmacologia , Método Duplo-Cego , Lidocaína , Nervo Mandibular , Dente Molar/cirurgia , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Pulpite/cirurgia
18.
Br Dent J ; 236(2): 97-99, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-38278899

RESUMO

Adverse reactions to dental local anaesthetics are fortunately rare. However, when they occur, they can be severe and debilitating to the patient. Adverse reactions may be either prolonged anaesthesia, with or without dysaesthesia, or systemic reactions. Although these systemic reactions are commonly thought to be allergies, this is rarely the case. Much more commonly, these adverse systemic reactions are either cardiovascular or from the central nervous system. This paper describes two contrasting cases of functional neurologic disorder which illustrates the consequences and appropriate management. The responsibilities of the dentist who injected the local anaesthetic are outlined.


Assuntos
Anestesia Dentária , Doenças do Sistema Nervoso , Humanos , Anestésicos Locais/efeitos adversos , Anestesia Local/efeitos adversos , Anestesia Dentária/efeitos adversos , Doenças do Sistema Nervoso/induzido quimicamente
19.
Br Dent J ; 236(2): 124-129, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-38278910

RESUMO

Methoxyflurane (MOF) as an agent for dental sedation has been used safely in Australasia for decades. The drug is now licensed for relief of pain associated with trauma and is being used during several medical outpatient procedures in the stead of traditional intravenous agents for sedation in the UK. Our aim was to analyse the safety and feasibility of the introduction of MOF as a drug for dental sedation in the UK community setting and assess its environmental impact. A literature review was conducted for available studies and a research audit of medical histories of patients that received nitrous oxide sedation in the previous year was carried out to assess suitability for MOF administration. The published literature shows MOF to be a safe drug for administration in the dental environment and local patients receiving nitrous oxide sedation are medically suitable for MOF administration. The advantages of considering MOF sedation are its environmental benefit and patient acceptability.


Assuntos
Anestesia Dentária , Anestésicos Inalatórios , Humanos , Óxido Nitroso/efeitos adversos , Metoxiflurano/efeitos adversos , Anestésicos Inalatórios/efeitos adversos , Estudos de Viabilidade , Anestesia Dentária/efeitos adversos , Anestesia Dentária/métodos , Sedação Consciente/métodos
20.
Quintessence Int ; 55(3): 250-258, 2024 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-38289004

RESUMO

OBJECTIVES: Sedation is commonly utilized for individuals otherwise unable to receive dental treatment, such as those with disabilities, medically complex conditions, and dentophobics. The aim was to characterize the profiles of patients receiving various types of sedation and assess the corresponding success rates. METHOD AND MATERIALS: This was a 5-year records-based retrospective study. Data regarding the indication for sedation, medical history, sedation type, and treatments performed were recorded. RESULTS: In total, 103 patients underwent 389 treatment sessions under sedation; 42.7% of the patients were disabled. The most commonly administered sedation was moderate sedation, (49.4%), followed by deep (36.8%) and inhaled sedation (13.9%). Successful treatment results were achieved in 96.1% of sessions, with no adverse effects noted during recovery. The high success rates were independent of patient age, sex, and sedation type. There was a positive association between the indication for sedation and the type of sedation. The medically complex patients and the dentophobic patients received mainly moderate sedation (85.3% and 58.2%, respectively), whereas the disabled patients received deep sedation (51.2%). In total, 94% of patients were returning (re-visiting) patients. A statistically significant association was found between the type of sedation administered and the success rate during the first and last sessions (P < .001). The success rate at the first session may be predictive of the success in subsequent sessions. CONCLUSION: A significant positive correlation was found between patient characteristics and the chosen sedation type leading to a high success rate across the various sedation modalities.


Assuntos
Anestesia Dentária , Humanos , Estudos Retrospectivos , Centros de Atenção Terciária , Anestesia Dentária/métodos , Resultado do Tratamento
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