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1.
J Appl Oral Sci ; 28: e20190025, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31778442

RESUMO

INTRODUCTION: Periodontal therapy usually requires local anesthesia. If effective, a non-invasive, liposomal anesthetic gel could increase the levels of acceptance of patients in relation to periodontal therapy. OBJECTIVE: This study investigated the efficacy of liposomal anesthetic gel for pain control during periodontal therapy. METHODOLOGY: Forty volunteers with moderate to severe chronic periodontitis were recruited, of which at least three sextants required periodontal therapy. At least one of the selected teeth had one site with a probing depth of ≥4 mm. The volunteers received the following three gels: a placebo, lidocaine/prilocaine (Oraqix®), or a liposomal lidocaine/prilocaine, which were applied to different sextants. Pain frequency was registered during treatment and the volunteers received a digital counter to register any painful or uncomfortable experiences. At the end of each session, the volunteers indicated their pain intensity using rating scales (NRS-101 and VRS-4). The volunteers had their hemodynamic parameters measured by a non-invasive digital monitor. RESULTS: Pain frequency/intensity did not show statistical difference between intervention groups. The tested gels did not interfere with the hemodynamic indices. Dental anxiety, suppuration and probing depth could influence pain during periodontal therapy. CONCLUSION: Our results suggest limited indications for the use of non-invasive anesthesia when used for scaling and root planing. Intra-pocket anesthetic gel could be a good option for anxious patients, or those who have a fear of needles.


Assuntos
Anestesia Dentária/métodos , Anestésicos Locais/administração & dosagem , Raspagem Dentária/efeitos adversos , Géis/administração & dosagem , Dor/prevenção & controle , Aplainamento Radicular/efeitos adversos , Adulto , Idoso , Periodontite Crônica/complicações , Periodontite Crônica/terapia , Método Duplo-Cego , Feminino , Humanos , Lidocaína/administração & dosagem , Combinação Lidocaína e Prilocaína , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Bolsa Periodontal , Placebos , Prilocaína/administração & dosagem , Adulto Jovem
2.
Niger J Clin Pract ; 22(8): 1172-1174, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31417065

RESUMO

Dental anesthesia is one of the most frequently performed medical procedures. Although the frequency of ocular complications is extremely low, these reactions can be highly alarming and may bring up medicolegal issues when they do occur. Dentists and oral surgeons should be well-informed of these adverse reactions and should be aware that both ophthalmologists and emergency physicians might be required to care for these patients.


Assuntos
Anestesia Dentária/efeitos adversos , Anestesia Local/efeitos adversos , Anestésicos Locais/efeitos adversos , Carticaína/efeitos adversos , Diplopia/etiologia , Epinefrina/efeitos adversos , Oftalmoplegia/etiologia , Extração Dentária , Adulto , Anestesia Dentária/métodos , Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Carticaína/administração & dosagem , Epinefrina/administração & dosagem , Humanos
3.
Oral Maxillofac Surg Clin North Am ; 31(4): 611-619, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31427193

RESUMO

During surgery, one of the primary functions of the anesthesiologist is to monitor the patient and ensure safe and effective conduct of anesthesia to provide the optimum operating conditions. Standard guidelines for perioperative monitoring have been firmly established by the American Society of Anesthesiologists. However, in recent years, new advances in technology has led to the development of many new monitoring modalities, especially involving the neurologic and cardiovascular systems. This article presents a targeted review to discuss the functions and limitations of these new monitors and how they are applied in the modern operating room setting.


Assuntos
Anestesia Dentária/métodos , Anestesiologia/normas , Monitorização Fisiológica/métodos , Período de Recuperação da Anestesia , Humanos , Monitorização Intraoperatória , Salas Cirúrgicas , Assistência Perioperatória
4.
Gen Dent ; 67(3): 26-30, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31199741

RESUMO

Buccal and palatal injections are required for administration of anesthetic agents before maxillary tooth extractions, but palatal injections are painful for patients. Studies suggest that the palatal injection can be eliminated when articaine is delivered as a local anesthetic agent via buccal injection, but the anatomical mechanism for this effectiveness remains unclear. The objective of this study was to explore the potential mechanism by which buccal infiltration results in palatal anesthesia. The study approach included examining cadaveric specimens and investigating the pharmacologic properties of articaine. Twenty-eight formalin-fixed cadaveric hemimaxillae were dissected and sectioned into anterior, premolar, and molar regions. The maxillary sections were measured in 3 planes: inferior, middle, and superior. Buccal cortical plate (BCP), palatal cortical plate (PCP), and total buccopalatal (TBP) thickness were independently evaluated by 2 measurers using standard digital calipers. Statistical analysis of regional maxillary thickness measurements was achieved via 2-way analysis of variance. Measurements of BCP and PCP thickness revealed no statistically significant differences along the maxillae (P > 0.05). Both the BCP and PCP mean values were significantly less than the TBP measurement (P < 0.0001). In all 3 regions, the mean TBP thickness in the superior plane was significantly greater than that of the inferior plane (P < 0.05). The mean TBP thickness was significantly greater in the molar and premolar regions than in the anterior region (P < 0.05). The mean BCP measurements were significantly lesser in the maxillary premolar and molar regions than in the corresponding mandibular regions (P < 0.0001). The pharmacologic properties of articaine, which is capable of diffusing greater distances than other local anesthetics, coupled with the uniformly thin, cancellous maxillary bone, provide a plausible explanation for the success of palatal anesthesia achieved through buccal infiltration of articaine, obviating the need for a palatal injection.


Assuntos
Anestesia Dentária , Anestesia Local , Anestésicos Locais/administração & dosagem , Carticaína , Palato Duro , Administração Bucal , Anestesia Dentária/métodos , Anestesia Local/métodos , Carticaína/administração & dosagem , Humanos , Membrana Mucosa , Palato Duro/metabolismo
6.
Anesthesiol Clin ; 37(2): 333-348, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31047133

RESUMO

The provision for and administration of dental office-based sedation and anesthesia requires considerations and preparations that are unique to dentistry and unlike that of any other office-based and nonoperating room procedures. Anesthesia providers who have only performed dental cases in an operating room are often unaware of the idiosyncrasies and risks associated with performing sedation and anesthesia in the dental office. This article explores the demographics, patient characteristics, morbidity, mortality, and clinical concerns with an in-depth discussion of the dental operating environment. The content is integrated with the current medical and dental guidelines for office-based anesthesia.


Assuntos
Anestesia Dentária/métodos , Sedação Consciente/métodos , Adolescente , Criança , Pré-Escolar , Consultórios Odontológicos , Humanos , Monitorização Intraoperatória , Segurança do Paciente
8.
Br J Anaesth ; 122(5): 587-604, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30916011

RESUMO

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.


Assuntos
Anestésicos Inalatórios/farmacologia , Óxido Nitroso/farmacologia , Analgesia Obstétrica/métodos , Analgésicos não Entorpecentes/efeitos adversos , Analgésicos não Entorpecentes/farmacologia , Analgésicos não Entorpecentes/uso terapêutico , Anestesia Dentária/métodos , Anestésicos Inalatórios/efeitos adversos , Antidepressivos/uso terapêutico , Dor Crônica/prevenção & controle , Sedação Consciente/métodos , Contraindicações de Medicamentos , Transtorno Depressivo Maior/tratamento farmacológico , Medicina Baseada em Evidências/métodos , Humanos , Óxido Nitroso/efeitos adversos , Óxido Nitroso/uso terapêutico
9.
Anesth Prog ; 66(1): 44-51, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30883229

RESUMO

The safe treatment of patients with chronic obstructive pulmonary disease (COPD) in dental office office-based settings can be quite complex without a current understanding of the etiology, course, severity, and current treatment modalities of the disease. The additional concerns of providing sedation and/or general anesthesia to patients with COPD in settings outside of a hospital demand thorough investigation of individual patient presentation and realistic development of planned treatment that patients suffering from this respiratory condition can tolerate. Along with other co-morbidities, such as advanced age and potential significant cardiovascular compromise, the dental practitioner providing sedation or general anesthesia must tailor any treatment plan to address multiple organ systems and mitigate risks of precipitating acute respiratory failure from inadequate pain and/or anxiety control. Part I of this article covered the epidemiology, etiology, and pathophysiology of COPD. Patient considerations in the preoperative period were also reviewed. Part II will cover which patients are acceptable for sedation/general anesthesia in the dental office-based setting as well as sedation/general anesthesia techniques that may be considered. Postoperative care will also be reviewed.


Assuntos
Anestesia Dentária , Anestesia Geral , Doença Pulmonar Obstrutiva Crônica , Anestesia Dentária/métodos , Anestesia Geral/métodos , Sedação Consciente , Consultórios Odontológicos , Odontólogos , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações
10.
Curr Drug Res Rev ; 11(1): 12-20, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30829177

RESUMO

BACKGROUND: Joseph Priestley's discovery of nitrous oxide (N2O) was recorded in 1772. In the late 1790's, Humphry Davy experimented with the psychotropic properties of N2O, describing his observations in a book, published in 1800. A dentist, Horace Wells discovered anaesthesia with N2O in 1844. Over a century after Davy, its potential usefulness in psychiatry was first recognised. The seminal researches in neuropsychiatry, between 1920 and 1950, mainly used anaesthetic concentrations of the gas. The psychotropic actions of N2O, at non-anaesthetic doses, were first used by dentists, mainly for its anxiolytic action. In modern dentistry, N2O is always mixed with at least 30% oxygen and titrated to doses rarely exceeding 40% of N2O. At these lower concentrations, untoward effects are almost always avoided, including over-sedation and/or anaesthesia. In the early 1980's, the low-dose dental titration technique was first used to investigate and treat psychiatric conditions, including substance abuse. Until then, most physicians regarded the gas only as an anaesthetic agent. An exception was obstetricians who used a fixed 50% concentration of N2O diluted with oxygen for analgesia during parturition. In 1994, to clearly distinguish between anaesthetic and non-anaesthetic concentrations (as used in dentistry), the term Psychotropic Analgesic Nitrous oxide (PAN) was introduced. OBJECTIVE: This paper will give a brief history of the use of the N2O in psychiatry since the psychotropic actions were first recognised in the 18th century until the present. CONCLUSION: The role of other non- opioid systems, and the extent to which they contribute to the psychotropic properties of N2O, still remains to be established.


Assuntos
Ansiolíticos/uso terapêutico , Ansiedade/tratamento farmacológico , Óxido Nitroso/uso terapêutico , Dor/tratamento farmacológico , Anestesia Dentária/métodos , Anestésicos Inalatórios , Ansiolíticos/administração & dosagem , Humanos , Óxido Nitroso/administração & dosagem
11.
J Dent Educ ; 83(4): 423-428, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30745346

RESUMO

The aim of this study was to evaluate the effectiveness of a mobile augmented reality simulator for local anesthesia training with dental students who are administering inferior alveolar nerve block (IANB) for the first time. Participants in this prospective study conducted in 2016 were 41 fourth- and fifth-year students randomly divided into two groups: a control group with 19 students and an experimental group with 22 students. In addition to theoretical instruction and exercises, students in the experimental group used the mobile augmented reality simulator in a dental office 2h weekly for four weeks. The Sony SmartBand-2 was used to measure all students' heart rate five minutes before and during anesthesia administration. After anesthesia, students in both groups completed a post-clinical questionnaire evaluating their knowledge and skills. The experimental group had a higher average score and/or a more limited range of responses on each item of the questionnaire than the control group. The average time for performing IANB in the experimental group was 50.0±14.3 seconds, while the control group's average was 68.4±25.5 seconds. In addition, the group that used the augmented reality simulator had an anesthesia success rate of 90.9% compared to 73.7% for the control group. Students in both groups had a statistically significant increase in heart rate while performing anesthesia. Overall, the students who used the mobile simulator in addition to their education in augmented reality carried out anesthetic procedures for IANB in a shorter period of time and had greater success than the students who used only the conventional educational methods.


Assuntos
Anestesia Dentária , Educação em Odontologia/métodos , Nervo Mandibular , Bloqueio Nervoso , Interface Usuário-Computador , Anestesia Dentária/métodos , Avaliação Educacional , Humanos , Bloqueio Nervoso/métodos , Estudos Prospectivos
12.
Bull Tokyo Dent Coll ; 60(1): 53-60, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30700644

RESUMO

The purpose of this study was to survey parental satisfaction with ambulatory anesthesia during dental treatment in disabled patients. Factors associated with parental preference for general anesthesia during future dental treatment in such patients were also investigated. A questionnaire was mailed to the parents of 181 disabled individuals who underwent dental treatment under ambulatory anesthesia at Tokyo Dental College Suidobashi Hospital between 2012 and 2016. A total of 71 responses were received (39.2%). The mean patient age was 18 years, and disabilities included autism spectrum disorder, intellectual disability, cerebral palsy, and epilepsy. The items surveyed included dental treatment details, number of times patients received general anesthesia, type of anesthetic used, anesthesia induction method, durations of treatment and anesthesia, and the presence or absence of intraoperative or postoperative complications. Questionnaire items queried problems related to dental care, anesthesia history, preoperative anxiety, length of fasting period, induction of general anesthesia, nursing and hospital room environment, postoperative anxiety, overall evaluation, and whether the parent would prefer general anesthesia during future dental treatment. The patients were divided into 2 groups: those whose parents preferred general anesthesia during future dental treatment and those whose parents did not. The results revealed that, where disabled individuals had previously received general anesthesia during dental treatment, the parents were more likely to prefer general anesthesia during future dental treatment.


Assuntos
Anestesia Dentária/métodos , Assistência Odontológica para Pessoas com Deficiências/métodos , Pais , Satisfação do Paciente , Adolescente , Adulto , Assistência Ambulatorial/métodos , Assistência Ambulatorial/psicologia , Anestesia Dentária/psicologia , Transtorno do Espectro Autista/complicações , Paralisia Cerebral/complicações , Criança , Assistência Odontológica para Pessoas com Deficiências/psicologia , Epilepsia/complicações , Feminino , Humanos , Deficiência Intelectual/complicações , Masculino , Pessoa de Meia-Idade , Pais/psicologia , Inquéritos e Questionários , Adulto Jovem
13.
Pediatr Dent ; 41(1): 52-55, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30803478

RESUMO

Purpose: Use of general anesthesia (GA) for comprehensive dental treatment of children is an essential health benefit. Pediatric dentists utilize dentist anesthesiologists to provide GA for dental rehabilitation of severe early childhood caries. Dentist anesthesiologists deliver GA using intubated or nonintubated GA. The purpose of this study was to compare the incidence of respiratory complications when intubated versus nonintubated general anesthesia was completed by dentist anesthesiologists in a pediatric dentistry setting. Methods: The Society of Ambulatory Anesthesia (SAMBA) Clinical Outcomes Registry (SCOR) database was queried for pediatric dental GA cases completed by dentist anesthesiologists from January 1, 2010 to December 31, 2016. Logistic regression compared intubated GA versus nonintubated GA for differences in the incidence of respiratory complications. Results: Within 9,333 cases, there were 30 incidents of laryngospasm (0.3 percent), 19 incidents of bronchospasm (0.2 percent), two incidents of hypoxia (less than 0.1 percent), and six incidents of difficult airway (0.1 percent). When intubated versus nonintubated GA was compared for respiratory complication incidence, no significant association was found (P=0.81, odds ratio equals 0.93). Conclusion: No significant difference was found between the incidence of respiratory complications with intubated versus nonintubated GA provided by dentist anesthesiologists.


Assuntos
Anestesia Dentária/métodos , Anestesia Geral/métodos , Assistência Odontológica para Crianças/métodos , Intubação Intratraqueal , Anestesia Dentária/efeitos adversos , Anestesia Geral/efeitos adversos , Criança , Pré-Escolar , Assistência Odontológica para Crianças/efeitos adversos , Feminino , Humanos , Incidência , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/métodos , Masculino , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/etiologia
14.
J Endod ; 45(3): 257-262, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30803532

RESUMO

INTRODUCTION: Needle-free anesthetic delivery is a promising alternative to traditional anesthetic routes of administration. The purpose of this study was to determine the patient preference for and pulpal anesthetic efficacy of a 3% tetracaine plus 0.05% oxymetazoline (Kovanaze) nasal spray in maxillary lateral incisors and first premolars. METHODS: Fifty adult subjects randomly received a 3% tetracaine plus 0.05% oxymetazoline (Kovanaze) nasal spray and mock infiltration or a mock nasal spray and 2% lidocaine with 1:100,000 epinephrine infiltration at the maxillary lateral incisor or first premolar in 2 appointments spaced at least 1 week apart in a single-blind cross-over design. Pulpal anesthesia was evaluated with an electric pulp tester. Side effects and subject preferences were also recorded. RESULTS: Anesthetic success was significantly lower for the Kovanaze nasal spray and mock infiltration (22%-37%) than for the mock nasal spray and lidocaine infiltration (89%-91%). Subjects reported more unwanted effects (nasal drainage and congestion, burning, pressure, and sinus congestion) after the Kovanaze nasal spray and mock infiltration than the mock spray and maxillary infiltration. Before participating in the study, more subjects (56%) preferred the nasal spray route versus a standard infiltration (44%). After experiencing both routes of administration, 100% of subjects preferred the standard infiltration. CONCLUSIONS: The 3% tetracaine plus 0.05% oxymetazoline (Kovanaze) nasal spray provided significantly less successful pulpal anesthesia than the lidocaine infiltration, was less preferable, and caused more unwanted effects.


Assuntos
Anestesia Dentária/métodos , Maxila , Sprays Nasais , Oximetazolina/administração & dosagem , Tetracaína/administração & dosagem , Administração Intranasal , Adolescente , Adulto , Estudos Cross-Over , Combinação de Medicamentos , Feminino , Seguimentos , Humanos , Masculino , Método Simples-Cego , Inquéritos e Questionários , Adulto Jovem
15.
Saudi Med J ; 40(1): 97-100, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30617388

RESUMO

OBJECTIVES: To investigate the potency and speed of action of 2% lidocaine and 3% prilocaine for upper teeth extractions. METHODS: This prospective clinical study was conducted from November 2016 to May 2017. Ninety-six patients, aged between 16 to 70 years old were recruited in this study. Two regimens were randomly administered over one visit. Patients, treatment group I, received 2% lidocaine with 1:00.000 adrenaline. Patients treatment group II received prilocaine 3% and felypressin 0.03 I.U. per ml. The efficacy of pulp anesthesia was determined by electronic pulp testing. At any point of trial (10 minutes), the anesthetized tooth becomes unresponsive for maximal pulp stimulation (64 reading), the extraction was carried out.  Results: There were no significant differences in the mean onset time of pulpal anesthesia and extraction between the prilocaine and lidocaine buccal infiltration groups (p=0.28). However, clinically, the patients in prilocaine group recorded faster onset time of anesthesia and teeth extraction than those in lidocaine group. Conclusion: Prilocaine has a better clinical performance in terms of providing rapid dental anesthesia and earlier teeth extraction than lidocaine but the differences were not significant. Prilocaine with felypressin could be a good choice for patients who have contraindication to the use of lidocaine with adrenaline.


Assuntos
Anestesia Dentária/métodos , Anestésicos Locais/administração & dosagem , Prilocaína/administração & dosagem , Extração Dentária , Adolescente , Adulto , Idoso , Feminino , Humanos , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Fatores de Tempo , Adulto Jovem
16.
J Appl Oral Sci ; 27: e20180195, 2019 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-30673030

RESUMO

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.


Assuntos
Anestesia Dentária/métodos , Anestésicos Locais/administração & dosagem , Injeções a Jato/métodos , Medição da Dor/métodos , Dor Processual/diagnóstico , Adulto , Anestesia Dentária/efeitos adversos , Polpa Dentária/efeitos dos fármacos , Restauração Dentária Permanente/métodos , Estimulação Elétrica , Feminino , Humanos , Masculino , Agulhas , Limiar da Dor , Reprodutibilidade dos Testes , Método Simples-Cego , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
17.
J Endod ; 45(1): 1-5, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30527595

RESUMO

INTRODUCTION: The present study comparatively evaluated the anesthetic efficacy of 4% articaine versus 2% lidocaine given as supplemental intraligamentary injections after a failed inferior alveolar nerve block. METHODS: One hundred six adult patients with symptomatic irreversible pulpitis in a mandibular first or second molar received an initial inferior alveolar nerve block with 2% lidocaine with 1:80,000 epinephrine. Pain during the endodontic treatment was assessed using the Heft-Parker visual analog scale. Eighty-two patients with unsuccessful anesthesia were randomly allocated to 2 treatment groups: 1 group received 0.6 mL/root of supplementary intraligamentary injection of 4% articaine with 1:100,000 epinephrine, and the second group received 2% lidocaine with 1:80,000 epinephrine. Endodontic treatment was reinitiated. Success after the primary injection or supplementary injection was defined as no or mild pain (less than 55 mm on the Heft-Parker visual analog scale) during access preparation and root canal instrumentation. Patients' heart rate was monitored using a finger pulse oximeter. The anesthetic success rates were analyzed with the Pearson chi-square test at 5% significance levels. The heart rate changes were analyzed using the t test. RESULTS: The patients receiving supplementary intraligamentary injections of 4% articaine had a success rate of 66%, whereas 2% lidocaine injections were successful in 78% of cases. The difference was statistically nonsignificant (χ2 = 1.51, P = .2). There was no significant effect of the different anesthetic agents on the heart rate. CONCLUSIONS: Both 4% articaine and 2% lidocaine improved the success rates after a failed primary anesthetic injection, with no significant difference between them.


Assuntos
Anestesia Dentária/métodos , Anestésicos Locais/administração & dosagem , Carticaína/administração & dosagem , Lidocaína/administração & dosagem , Nervo Mandibular , Bloqueio Nervoso , Dor/prevenção & controle , Pulpite/cirurgia , Falha de Tratamento , Adulto , Método Duplo-Cego , Feminino , Humanos , Injeções/métodos , Masculino , Mandíbula , Dente Molar , Medição da Dor , Tratamento do Canal Radicular , Resultado do Tratamento , Adulto Jovem
18.
Paediatr Anaesth ; 29(3): 226-230, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30576047

RESUMO

Children with autistic spectrum disorder are more likely to become distressed during induction of anesthesia. Inhalational induction is almost always the preferred route with acceptance of the face mask often presenting a considerable challenge. Tempering measures to facilitate gas induction such as forced premedication and physical restraint are no longer viable options except in extenuating circumstances. Recent research interest has focused on the need for advanced planning in collaboration with the caregiver to tailor an individualized perioperative plan. This plan may include both pharmacological and non-pharmacological interventions. Applied behavior analysis strategies have a well-documented efficacy in this unique population to systematically change an individual's usual behavior. These can be used, as a non-pharmacological strategy, to ensure a smooth perioperative course. We present a successful case of preoperative desensitization of a child with severe autistic spectrum disorder using a mirror demonstration technique associated with positive reinforcement to prepare him for general anesthesia. We discuss the potential application of applied behavior analysis strategies for anesthesia in this unique population. From a practical point of view, early communication with carers is required to establish who may benefit from this behavioral training. Planned individual preparation for general anesthesia must be provided by trained multidisciplinary staff.


Assuntos
Anestesia/métodos , Anestesia/psicologia , Transtorno do Espectro Autista/psicologia , Cuidadores/educação , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/psicologia , Anestesia Dentária/métodos , Anestesia Dentária/psicologia , Anestesia Geral/métodos , Anestesia Geral/psicologia , Transtorno do Espectro Autista/cirurgia , Transtorno Autístico , Criança , Humanos
19.
Clin Oral Investig ; 23(2): 839-845, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29882110

RESUMO

OBJECTIVES: The aim of this study was to compare the onset, success rate, injection pain, and post-injection pain of mental/incisive nerve block (MINB) with that of inferior alveolar nerve block (IANB) using 4% articaine in mandibular premolars with symptomatic irreversible pulpitis. The accuracy of electrical pulp test (EPT) in determining pulpal anesthesia was also examined. MATERIALS AND METHODS: The study was designed as a randomized clinical trial with two study arms-MINB and IANB. Injections were performed using a standardized technique. Root canal treatment was initiated 10 min after the injection. Success was defined as no pain or mild pain during access cavity preparation and instrumentation. Injection pain and post-injection pain (up to 7 days) were recorded. All pain ratings were done using Heft-Parker Visual Analog Scale (HP VAS). RESULTS: Sixty-four patients were enrolled. The success rate of MINB (93.8%) was higher than IANB (81.2%) but the difference was not significant (p > 0.05). The onset of anesthesia with MINB was significantly quicker, and injection pain was significantly less (p < 0.05), but post-injection pain was significantly higher during the first 4 days (p < 0.001). The accuracy of EPT in determining pulpal anesthesia was 96.88%. CONCLUSIONS: MINB and IANB with 4% articaine had similar efficacy in anesthetizing mandibular premolars with irreversible pulpitis. Post-injection pain with MINB was higher than with IANB. CLINICAL RELEVANCE: MINB and IANB with 4% articaine can be used interchangeably to anesthetize mandibular premolars with irreversible pulpitis.


Assuntos
Anestesia Dentária/métodos , Anestésicos Locais/administração & dosagem , Carticaína/administração & dosagem , Bloqueio Nervoso/métodos , Pulpite/cirurgia , Adolescente , Adulto , Idoso , Dente Pré-Molar , Feminino , Humanos , Masculino , Mandíbula , Nervo Mandibular/efeitos dos fármacos , Pessoa de Meia-Idade , Medição da Dor
20.
Clin Oral Investig ; 23(2): 673-680, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29748864

RESUMO

OBJECTIVES: The aim of this study was to determine the effect of intraosseous (IO) anesthesia with 4% articaine and 1:100,000 epinephrine on pulpal blood flow (PBF) and pulpal anesthesia of mandibular first molars and canines in human subjects. MATERIALS AND METHODS: Ten healthy volunteers with intact mandibular first molar and canine were given an osteocentral technique of IO injection using the Quick Sleeper 5 system and 4% articaine with 1:100,000 epinephrine at distal site of mandibular first molar. The PBF was monitored by a laser Doppler flowmeter (LDF). Pulpal anesthesia was assessed with an electric pulp tester (EPT). RESULTS: IO injection caused a decrease in PBF in molars from 6.31 ± 3.85 perfusion units (P.U.) before injection to 2.51 ± 2.53 P.U. 1 min after injection (P < 0.001). The percentage reduction in PBF was 60% after 1 min and PBF returned back to the baseline after 45 min. No significant reduction in PBF was observed in the canines (P = 0.212). For pulpal anesthesia in the molars, the mean onset was 2.40 ± 0.84 min and the mean duration was 38 ± 16.19 min. In the canines, there was a decrease in the sensitivity to EPT but complete pulpal anesthesia was not achieved. CONCLUSIONS: IO injection distal to mandibular first molar caused a decrease in PBF and successful pulpal anesthesia in first molar, but not in canine. Both PBF and EPT readings returned to normal, suggesting that pulpal ischemia may not occur. CLINICAL RELEVANCE: IO anesthesia is safe to use as a primary technique in teeth with normal pulp.


Assuntos
Anestesia Dentária/métodos , Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Carticaína/administração & dosagem , Polpa Dentária/irrigação sanguínea , Polpa Dentária/efeitos dos fármacos , Epinefrina/administração & dosagem , Bloqueio Nervoso/métodos , Vasoconstritores/administração & dosagem , Adolescente , Adulto , Dente Canino , Feminino , Voluntários Saudáveis , Humanos , Injeções/métodos , Fluxometria por Laser-Doppler , Masculino , Mandíbula , Dente Molar
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