Comparison of the Gow-Gates mandibular block and inferior alveolar nerve block using a standardized protocol.

BACKGROUND: Although several previous studies have compared the efficacy of Gow-Gates mandibular block (GGMB) and inferior alveolar nerve block (IANB), the results remain controversial. This study used an objective, standardized and precise protocol to evaluate and compare the effectiveness and success rate of GGMB and IANB. METHODS: The study group consisted of 162 patients (93 males and 69 females) who were randomly allocated to receive GGMB or IANB for extraction of third molars. Both methods used 2.7 mL of 2% xylocaine for each patient. Pulpal and gingival tissue anesthesia of mandibular central incisors, canines, first premolars and first molars were evaluated at 0, 5, 10, 15 and 60 minutes after injection of local anesthetic solution using both an electric pulp tester and a sharp explorer. RESULTS: The success rates of pulpal anesthesia in the IANB group (central incisor, 6%; canine, 37%; first premolar, 54%; first molar, 88%) were not significantly different from the GGMB group (central incisor, 8.1%; canine, 37.1%; first premolar, 54.8%; first molar, 83.9%). All subjects achieved 100% lip numbness with both methods. At 60 minutes after injection, the success rates of gingival tissue anesthesia in canine buccal and lingual areas were higher in the IANB group (100% and 100%, respectively) than in the GGMB group (91.9% and 93.5%, respectively). In the molar buccal area, the success rates at 5 and 60 minutes after injection were higher in the IANB group (97% and 100%, respectively) than in the GGMB group (88.7% and 91.9%, respectively). Furthermore, the success rates in the molar lingual area at 10, 15 and 60 minutes after injection were higher in the IANB group (100%, 100% and 100%, respectively) than in the GGMB group (91.9%, 93.5% and 91.9%, respectively). Although IANB achieved higher success rates of gingival tissue anesthesia in some gingival areas, no significant difference between the two methods was found in overall efficacy. CONCLUSION: This study demonstrated that the efficacy of pulpal and gingival tissue anesthesia are not significantly different between the GGMB and IANB methods.

Effectiveness of an educational program in reducing the incidence of wrong-site tooth extraction.

OBJECTIVES: The aim of the study was to investigate the effectiveness of an educational program on the reduction of the incidence of wrong-site tooth extraction at the outpatient department of a university hospital in Taiwan. STUDY DESIGN: Data collected from cases of wrong-site tooth extraction during 1996 to 1998 were used to develop a specific educational intervention that was implemented from 1999 to 2001. The annual incidence of erroneous extraction was compared between the preintervention and intervention periods. The factors contributing to wrong tooth extraction were also analyzed. RESULTS: The annual incidence rates of erroneous extraction from 1996 to 1998 were 0.026%, 0.025%, and 0.046%, respectively. During the intervention period from 1999 to 2001, wrong-site tooth extraction did not occur at the department. There was a significant difference in the incidence of erroneous extraction between the preintervention and intervention periods (P<.01). Cognitive failure was the most frequent form of active failure responsible for wrong-site tooth extraction, whereas communication and training were found to be major latent factors contributing to these errors. CONCLUSIONS: Our results suggest the effectiveness of an educational program comprising case-based materials, information feedback, and clinical guidelines in reducing the incidence of wrong-site tooth extraction.

Cardiovascular influence of dental anxiety during local anesthesia for tooth extraction.

OBJECTIVE: The present study evaluated whether dental patient anxiety has an effect on the cardiovascular response to the delivery of anesthetic to achieve mandibular anesthesia. STUDY DESIGN: One hundred eighty adult patients scheduled to receive routine dental extraction under local anesthesia were enrolled in this prospective study. Anxiety was measured at 15 minutes before local anesthetic delivery using Corah's Dental Anxiety Scale (Corah's DAS). Anesthetic was delivered using a standard technique for mandibular nerve block with the same dose (2 cartridges) given to all patients. Cardiovascular response data including blood pressure, heart rate, O(2) saturation, and electrocardiographic changes were measured at 5 time points from 5 minutes before to 15 minutes after the administration of anesthetic. RESULTS: The mean anxiety scale score before administration of anesthetic was 9.3 (SD +/- 2.5) with a range from 4 to 20. Women had a significantly higher mean dental anxiety level than men (P < .05). Younger age was associated with a higher anxiety scale score. Severe preoperative anxiety (Corah's DAS >12) was associated with significantly increased heart rate during administration of anesthetic. Patients with severe anxiety also had a significantly greater increase in heart rate during anesthetic administration (P < .001). Younger age was associated with increased likelihood of high dental anxiety and associated cardiovascular response to dental anesthesia (P = .001). Pain on injection was also associated with increased heart rate during anesthetic administration. CONCLUSION: This study showed that Corah's dental anxiety scale is a useful tool for estimating the impact of anxiety on the heart rate during local anesthetic delivery to achieve mandibular block for dental extraction. Younger patients undergoing tooth extraction were more likely to have high anxiety levels, and younger patients with high anxiety were more likely to report a traumatic dental history. High anxiety, younger age, and traumatic dental history were correlated with greater increases in heart rate during the administration of local dental anesthesia.

Ectopic mandibular third molar in the ramus region: report of a case and literature review.

OBJECTIVES: Ectopic mandibular third molar is a rare condition, and information is limited about its causes and characteristics. This article reports a case of ectopic mandibular third molar and reviews the literature on the clinical signs and symptoms and management of this condition. STUDY DESIGN: We report a case of an impacted mandibular third molar dislocated high on the right side of the mandibular ramus. Thirteen cases of ectopic mandibular third molars reported in the English-language literature over the past 25 years, identified from Pubmed and Medline databases are also reviewed. RESULTS: Among the 13 case reports identified, 10 occurred in women. Pain and swelling on the ispilateral side of the mandible or the preauricular region were the most common symptoms. Seven cases involved an ectopic mandibular third molar in the condylar or subcondylar region. Eight of the 11 cases included the description of a radiolucent image around the ectopic molar on the radiograph and described diagnosis of a dentigerous cyst. Seven of the ectopic third molars were extracted through intraoral access, and 3 were extracted through extraoral access. CONCLUSIONS: The etiology of ectopic mandibular third molars has not yet been completely clarified. Annual follow-up visits with panoramic radiographs are required for patients with symptom-free highly aberrant wisdom teeth. Treatment should be carefully planned according to the position of the ectopic tooth and the potential for trauma caused by the surgery.

Evaluation of mandibular block using a standardized method.

The purpose of this prospective randomized study was to investigate the manifestations and efficiency of mandibular block (MB) using a standardized method. In this study, 123 patients requiring MB were randomly assigned to receive MB using a repeated measures design. Mandibular block was administered in each patient by using 2.1 mL of 2% lidocaine with 1:100 000 epinephrine for the inferior alveolar nerve, lingual nerve, and/or buccal nerve. Clinical parameters including the electric pulp test and test for soft tissue sensation using a sharp dental explorer were assessed on both the operated side and contralateral side before and 5, 10, and 15 minutes after injection, and at the end of surgical procedure. Results of the test of the contralateral tooth served as the control group. No response to the electric pulp test at a maximum output (80 readings) was used as the criterion for pulpal anesthesia. Results obtained with electric pulp test and sharp explorer test were not significantly different during various intervals on the contralateral side, indicating the reliability of this standardized method for assessing MB. The MB technique achieved a high rate of subjective numbness (100%) according to the perception of the patients of overall numbness and lip numbness. Overall anesthetic success rates of pulpal anesthesia were 5.7% for the central incisor, 38.2% for the canine, 55.3% for the first premolar, and 90.2% for the first molar. No significant difference was found in the efficiency of anesthesia related to sex or age of the patients. A slower onset of pulpal anesthesia after MB was found for the anterior teeth than for the posterior teeth. This study suggests that the use of a standardized method might produce a clearer and more comprehensive evaluation of the efficiency and manifestations of MB.