Journal of dental anesthesia and pain medicine最新文献

Background: This study aimed to evaluate and compare the efficacy of oral premedication with ibuprofen on the anesthetic efficacy of inferior alveolar nerve block (IANB) using 2% lignocaine and 1:100000 epinephrine in tobacco-chewing (TC) and non-tobacco-chewing (NTC) patients with symptomatic irreversible pulpitis (SIP) during nonsurgical endodontic intervention (NEI).

Methods: This multicenter, prospective, double-blind, two-arm parallel-group randomized controlled trial involving 160 patients was conducted for a period of 9 months. The patients were classified into the study (TC patients) and control (NTC patients) groups, which were subdivided into two subgroups 1 hour before the procedure based on oral premedication with tab ibuprofen 600 mg. Nicotine dependence was assessed using the Modified Fagerstrom Tolerance Nicotine Scale. Patients were administered an IANB injection of 2% lignocaine containing epinephrine 1:100000 after premedication. Pulpal anesthesia before NEI was confirmed using electric pulp testing and cold spraying. Patients rated their pain on the 10-point visual analog scale (VAS) during NEI thrice at the dentin, pulp, and instrumentation levels. No pain at each level indicated the success of anesthesia.

Results: The success and failure rates did not differ between the premedication and non-premedication subgroups in the TC or NTC groups (P > 0.05). However, the success rate was higher in the premedication subgroup of the NTC group (52.5%) than in the TC group (45%). Most patients with premedication experienced failure at the instrumentation level, whereas patients in the non-premedication group experienced pain at the dentin level. Failure rates of IANB did not differ significantly at different levels between the groups (P > 0.05). The mean VAS scores differed significantly at the dentin level in both groups, with lower values in the premedication group (P < 0.05).

Conclusions: The efficacy of ibuprofen premedication with IANB during NEI did not differ significantly between the TC and NTC patients with SIP. The effect of premedication was more significant in the NTC group than in the TC group. A causal relationship between nicotine consumption and the success of premedication could not be established, and further studies are required to validate the results of the present study.

This study aims to compare the analgesic efficacy of dexketoprofen trometamol (DT) with other analgesic drugs for pain relief after third molar surgery. The PubMed, Scopus, and Web of Science databases were searched to identify randomized controlled trials comparing DT with other analgesics for third molar surgery. The outcome measures were the sum of pain intensity differences (SPID), total pain relief (TOTPAR) at the 6^th and 8^th postoperative hours, time to rescue medication, and tolerability. In total, four studies met our inclusion criteria. A total of 660 third molar surgeries were performed: 365 in the DT group and 295 in the active control group. Compared to other analgesics, DT produced significantly better pain relief at the 6^th postoperative hour: SPID (MD, 0.33; P = 0.01) and TOTPAR (MD, 0.41; P = 0.02). However, there were no statistically significant differences in the efficiency of pain relief at the 8^th postoperative hour, time to rescue medication, or tolerability. Overall, a 25 mg dose produced the best results for pain relief. In conclusion, DT (25 mg) is a viable alternative to contemporary analgesics for pain relief after third molar surgery, particularly during the early postoperative period.

Background: It is vital to identify more efficient anesthesia techniques for the restorative or endodontic treatment of mandibular molars. Both articaine buccal infiltration anesthesia (ABI) and lidocaine inferior alveolar nerve block anesthesia (LIANB) may not provide profound anesthesia, necessitating supplementary anesthesia. This study aimed to investigate whether lidocaine intraosseous lidocaine intraosseous anesthesia (LIO) is more suitable than ABI as primary anesthesia for caries treatment of mandibular molars.

Methods: This study retrospectively analyzed patients treated for advanced caries according to the International Caries Detection and Assessment System (ICDAS) 5 and 6. The study involved 48 patients, split evenly between those receiving ABI and LIO, and examined the anesthesia success rate, pain during anesthesia, onset time, duration, and post-anesthesia lower lip numbness using Chi-square and Independent T-tests.

Results: In the ABI group, 17 patients (70.8%) did not require additional anesthesia, whereas all 24 patients (100%) in the LIO group did not require additional anesthesia (P < 0.001). ABI was associated with significantly higher pain during anesthesia, slower onset time, and longer duration of anesthesia than LIO. There was no significant difference in post-anesthesia lower lip numbness between the two methods.

Conclusion: Intraosseous anesthesia using lidocaine is more effective for treating severe caries in the mandibular molars because of its higher success rate, decreased pain during anesthesia, faster onset, and shorter recovery time.

Background: Achieving successful pain control and adequate anesthesia through an inferior alveolar nerve block for endodontic treatment in cases with symptomatic irreversible pulpitis (SIP) is difficult, especially in mandibular molars. This study was designed to compare the effect of oral medication with ibuprofen and soft laser therapy on inferior alveolar nerve block during endodontic treatment.

Methods: The trial comprised 180 patients (45 each group) with SIP. Four groups of patients were created: group 1 received 400 mg of ibuprofen; group 2 received soft laser irradiation; group 3 received a combination of soft laser and ibuprofen 400 mg; and group 4 received a placebo 1 h prior to local anesthesia. Patients recorded their pain scores on the Heft-Parker visual analog scale (VAS) before the start of intervention, 15 min after anesthesia, during access cavity preparation, and ultimately during root canal instrumentation. Each patient also rated their level of discomfort on a VAS. Every stage with no or minimal discomfort was deemed successful. The chi-square, Kruskal-Wallis, and one-way analysis of variance tests were used to evaluate the data.

Results: The best success rate was achieved for soft laser ibuprofen combination, ibuprofen and soft laser groups reported similar success results, and control group recorded the least pain scores. The mean pain scores were lowest for group 3 and highest for group 4 (P < 0.001). Ibuprofen and soft laser combination was significantly better than control group (P < 0.001). There was no significant difference between ibuprofen and laser groups (P = 0.24).

Conclusion: For teeth with irreversible pulpitis, preoperative ibuprofen treatment combined with soft laser irradiation greatly improved the success rates of inferior alveolar nerve block anesthesia.

Background: Dental treatment is challenging for children experiencing pain and anxiety. Effective administration of local anesthesia (LA) is crucial for most pediatric dentistry treatments. Eye Movement Desensitization and Reprocessing (EMDR) therapy has emerged primarily to manage post-traumatic stress disorder (PTSD) and a wide variety of anxiety- and pain-related conditions. However, the use of this therapy to manage pain in pediatric dentistry has not yet been reported. This study aimed to assess the trends in pain in pediatric dental patients with and without EMDR therapy during LA and extraction. The need for analgesic consumption within 24 h post extraction and the overall dental experience were also evaluated.

Methods: Sixty children aged 8-12 years participated in a randomized controlled clinical trial with the goal of extracting the primary mandibular first or second molar on the right or left side and were stratified into: group I: EMDR therapy; group II: Tender Love and Care. Pain was measured at three different time intervals. An unpaired t-test was performed for intergroup comparison of continuous data, and the repeated measures ANOVA was applied for intergroup comparison between the groups.

Results: Pain was significantly lower in group I (pain after topical LA gel application, P = 0.229; pain after LA administration, P = 0.036; pain after extraction, P < 0.001). The need for analgesic consumption was lower in this group (P = 0.072), and the overall dental experience was rated better (P < 0.0001).

Conclusion: Research has shown that EMDR therapy effectively reduces pain in children, making it a recommended practice for pediatric dentists trained in this technique.

Toothaches are the main reason patients seek dental care, but not all pain in the orofacial region originates from the teeth. Some toothaches may stem from musculoskeletal, neuropathic, or neurovascular issues. Additionally, certain toothaches may not be tooth-related, but rather, referred from nearby orofacial structures, where the site and source of pain differ. In referred pain, the pain typically travels to the site from an ipsilateral source in the orofacial region. However, when the site and source of pain are on different parts of the body, but the pain is referred in a predictable manner, it is termed mirror-image pain. This case report illustrates mirror-image pain originating in the right mandibular tooth, referred from the contralateral superficial masseter muscle. A comprehensive history, thorough head and neck evaluation, an understanding of anatomy, and the utilization of diagnostic trigger-point injections were instrumental in reaching the correct diagnosis and the management of this non-odontogenic toothache, thus avoiding unnecessary dental interventions for managing the pain site.

Orthognathic surgery often requires intraoral orthodontic appliances that are fixed directly to the bone, which can complicate nasotracheal intubation if the devices protrude into the nasal cavity. This case report describes a 19-year-old man scheduled for elective orthognathic surgery who experienced recurrent cuff tears of the endotracheal tube during nasotracheal intubation due to protruding orthodontic screws in the palate. Despite initial attempts at nasotracheal intubation through the left nostril, the cuff of the 7.0 mm internal diameter (ID) Ring, Adair & Elwyn (RAE) tube repeatedly ruptured, with identical rupture patterns observed. Facial CT revealed that the orthodontic screws had protruded into both nasal cavities with significant visibility in the sagittal, coronal, and transverse views. Fiberoptic examination of the left nasal passage identified a firm protrusion below the inferior turbinate, corresponding to the location of the screw, which likely caused the cuff tears. Intubation was successfully performed via the right nostril during the fiberoptic examination. This case highlights the critical importance of evaluating intraoral corrective devices using comprehensive craniofacial imaging before anesthesia induction, as well as conducting fiberoptic examinations during intubation to avoid complications and ensure patient safety.

Computer-controlled local anesthesia delivery (CCLAD) is an innovative electronic injection device that represents a cutting-edge approach to dental anesthesia. This system is promising for painless anesthesia using controlled anesthetic injections. This review aimed to compare the discomfort experienced by patients during local anesthesia using a traditional syringe and the CCLAD system and evaluate the potential of the CCLAD system as a painless dental anesthesia solution. The inclusion criteria for this study were based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The study population, including children and adults, underwent dental anesthesia using the CCLAD system, ensuring a comprehensive and representative sample that instills confidence in the validity of the results. Fourteen clinical trials were included in the analysis after they fulfilled the eligibility criteria. We found that using computer-assisted anesthetic equipment not only led to a significantly lower pain perception score, but also had a profound positive impact on patient behavior. Patients using the CCLAD device exhibited more cooperative and helpful conduct, indicating the system's effectiveness in improving patient comfort and experience and reassuring the audience about its positive impact. In conclusion, using a computer-assisted anesthetic device such as the CCLAD system significantly reduced pain perception scores and improved patient behavior, making them more cooperative and helpful. These findings offer hope for pediatric dentistry and apprehensive adult patients, suggesting a more comfortable and less daunting dental experience with the CCLAD system.

Background: This study evaluated the effect of remimazolam and propofol on changes in autonomic nerve activity caused by surgical stimulation during orthognathic surgery, using power spectrum analysis of blood pressure variability (BPV) and heart rate variability (HRV), and their respective associations with cardiovascular fluctuations.

Methods: A total of 34 patients undergoing Le Fort I osteotomy were randomized to the remimazolam (Group R, 17 cases) or propofol (Group P, 17 cases) groups. Observables included the low-frequency component of BPV (BPV LF; index of vasomotor sympathetic nerve activity), high-frequency component of HRV (HRV HF; index of parasympathetic nerve activity), balance index of the low- and high-frequency components of HRV (HRV LF/HF; index of sympathetic nerve activity), heart rate (HR), and systolic blood pressure (SBP). Four observations were made: (1) baseline, (2) immediately before down-fracture, (3) down-fracture, and (4) 5 min after down-fracture. Data from each observation period were compared using a two-way analysis of variance with a mixed model. A Bonferroni multiple comparison test was performed in the absence of any interaction. One-way analysis of variance followed by Tukey's multiple comparisons test was performed when a significant interaction was observed between time and group, with P < 0.05 indicating statistical significance.

Results: Evaluation of autonomic nerve activity in comparison with baseline during down-fracture showed a significant increase in BPV LF (P < 0.001), an increasing trend in HRV LF/HF in Group P, and an increasing trend in HRV HF in Group R. There were no significant differences in HR or SBP between the two groups.

Conclusion: During down-fracture of Le Fort I osteotomy, sympathetic nerve activity was predominant with propofol anesthesia, and parasympathetic nerve activity was predominant with remimazolam anesthesia.