Journal of dental anesthesia and pain medicine最新文献

Background: The COVID-19 pandemic disrupted healthcare delivery worldwide, including dental services. In Japan, the burden and age-specific patterns of dental anesthesia use have not been quantified. We aimed to describe national trends in dental sedation and general anesthesia (GA) in Japan from fiscal year (FY) 2019 (pre-pandemic baseline) through FY 2023 using aggregated claim-level data from the National Database Open Data Japan and interpret these trends in the context of COVID-19-related healthcare constraints. We compared the age distributions of patients who underwent GA in dentistry and medicine.

Methods: This analysis used aggregated claim counts from the National Database Open Data (FY 2019-FY 2023). Sedation and GA categories were defined using reimbursement codes: inhalation sedation (K002), intravenous sedation interpreted as conscious or moderate sedation (K003), intravenous anesthesia interpreted as deep sedation (L001-2), and GA (L008). Outcomes were annual claim counts, relative indices standardized to FY 2019 (=100), and age-stratified distributions in 5-year groups (0-4 years to ≥90 years). Age distributions for GA were visualized as mirrored pyramids in dentistry and medicine. No inferential tests were performed.

Results: Inhalation sedation increased by approximately 7% in FY 2023. Intravenous sedation increased substantially by 68%. Intravenous anesthesia declined sharply in FY 2020, the first pandemic year, and then plateaued. Dental GA decreased in FY 2020, recovered, and expanded to 110,000 claims by FY 2023 (relative index: 122.3). Dental GA showed a bimodal age distribution (peaking at 5-9 years and 15-29 years), whereas medical GA were concentrated at 70-85 years, indicating distinct modality- and sector-specific demand structures.

Conclusion: Using claims tabulations spanning the pre-pandemic, pandemic, and "with-COVID" phases, we found heterogeneous trajectories in dental sedation and GA in Japan, characterized by robust growth in conscious or moderate sedation and recovery and expansion of dental GA after an initial 2020 decline. The divergent GA age distributions between dentistry and medicine underscore fundamentally different demand profiles. Interpreted within the context of COVID-19, these modality- and age-specific patterns highlight the adaptive and resilient responses of Japan's dental anesthesia services under pandemic-related constraints and provide a foundation for future policy and workforce planning.

Background: Individuals with disabilities often face significant barriers to receiving appropriate dental care due to limited cooperation, communication difficulties, and underlying medical conditions. Dental treatment under general anesthesia (GA) is an effective alternative for patients who are unable to tolerate conventional outpatient procedures. This study aimed to analyze cases of dental treatment under GA performed at the Gyeongnam Dental Clinic Center for the Disabled and to compare them with findings from other regional centers in Korea.

Methods: A retrospective review of 181 cases of dental treatment under GA performed at the Gyeongnam Center between November 8, 2022, and October 30, 2024, was conducted. Patient data, including demographic characteristics, disability type, American Society of Anesthesiologists (ASA) physical status classification, treatment type, number of GA sessions, procedure duration, and regional residence, were collected from anonymized electronic medical records. Statistical comparisons were made with findings from previous studies to assess trends and clinical implications.

Results: Among the 181 patients treated under GA, 61.9% were male, with a mean age of 22.4 years. Intellectual disabilities (41.4%) and autism spectrum disorder (28.6%) were the most common indications. Most patients were classified as ASA class II (60.8%) and underwent an average of 14 procedures per session, with restorative treatment being the most frequent (43.5%). Single-session treatments were predominant (90.9%), with an average duration of 147.5 m. Most patients resided in Gyeongsangnam-do (62.4%), reflecting the center's geographic accessibility.

Conclusion: This study provides foundational data on dental treatment under GA for individuals with disabilities at a regional center. The findings emphasize the need for specialized facilities, efficient treatment planning, and structured follow-up systems. Improved accessibility and financial support are essential to enhancing oral health outcomes in this population. Future studies should include pediatric cases and account for overlapping disabilities to better reflect clinical complexity.

Background: Pain remains one of the main causes of apprehension during dental procedures. In this context, topical anesthetics play an essential role in reducing discomfort, and new compounds such as amitriptyline and jambu (Acmella oleracea) extract have been investigated as promising alternatives. Drug delivery systems, such as Pentravan^®, a nanosomal transdermal base, are also of interest; however, their application on oral mucosa has not yet been clinically evaluated. Therefore, this study aimed to compare the anesthetic efficacy of lidocaine (LDC) and prilocaine (PLC) combined with either amitriptyline or jambu, formulated as ointments or incorporated into Pentravan^®, for topical anesthesia of the buccal and palatal mucosa of maxillary premolars, using pulpal response and puncture sensitivity as outcome measures.

Methods: A randomized, blinded, crossover clinical trial was conducted with 40 healthy volunteers who received six formulations: (1) LDC 2.5% + PLC 2.5% (positive control); (2) LDC 2.5% + PLC 2.5% + amitriptyline 5%; (3) LDC 2.5% + PLC 2.5% + jambu extract 20% (7.5% spilanthol); (4) LDC 2.5% + PLC 2.5% + amitriptyline 5% in Pentravan^®; (5) LDC 2.5% + PLC 2.5% + jambu extract 20% in Pentravan^®; and (6) base ointment without active ingredients (placebo). Pain upon needle puncture was assessed using the visual analog scale, and pulpal anesthesia was evaluated with an electric pulp tester.

Results: Formulations 1 and 2 produced the lowest pain scores in the buccal mucosa, with Formulation 1 showing statistically superior results than Formulations 3, 4, 5, and 6 (P < 0.05). Formulation 6 yielded the highest pain scores, while Formulations 2-5 demonstrated intermediate efficacy without significant differences. Formulations 1 and 2 were also the most effective on the palatal mucosa. None of the formulations achieved significant pulpal anesthesia. Adverse effects were mild and self-limiting, with mucosal desquamation observed only with Formulation 2.

Conclusion: Amitriptyline demonstrated relevant clinical potential, whereas jambu extract showed intermediate efficacy. Pentravan^®-based formulations did not exhibit clinical superiority. Future studies should focus on optimizing these combined formulations to enhance the efficacy of topical anesthesia in dentistry.

Recent studies have investigated the use of dexmedetomidine (DEX) as an adjuvant to local anesthetic solutions. Building on this emerging evidence, this study aimed to assess the efficacy of adding DEX to local anesthetics in patients undergoing impacted third molar surgery. A systematic search was conducted across four electronic databases, PubMed, ScienceDirect, Web of Science, and the Cochrane Library, using a combination of Medical Subject Headings terms and free-text keywords related to impacted third molar surgery. Six studies comprising 266 patients were included in the qualitative systematic review, and only four of them, involving 200 patients, were included in the quantitative meta-analysis. The random-effects model demonstrated statistically significant reductions in anesthetic onset time (mean difference [MD] = -0.96 min; 95% confidence interval [CI]: -1.52 to -0.39; P = 0.0009), systolic blood pressure (MD = -3.58 mmHg; 95% CI: -6.58 to -0.58; P = 0.020), and pain at 6 and 12 h postoperatively (MD = -2.32, 95% CI: -2.85 to -1.78; P = 0.0001) in the local anesthesia + DEX group compared with local anesthesia alone. The findings indicated that incorporating DEX into local anesthesia for impacted third molar surgery resulted in statistically significant improvements in the onset of anesthetic effects and postoperative pain scores.

Background: Nitrous oxide-oxygen (N₂O:O₂) inhalation sedation is a safe and effective technique for managing dental anxiety and achieving light conscious sedation. It increases the pain threshold, reduces fatigue, and improves patient cooperation. Two primary induction techniques are used: slow and rapid induction, with the latter preferred for highly anxious or uncooperative patients who require immediate sedation during dental procedures. This study aimed to evaluate the efficacy of different concentrations of N₂O:O₂ inhalation sedation and to assess changes in physiological and psychomotor parameters, and post-sedation recovery, in pediatric patients.

Methods: A total of 78 children who met the inclusion criteria were randomly divided into three groups: Group A (conventional slow induction), Group B (rapid induction with 30:70 N₂O:O₂), and Group C (rapid induction with 50:50 N₂O:O₂). Demographic and medical data were recorded. Baseline vital signs and the Trieger Dot Test were performed before treatment. Induction was carried out according to group protocol. The Face, Legs, Activity, Cry, Consolability (FLACC) pain score and the Observer's Assessment of Alertness/Sedation (OAA/S) scale were used to assess pain and sedation levels, respectively. Vital signs were monitored during and after treatment. Post-recovery, the Trieger Dot Test was repeated, and a 24-hour follow-up call was made to assess the child's well-being.

Results: All groups maintained vital signs within normal limits. Differences in pain perception and psychomotor impairment were statistically non-significant. A statistically significant difference was observed in the sedation levels among the groups (P = 0.033). Light sedation was achieved in 69.23%, 57.69%, and 73.08% of participants in Groups A, B, and C, respectively, while moderate sedation was observed in 19.23% of participants in the 50:50 induction group. A 24-hour telephonic follow-up revealed that all children had resumed normal activities and daily routines.

Conclusion: The results provide clinicians with evidence-based guidance on N₂O:O₂ titration and induction techniques. The preadjusted mixture of 30% N₂O and 70% O₂ offers a more efficient approach to achieving an adequate depth of sedation in a shorter period while increasing pain tolerance. Therefore, it can serve as an effective alternative to slow induction for administering N₂O:O₂ inhalation sedation in restless and anxious pediatric patients.

Inferior alveolar nerve (IAN) injury is one of the most significant adverse outcomes of dental implantation. IAN injury can occur because of direct invasion of the mandibular canal, compression from implant placement, or postoperative hematoma formation. These injuries may result in prolonged neurosensory disturbances, and the prognosis largely depends on how quickly treatment is initiated. A 71-year-old male presented with persistent hypoesthesia, pain, and tinnitus in the left mandibular region of 6 years duration after implant placement. Clinical and radiographic examinations revealed peri-implantitis around the implant in the affected region. Neurosensory disturbances completely resolved after removal of the affected implant with peri-implantitis. This case highlights the fact that even long-standing inferior alveolar nerve injuries may be reversible if the underlying cause is resolved. Prompt recognition and elimination of etiologic factors such as implant-induced nerve compression in the presence of peri-implant pathology are crucial for achieving favorable recovery in patients with chronic IAN injury.

The inferior alveolar nerve block (IANB) is the most frequently used mandibular nerve block in oral surgery; however, it has a reported failure rate of 15%-45%. The presence of the retromolar canal (RMC) and nerve, an anatomical variation in the mandibular retromolar region, can cause IANB failure. Although its occurrence is variable, the canal has gained increasing clinical relevance because of its vulnerability during oral and maxillofacial surgical procedures. Its presence may result in anesthetic failure during IANB and, less commonly, may act as a conduit for spreading infection or tumor metastasis. Although several studies have examined the prevalence and anatomical variations of the RMC, literature specifically addressing the traumatic neuropathy from injury to this area during third-molar extraction is lacking. This case report details post-traumatic trigeminal neuropathy following injury to the RMC during third-molar extraction. The case findings contribute to the limited clinical evidence, emphasize the importance of preoperative identification of anatomical variations, and underscore the need for meticulous intraoperative management to minimize the risk of iatrogenic neuropathic complications.

Background: Fear of injections and dental anxiety are the major barriers to successful pediatric dental treatment. Visual threats associated with conventional syringes can increase anxiety and pain perception in children, necessitating the use of child-friendly strategies. This study aimed to evaluate and compare the impact of camouflaged and insulin syringes, with and without counter-stimulation, on anxiety levels, pain perception, and behavioral responses during local anesthesia administration in children.

Methods: A clinical trial involving 120 children aged 8-10 years who required bilateral maxillary local anesthesia was performed. Local anesthesia with camouflaged and insulin syringes was administered to each child once with and without thumb pressure counter-stimulation. Anxiety was measured using pulse rates, pain was measured using the Wong-Baker Faces Pain Rating Scale, and behavior was measured using the Face, Legs, Activity, Cry, Consolability (FLACC) scale. Statistical analyses were performed using the independent t-test and chi-square test.

Results: Both groups were demographically comparable with no significant differences in age (independent t-test, P = 0.539) or sex distribution (chi-square test, P = 0.854). At first appointment, camouflaged syringes showed significantly lower pain scores (3.58 ± 0.74 vs. 4.17 ± 1.37; P = 0.005), lower pulse rates (89.10 ± 5.84 vs. 99.00 ± 1.80 bpm; P < 0.001), and better behavioral responses (FLACC score: 2.27 ± 0.78 vs. 2.80 ± 0.68; P < 0.001) compared with insulin syringes, as assessed by the independent t-test. These effects were further enhanced by counter-stimulation. At second appointment, although overall scores improved in both groups, post-treatment differences between the syringe types were not statistically significant (P > 0.05).

Conclusion: Camouflaged syringes combined with counter stimulation represent an effective, simple, and non-pharmacological method for reducing anxiety and improving cooperation during local anesthesia administration in pediatric dental patients. However, the findings are limited by the use of a homogenous sample of healthy, cooperative children aged 8-10 years and potential bias due to the inability of blind operators or participants. Future studies should evaluate a broader population and incorporate blind assessment protocols.