Journal of dental anesthesia and pain medicine最新文献

This systematic review aimed to assess the effect of various working length determination methods on the incidence of postoperative pain after root canal treatment. A comprehensive literature search was conducted across three electronic databases to identify randomized clinical trials. Two reviewers independently screened the articles, extracted relevant data, and assessed methodological quality using the Cochrane risk-of-bias assessment tool. For quantitative synthesis, a random-effects model was employed to compute the pooled mean difference by comparing the simultaneous and separate working-length determination methods. Sensitivity analyses were conducted after excluding studies that contributed disproportionately to overall heterogeneity. Seven studies met the criteria for qualitative review and three were included in the meta-analysis. The findings suggest that simultaneous determination of working length using integrated electronic apex locators may offer an advantage in reducing postoperative pain. However, this interpretation is limited by the substantial heterogeneity observed across the included studies. This review highlights the necessity for robust and well-designed clinical trials with large sample sizes and standardized protocols to obtain conclusive evidence.

The inferior alveolar nerve block (IANB) is one of the most painful procedures, especially in children. Effective pain management during IANB is a critical prerequisite for the successful treatment of pediatric patients. This systematic review aimed to evaluate the combined effectiveness of extraoral vibration and cooling (EVC) in reducing pain perception during IANB in children. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for the compilation of this systematic review. PROSPERO registration was performed using registration number CRD42024558538. PubMed, ScienceDirect, Cochrane, Google Scholar, and LILACS were searched for relevant studies published from the inception of the databases until January 1, 2025. Studies that compared the use of EVC with conventional methods for IANB in children were selected. The primary and secondary outcomes were subjective and objective measures of pain, respectively. The initial search of the five electronic databases yielded 483 records. After excluding 113 duplicates and screening 309 irrelevant titles and abstracts, 61 studies were included. Of these, six were selected for full-text analysis, and three studies met the inclusion criteria for the final systematic review. Meta-analysis was feasible for two of these studies because of their comparable methodologies and outcome measures. All included studies involved pediatric patients aged 5-12 years undergoing IANB. The intervention group underwent IANB using a combination of EVC, whereas the control group underwent conventional IANB without adjuncts. Pain and anxiety were assessed using both subjective (Wong-Baker Faces Pain Scale) and objective (Face, Legs, Activity, Cry, Consolability) scoring systems. The results indicated a statistically significant reduction in pain scores in the EVC group than in the control group, suggesting that EVC may be an effective adjunct for improving pain perception during IANB in children. Pain perception during IANB was significantly lower in the combined EVC group than in the control group. However, meta-analysis reports indicated that there was no significant difference in pain perception between the intervention and control groups.

Background: The goal of dental practice is to ensure painless treatments. This study aimed to assess the effectiveness of Low-level Laser Therapy (LLLT) in reducing pain perception and anxiety associated with conventional local anesthetic injections.

Methods: This was a randomized, single-blind, split-mouth study involving 36 participants divided into two groups. Group I underwent LLLT prior to local anesthesia injection, whereas Group II underwent the procedure without laser activation. Anxiety levels were measured using the Hamilton Anxiety Rating Scale (HAM-A), and pain was evaluated using the Visual Analog Scale (VAS) and Wong-Baker Faces Rating Scale (WBFRS).

Results: Statistical analyses were performed using the SPSS 22 software (IBM, Armonk, NY, USA). Post-intervention analysis of the HAM-A scores showed a reduction in anxiety levels following LLLT, with mild anxiety increasing from 52.8% to 69.44%, and moderate anxiety decreasing from 47.2% to 30.56%. In terms of pain assessment, VAS scores revealed that 38.9% of patients in Group I reported no pain compared to 0% of patients in Group II. Moderate pain was reported by 50% of patients in Group I and 75% of patients in Group II, while severe pain was reported by 11.1% and 25% of patients, respectively. Pain distribution (WBFRS) showed that 63.9% of patients in Group I reported no pain versus 0% of patients in Group II. Little pain was experienced by 36.1% of Group I and 58.3% of Group II patients, whereas 41.7% of Group II patients reported slightly more pain. Statistical comparison showed that Group I had significantly lower mean VAS (1.72 ± 0.659) and WBFRS (1.36 ± 0.487) scores than Group II (VAS: 2.25 ± 0.439; WBFRS: 2.42 ± 0.500), with both results being statistically significant (P < 0.001).

Conclusion: LLLT was effective in reducing pain associated with injections. It can be used successfully to manage procedures that patients commonly perceive as painful, thereby providing a natural analgesic effect. Additionally, LLLT contributes to creating positive treatment experiences, which play a key role in fostering a long-term, trusting relationship between the patient and clinician.

A hiatal hernia can increase abdominal pressure, potentially leading to vomiting after the induction of general anesthesia. Therefore, rapid sequence induction is the preferred method for inducing general anesthesia in patients with hiatal hernias. The use of high-flow nasal cannula oxygen (HFNC) has become increasingly common to reduce the risk of oxygen desaturation during rapid induction. This report describes a case in which a hiatal hernia was successfully induced using HFNC. A 90-year-old woman with a history of reflux esophagitis was under medical management. Preoperative chest radiography revealed hiatal hernia. Anesthesia was induced after admission to the operating room and preoxygenation with HFNC. The oxygen flow was then increased to 70 L/min, and tracheal intubation was performed. SpO₂ remained at ≥99% during apnea for approximately 2 min, and no gastric reflux occurred. Rapid sequence induction combined with HFNC may be an effective option for patients with hiatal hernias who are at a high risk of gastric reflux during anesthetic induction.

Background: The frequent use of cone-beam computed tomography (CBCT) has drawn attention to the anatomical variations of the mandibular canal (MC). This study aimed to analyze the bifid mandibular canal (BMC) types, frequency, and impact of inferior alveolar nerve block (IANB).

Methods: This study included 142 CBCT scans. For the analysis of the BMC types, an established classification method was used. CBCT sagittal and transverse planes were used to analyze the occurrences, dimensions of the BMC types, and differences based on the sex and age of patients.

Results: The frequency of BMC was 9.2%. There were no statistically significant differences in the occurrence related to sex (P = 0.317), age (P = 1.000), or localization (P = 0.317). The average BMC diameter ranged from 1.2 to 2.5 mm. The largest BMC diameter was in the retromolar region.

Conclusion: The high incidence of BMC must be considered during IANB. Untimely identification of anatomic variations in the MC can lead to IANB anesthesia failure, as well as intraoperative and postoperative complications.

Background: Local dental anesthesia is the most commonly used method for eliminating pain during dental treatment. Palatal injections, which are routinely used to extract deciduous molars, may be poorly tolerated by pediatric patients. The aim of this study was to evaluate the pain acceptance and anesthetic efficacy of the Comfort-In needle-free injection compared with the traditional injection method in upper deciduous molars requiring extraction.

Methods: Patients between the ages of 4 and 10 years who were admitted to our clinic and required extraction of their maxillary deciduous molars under local anesthesia were included in our study. Infiltration anesthesia with a conventional dental injector was applied to one of the symmetrical teeth, and a Comfort-in jet injection system was applied to the other. The Index of Dental Anxiety and Fear (IDAF-4C) anxiety scale was administered to children. The Wong-Baker Pain Rating Scale (WBPRS) and Face, Legs, Activity, Cry, Consolability (FLACC) scales were applied to the children during the injection. The physiological parameters of the children were evaluated using pulse oximetry. Data were analyzed using IBM SPSS V23 software (SPSS Inc., IBM Co., Somers, NY, USA). The significance level was set at P < 0.050.

Results: No significant difference was observed between Comfort-In jet injection and conventional dental anesthesia in terms of Frankl scores (P = 0.180), pulse rate (P = 0.569), oxygen saturation (P = 0.615), and FLACC total values (P = 0.082). IDAF-4C anxiety levels were low in most of the included children. The categorical distribution of the WBPRS showed a statistically significant difference according to the method used (P = 0.022).

Conclusions: We concluded that the Comfort-In jet injection system is as effective as the gold standard of infiltration anesthesia with a conventional dental syringe and that the Comfort-In jet injection system is acceptable to patients in the postoperative period. Needle-free jet injection is a promising alternative to palatal needle injection for palatal infiltration anesthesia in the maxillary first molars.

Children's fear of dental treatment can create challenges for dentists in managing their behavior, which may hinder the provision of proper dental care. The use of sedative agents can alleviate anxiety and control behaviors in pediatric dental patients. Nitrous oxide and midazolam are the two most commonly used pharmacological agents for behavioral management in pediatric dental care. However, evidence supporting their efficacy and safety is unclear. This systematic review and meta-analysis aimed to consolidate the most robust evidence on the efficacy and safety of nitrous oxide versus midazolam for conscious sedation in pediatric dental patients aged 3 to 16 years. As per the predefined protocol, a systematic review methodology was employed to search electronic databases. Titles and abstracts were screened, and the full text was reviewed by two authors. The included trials compared nitrous oxide and midazolam as single sedatives in children aged 3 to 16 undergoing dental treatment. These trials compared nitrous oxide with oral, intravenous, transmucosal, or intranasal midazolam. Data on the methods, participants, interventions, outcomes, and results were extracted, and each trial was assessed for risk bias. Of the seven articles, two had a moderate risk of bias and five had a high risk. The overall results showed no statistically significant differences between the two interventions (P = 0.64). Despite the limitations of this systematic review and meta-analysis, the present study provides important information regarding the efficacy of both sedatives. However, well-designed and well-documented clinical trials are still required. In addition, guidelines for the standardization of the criteria and definition of success in procedural sedation need to be developed.