Journal of dental anesthesia and pain medicine最新文献

Background: Children experience anxiety in unfamiliar dental environments, impacting their behavior and impeding dental treatment. Local anesthetic infiltration (LA) induces anxiety in children. Distraction is recommended to alleviate the pain and anxiety associated with LA administration. Origami and puzzle games are promising, economical, nonpharmacological techniques to minimize dental anxiety and can enhance intellectual and cognitive development. This study aimed to evaluate the effectiveness of origami and puzzle games as distraction techniques for reducing dental anxiety and pain during local anesthesia infiltration in children aged 5-10 years during local anesthesia infiltration.

Methods: Fifty-two healthy children, aged 5-10 years, undergoing dental procedures requiring local anesthesia were chosen and divided into two groups. Each group comprised 26 children as determined by simple randomization. Group I: Puzzle game group; Group II: Origami group. In both groups, a physiological measure (pulse rate by pulse oximeter) was measured prior to, during, and following LA administration, while the face, legs, activity, cry, and consolability (FLACC) scale was used to record anxiety levels before and after the intervention. The FLACC Scale, an objective measure, was used to record pain perception during LA administration, whereas the faces pain scale, a subjective measure, was used to record pain perception following LA administration. This was followed by the needful treatment. Pulse rates were compared between the two groups using independent and paired t-tests for inter-and intragroup assessments, respectively. The Wilcoxon signed-rank test and Mann-Whitney U test were used to analyze anxiety and pain scores.

Results: Intragroup comparisons of pulse rates before, during, and after LA administration were statistically significant (P < 0.001). Inter-group comparison of pulse rates was also statistically significant during LA administration (P = 0.04); however, there was no significant difference before intervention and after LA administration. However, after the intervention, the mean anxiety scores were significantly reduced in the puzzle game group (P = 0.004). The mean pain scores of the FLACC and Faces Pain Scale-Revised were lower (P < 0.001) in the puzzle game group than in the origami group.

Conclusion: Puzzle games were the most effective in lowering children's pain and anxiety during LA administration.

Dental fear and anxiety are prevalent challenges in pediatric dentistry. Sedation is crucial for managing these issues, ensuring a positive treatment experience, and enabling the safe and effective care of young patients who may otherwise be anxious or uncooperative. This systematic review and meta-analysis aimed to synthesize and compare existing evidence, offering a comprehensive evaluation of the performance of dexmedetomidine and midazolam in terms of sedation quality, onset of action, recovery time, and potential side effects in pediatric patients. The systematic review was registered with PROSPERO (registration number: CRD42024566935) and followed the PRISMA guidelines, including seven randomized controlled trials published between 2011 and 2024. The examined data focused on mask acceptance, parental separation, emergence delirium, satisfactory sedation, and the overall success of the sedation protocol. Risk of bias was assessed using the Cochrane Collaboration and ROBINS-I tools. Data were aggregated and weighted using Review Manager, followed by meta-analysis. To evaluate the pooled effect, heterogeneity, and potential publication bias, we used STATA 17.0, with statistical significance set at P < 0.05. Intranasal dexmedetomidine has demonstrated outcomes comparable or superior to those of midazolam in pediatric dental sedation. Midazolam exhibited a faster onset of action (10-57 min) than did dexmedetomidine (10-47 min), although the difference was not statistically significant. Parental separation outcomes favored dexmedetomidine with a statistically significant pooled effect, whereas mask acceptance and satisfactory sedation showed no significant differences. Dexmedetomidine significantly reduced emergence delirium compared with midazolam, suggesting a safer recovery profile. Both dexmedetomidine and midazolam have demonstrated effectiveness in managing pediatric dental patients, providing dependable sedation with similar results for parental separation and mask acceptance. Although midazolam exhibits a quicker onset of action and facilitates more rapid sedation, dexmedetomidine has the advantage of a lower incidence of emergent delirium, providing an additional layer of postoperative comfort. These results suggest that, although the choice of sedative may be influenced by the clinical need for faster onset or reduced postoperative complications, both agents effectively achieve satisfactory sedation, ensuring procedural comfort and promoting patient cooperation in pediatric dental settings.

Background: The inappropriate use of opioids in the United States continues to pose a significant challenge to public health. For a look into how the next generation of practitioners may be trained, this survey study sought to evaluate the current opioid prescribing patterns among Oral and Maxillofacial Surgery (OMFS) residency programs in the United States.

Methods: A 16-question survey was sent to 100 residency program directors, with responses from 27 programs. The survey aimed to assess the program's strategies for postoperative pain management, including the use of opioids, non-opioids, and other available modalities such as localized long-acting bupivacaine.

Results: The results showed that 74% of the responding programs still taught the use of opioid prescriptions for third-molar removal, and 40% of the surveyed programs used prescription narcotics for other extractions as well. One-third of residency programs have adopted the use of localized long-lasting bupivacaine to limit the amount of narcotic medication required for dentoalveolar procedures.

Conclusion: This study highlights the implications of these prescription habits and raises questions regarding future improvements to OMFS resident training programs.

Oral flavored solutions are effective for pain management. The intraoral application of sweet solutions at the injection site or on the tongue before local anesthetic administration leads to lower self-perceived pain than any other intervention. This systematic review aimed to evaluate the effect of sweet taste on injection pain in patients undergoing dental procedures. This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42024571962 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). An initial electronic search without a time limit up to September 2024 revealed 1,087 studies from indexed databases (PubMed, Scopus, Embase, Cochrane, and Web of Science). The Cochrane Bias Assessment Tool was used to evaluate the risk of bias. After eliminating duplicate and automated records, 103 studies were screened for inclusion. After reviewing the titles and abstracts and assessing the eligibility of the studies, three were excluded and eight RCTs were considered appropriate for inclusion and analysis. This review highlights that all the included studies reported significantly reduced pain perception after sweet solutions, regardless of the specific type or concentration.

Background: Patient age, preoperative anxiety, dental requirement, risks associated with pharmaceutical management, safety, parental expectations, and cost influence the choice of pharmacological behavior management. Thus, this randomized controlled clinical study aimed to compare the effectiveness and acceptance of intranasal dexmedetomidine and midazolam for sedation in children aged 5-8 years using a mucosal atomizer device (MAD).

Methods: A total of 48 participants with Frankl's II behavior were randomly divided into two groups: Group I received intranasal midazolam (0.25 mg/kg), and Group II received intranasal dexmedetomidine (1.5 µg/kg). The primary outcomes assessed were drug acceptance, onset and effectiveness of sedation, and pre-and post-treatment anxiety levels. Secondary measures were also evaluated pre- and post-treatment.

Results: Intranasal dexmedetomidine demonstrated significantly better drug acceptance (P < 0.001). Midazolam had a faster onset but was less effective than dexmedetomidine (P < 0.001). Additionally, dexmedetomidine exhibited better anxiolytic properties than midazolam (P < 0.001).

Conclusion: Dexmedetomidine was better accepted by children aged 5-8 years, was more effective, and had superior anxiolytic properties compared with midazolam.

Background: Patients who report to be difficult to anesthetize for dental procedures are commonly encountered. Determining their frequency and shared characteristics could improve understanding of pain management failures.

Methods: Categorical and continuous variables of 24 demographic, medical history, and dental history variables were compared in a deidentified cross-sectional study using electronic health records (EHR) of patients at the University of Iowa College of Dentistry. Individuals who self-reported to be difficult to anesthetize in their dental health history form were compared to those who reported no complications with local anesthesia. Descriptive, univariate regression, and multivariable regression statistical analyses were completed on the demographic, medical history, and dental history EHR variables.

Results: A total of 12,400 deidentified patient records met the inclusion criteria with a 11.4% (n = 1,411) prevalence of difficult to anesthetize self-reports. Eight categorical variables were found to have statistically significant (95% confidence interval [CI]) adjusted odds ratios (AOR) in the multivariable regression of difficult to anesthetize reporting patients: female gender (AOR = 1.61, 95% CI: 1.32-1.96, P < 0.001), dental fear (AOR = 3.60, 95% CI: 3.01-4.31, P < 0.001), mental health disorders (AOR = 1.21, 95% CI: 1.00-1.46, P < 0.045), problems with general anesthesia (AOR = 1.46, 95% CI: 1.11-1.89, P = 0.005), neurological/nerve disorders (AOR = 1.30, 95% CI: 1.05-1.60, P = 0.015), temporomandibular joint clicking/popping (AOR = 1.31, 95% CI: 1.08-1.60, P = 0.006), needle anxiety (AOR = 29.03, 95% CI: 23.80-35.52, P < 0.001), and history of root canal treatment (AOR 0.82, 95% CI: 0.68-0.99, P = 0.035).

Conclusion: A clinically relevant percentage of patients self-reported being difficult to anesthetize for dental procedures. The relationship between local anesthesia inadequacies and variables such as female gender, dental fear, mental health, and neurological disorders requires further investigation. The use of evidence-based local anesthesia approaches and communication practices is suggested to minimize pain experienced and subsequent fear of dental care.

1p36 deletion syndrome is characterized by a genetic deletion that frequently causes central nervous system, craniofacial, cardiac, and musculoskeletal anomalies. Perioperative management of patients with 1p36 deletion syndrome presents unique challenges due to multiple anomalies and potential complications. We present the successful anesthetic management of a 16-year-old patient diagnosed with 1p36 deletion syndrome who underwent general anesthesia for multiple dental procedures, including dental fillings, extractions, and tartar removal. The patient had micrognathia, hypotonia, flat eyebrows, a short neck, inability to sit without support, absence of speech and self-care skills, limited ability to follow simple commands, and poor cooperation. These factors increase the risk of difficult mask ventilation and intubation. To minimize aspiration risk, we successfully intubated the patient using rapid-sequence induction and intubation (RSII) method with cricoid pressure. A perioperative multidisciplinary team approach and comprehensive preoperative evaluation are crucial due to the existing anomalies, developmental and motor delays, and potential airway complications associated with this syndrome.

Background: Postoperative pain management is challenging in patients with oral cancer, especially those undergoing reconstructive surgery. Patient-controlled analgesia (PCA) is widely used, and fentanyl (FTN) concentration adjustments may improve pain control. This study aimed to evaluate the effects of FTN PCA concentration and reconstructive surgery on postoperative pain in patients with oral cancer.

Methods: This retrospective observational study analyzed 140 patients with oral cancer who underwent surgery under general anesthesia. Patients were categorized based on FTN PCA dosage (FTN 700 mcg and ketorolac 150 mg vs. FTN 1400 mcg and ketorolac 150 mg). Pain was assessed using the visual analog scale (VAS) at multiple time points postoperatively (0, 12, 24, 36, 48, 60, and 72 h). PCA usage patterns, including demand count, delivery count, and delivery/demand ratios, were compared across subgroups. Missing data were imputed using linear interpolation.

Results: PCA usage and pain control were evaluated between the FTN 700 mcg (N = 40) and 1400 mcg (N = 100) groups, stratified by reconstruction status. Demographic characteristics showed no significant difference. In the reconstructive surgery subgroup, patients in the FTN 1400 mcg group showed lower PCA refill counts (1.45 ± 0.69 vs. 1.61 ± 0.58) and fewer delivery counts (17.1 ± 21.3 vs. 25.1 ± 28.5) compared to those in the FTN 700 mcg group, achieving similar or superior pain control with fewer interventions. Similarly, patients without reconstructive surgery in the FTN 1400 mcg group demonstrated lower PCA refill counts, shorter PCA usage times, and fewer delivery counts. VAS scores decreased consistently over time across all groups but remained higher in the reconstruction groups. Logistic regression analysis revealed that patients with reconstructive surgery in the FTN 1400 mcg group were more likely to achieve a VAS score of ≤ 3.0 at 72 h postoperatively (P = 0.022). These findings indicate FTN 1400 mcg's superiority in managing postoperative pain.

Conclusion: Comparing FTN PCA dosages, 1400 mcg demonstrated superior pain control to 700 mcg in patients undergoing oral cancer surgery, particularly those who underwent reconstructive surgery. This finding underscores the importance of optimizing FTN dosages to enhance postoperative pain management, reduce PCA-related demands, and achieve better patient outcomes.