Alternative practices of achieving anaesthesia for dental procedures: a review

Managing pain and anxiety in patients has always been an essential part of dentistry. To prevent pain, dentists administer local anaesthesia (LA) via a needle injection. Unfortunately, anxiety and fear that arise prior to and/or during injection remains a barrier for many children and adults from receiving dental treatment. There is a constant search for techniques to alleviate the invasive and painful nature of the needle injection. In recent years, researchers have developed alternative methods which enable dental anaesthesia to be less invasive and more patient-friendly. The aim of this review is to highlight the procedures and devices available which may replace the conventional needle-administered local anaesthesia. The most known alternative methods in providing anaesthesia in dentistry are: topical anaesthesia, electronic dental anaesthesia, jet-injectors, iontophoresis, and computerized control local anaesthesia delivery systems. Even though these procedures are well accepted by patients to date, it is the authors' opinion that the effectiveness practicality of such techniques in general dentistry is not without limitations

Anesthetic effectiveness evaluation of Morpheus® through intrasseptal technical CaZOE in pulpotomy of deciduous teeth : pilot study

Introdução: o medo de sentir dor é um dos principais motivos pelos quais muitos pacientes evitam submeter-se a tratamento dentário, principalmente as crianças. Em vários procedimentos odontopediátricos, o uso de anestésicos locais se faz necessário. O aparelho Morpheus® se propõe a uma introdução da agulha sem dor e anestesia satisfatória com uso de menor volume de anestésico local. Associando-o à técnica CaZOE, o paciente perceberia a pressão antes da dor, podendo assim evitá-la. Objetivo: avaliar a eficácia anestésica do Morpheus® através da técnica intrasseptal CaZOE na pulpotomia de molares inferiores decíduos. Material e método Dezenove voluntários foram selecionados de acordo com os critérios de inclusão e exclusão. O procedimento foi realizado em sessão única, utilizando 0,9 mL de Articaína 4% com epinefrina 1:100.000, através da técnica anestésica CaZOE, empregando o injetor de anestésicos Morpheus®. Esta foi realizada por um único operador, não envolvido na avaliação dos parâmetros da anestesia, e seguiu as recomendações do fabricante. Para a análise dos dados, foi realizada estatística descritiva. Resultado: dos 19 voluntários, 63% foram do sexo feminino e 37%, do masculino. Em pouco mais da metade da amostra (63%), houve sucesso na realização do procedimento. Os casos de insucesso (37%) ocorreram durante a abertura coronária e a amputação da polpa. Conclusão: a eficácia anestésica do Morpheus® através da técnica intrasseptal CaZOE na pulpotomia de molares inferiores decíduos foi constatada em 63% da amostra. Para que possa ser comprovada a eficácia desse sistema, são necessários mais estudos.Introduction: the fear of pain is one of the main reasons why many patients avoid dental treatment, especially children. In several pediatric dentistry procedures, the use of local anesthetic is necessary. Morpheus® system proposes an insertion of the needle painlessly and satisfactory anesthesia with lower volume of local anesthetic. With the CaZOE technique, the patient realizes the pressure before the pain, thus being able to avoid it. Objective: to evaluate the anesthetic efficacy of Morpheus® through intrasseptal technical CaZOE in pulpotomy of mandibular’s primary molars. Material and method: nineteen volunteers were selected according to the inclusion and exclusion criteria. The study was conducted in a single session using 0.9 mL of Articaine 4% with epinephrine 1: 100,000 through anesthetic CaZOE technique, using the Morpheus®. This was carried out by a single operator not involved in the evaluation of anesthesia parameters and followed the manufacturer's recommendations. For data analysis, descriptive statistics was performed. Result: of the 19 volunteers, 63% were female and 37% male. In just over half of the sample (63%), was successful in performing the procedure. Cases of failure (37%) occurred during coronary opening and removal of pulp. Conclusion: the efficacy of Morpheus® through intrasseptal technical CaZOE in pulpotomy of mandibular’s primary molars was noted in 63% of the sample. Further studies should be carried out to prove this efficacy

Cartridge syringe vs computer controlled local anesthetic delivery system: pain related behaviour over two sequential visits – a randomized controlled trial

Background: Local anesthetic injection is one of the most anxiety provoking procedure in dentistry. Knowledge about change in pain related behaviour during consecutive visits helps in and scheduling of treatment procedures and management of children in dental clinic. Aim: To compare the pain perception, behavioural response and the associated change in physiological parameters while receiving local anesthesia injection with cartridge syringe and computer controlled local anesthetic delivery system (CCLAD) over two consecutive visits. Material and Methods: In this randomized controlled cross over trial, 120 children aged 7 – 11 years were randomly divided into group A: receiving injections with CCLAD during first visit; group B: receiving injections with cartridge syringe during first visit. The physiological parameters (heart rate and blood pressure) were recorded before and during injection procedure. Objective evaluation of disruptive behaviour and subjective evaluation of pain perceived were done using Face Legs Activity Cry Consolability (FLACC) scale and modified facial image scale (FIS) respectively. Results: No statistical difference in pain response ( p = 0.164) and disruptive behaviour ( p = 0.120) between cartridge syringe and CCLAD injections were seen during the first visit although the latter showed lesser scores. However, during the second visit there were significant increase in pain response ( p = 0.004) and disruptive behaviour ( p = 0.006) in cartridge syringe group with an associated increase in heart rate. Conclusions: Injections with CCLAD produced lesser pain ratings and disruptive behaviour than cartridge syringe in children irrespective of order of visi

컴퓨터를 이용한 속도 조절형 치과 국소마취 기구: 문헌고찰

Background: Today, there are computer controlled local anesthesia devices used clinically. The main principle is to control injection speed by computer aided system, and it relieves pain. However, there are few objective data considering this subject. In this literature review, we researched studies about computer controlled anesthetic delivery. We compared pain control effect of computer controlled to conventional local anesthetic syringe system. Methods: A bibliographic search in PubMed was performed and we reviewed original articles. Results: There were 18 publications that compared pain control effect of computer controlled to conventional system. There were 8 articles reported of children, similar pain control effect was found in 7 of them. One study showed superior pain control effect of computer controlled anesthetic delivery. For adults, 10 studies showed superior pain control effect in computer aided system. Conclusions: Computer controlled anesthetic delivery has similar or superior pain control effect compared to conventional local anesthetic syringe system. For both children and adults, computer controlled anesthetic delivery could be clinically useful, still it may be more effective for adults.ope

Sedation in Children: Current Concepts

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90049/1/j.1875-9114.1998.tb03900.x.pd

A randomized split-mouth clinical trial comparing pain experienced during palatal injections with two different computer-controlled local anesthetic delivery systems

Several methods have been proposed to reduce pain during injection. The main aim to this study was to compare the pain perception in patients receiving palatal injections of local anesthesia using two different computer-controlled local anesthetic delive

Innovative techniques in administration of local anesthesia in children

Introducere. Frica și anxietatea dentară sunt probleme frecvente în stomatologia pediatrică, influențând complianța pacienților și succesul tratamentului. Durerea resimțită în timpul administrării anesteziei locale este unul dintre principalii factori declanșatori ai anxietății, iar tehnologiile inovatoare de administrare a anestezicelor pot contribui la reducerea acestei probleme. Scopul lucrării. Evaluarea metodelor inovative de administrare a anesteziei locale la copii și analiza impactului acestora asupra reducerii anxietății dentare. Materiale și metode. Studiul a inclus 57 de copii cu vârste între 5 și 10 ani, care au completat un chestionar bazat pe Facial Image Scale (FIS), evaluând nivelul fricii față de diverse aspecte stomatologice. Datele obținute au fost comparate cu literatura de specialitate, analizând eficiența metodelor alternative de anestezie, precum injecțiile fără ac, anestezia computerizată și dispozitivele vibrotactile. Rezultate. Datele studiului evidențiază că frica de injecții este principalul factor anxiogen (53%), urmată de teama provocată de instrumentele stomatologice (34%). Utilizarea tehnologiilor inovatoare de administrare a anesteziei a demonstrat o reducere semnificativă a anxietății dentare. Studiile analizate confirmă că metodele precum anestezia fără ac și vibrațiile aplicate la locul injectării contribuie la un control mai eficient al durerii și la o experiență mai pozitivă a pacientului pediatric. Concluzii. Studiul demonstrează că utilizarea metodelor inovative de administrare a anesteziei locale în stomatologia pediatrică reduce semnificativ anxietatea și îmbunătățește acceptarea tratamentului de către copii. Aceste metode reprezintă o soluție eficientă pentru optimizarea experienței pacientului și pentru creșterea eficienței tratamentelor stomatologice.Introduction. Dental fear and anxiety are common issues in pediatric dentistry, affecting patient compliance and treatment success. The pain experienced during local anesthesia administration is one of the primary triggers of anxiety, and innovative anesthetic delivery technologies can help mitigate this problem. Purpose of the work. To evaluate innovative methods of local anesthesia administration in children and analyze their impact on reducing dental anxiety. Material and Methods. The study included 57 children aged 5 to 10 years who completed a questionnaire based on the Facial Image Scale (FIS) to assess their level of fear regarding various dental aspects. The collected data were compared with the specialized literature, analyzing the effectiveness of alternative anesthesia methods such as needle-free injections, computerized anesthesia and vibrotactile devices. Results. The study data highlight that the fear of injections is the primary anxiety-inducing factor (53%), followed by the distress caused by dental instruments (34%).The use of innovative anesthesia administration technologies significantly reduced dental anxiety. The reviewed studies confirm that methods such as needle-free anesthesia and vibration applied at the injection site contribute to more effective pain control and a more positive experience for pediatric patients. Conclusions. The study demonstrates that the use of innovative local anesthesia administration methods in pediatric dentistry significantly reduces anxiety and improves children’s acceptance of treatment. These methods represent an effective solution for optimizing the patient experience and enhancing the efficiency of dental treatments

A randomized split-mouth clinical trial comparing pain experienced during palatal injections with two different computer-controlled local anesthetic delivery systems

Background: Several methods have been proposed to reduce pain during injection. The main aim to this study was to compare the pain perception in patients receiving palatal injections of local anesthesia using two different computer-controlled local anesthetic delivery systems (C-CLAD) - Dentapen® and The STA Wand®). Material and methods: A randomized, split-mouth and simple blind clinical trial was carried out at the Dental Hospital of the University of Barcelona (Spain) involving a sample of 20 healthy volunteers. Each participant received two palatal injections in the same session (0.3 ml of 3% mepivacaine without vasoconstrictor), using The STA Wand® on one side and the Dentapen® on the contralateral side. The order of the devices and the side of the injections were randomly selected. Pain perception was recorded after each injection using a 10-cm numeric rating scale (NRS). A descriptive and bivariate analysis of the data was performed. Results: Pain perception was similar with both devices (p>0.05). The STA Wand® and Dentapen® groups yielded a mean pain score of 2.40 cm (standard deviation (SD) = 1.47, range 0-6) and 2.35 cm (SD 1.3, range 1-6), respectively. Most participants referred mild pain (80%), and none experienced severe pain. There were no adverse events. Conclusions: In the majority of cases (80%), both C-CLAD devices allow the administration of local anesthetics in the palatal area with mild pain. Both The STA Wand® and Dentapen® are equally effective in reducing pain perception levels for palatal injections