Anesthetic efficacy of gow-gates versus inferior alveolar nerve block for irreversible pulpitis

Introduction: Local anesthesia is a drug used to induce loss of sensation in a particular part of the body that results in nerve endings or obstruction of the peripheral nerve function. Local anesthetic injection may not only generate pain and fear, but also be a triggering factor related to medical emergencies in dental offices, with vasodepressor syncope and hyperventilation as major psychogenic reactions. Various techniques used for Inferior Alveolar Nerve Block (IANB) Mandibular teeth are: • Conventional IANB • Gow-Gates mandibular nerve block (GGMNB) • Vazirani/Akinosi block (Closed mouth block) Mainly Infiltration technique is used for anaesthetizing maxillary teeth (Maxillary nerve). Various approaches have their advantages and limitations. The failure rate for IANB is quite high as compared to Maxillary nerve infiltration. Clinicians have consistently sought an anesthetic alternative, which can increase success rates well below one hundred percent in the posterior mandible in particular. Therefore, during the treatment of the nerve block, dentists should therefore choose the highly appropriate technique with patient interest. Foregoing in view, the purpose of this review was to assess the anesthetic efficacy of the IANB and GGMNB in patients with symptomatic irreversible pulpitis. Objectives: • To systematically review researches on the anesthetic efficacy of GGMNB versus IANB for irreversible pulpitis. • To compare the outcomes of GGMNB and IANB for irreversible pulpitis. Methodology: It was a descriptive systematic review of quantitative researches wherein the “Preferred Reporting Items for Systematic Reviews (PRISMA)” was adopted, which ensured clarity in selection process of shortlisted paper and facilitated comprehensive approach to compose systematic review. PICO criteria, clearly identifying population (P), Intervention (I), Comparison (C),and Outcome (O), was used to structure the research question: “Is Gow-Gates technique (I) has better anesthetic efficacy (O) as compared to IANB (C) for patients with irreversible pulpitis (P)”? The literature search was done on PubMed/Medline, Cochrane library, Google scholar and Ovid. Selection criteria was applied for population as patients of age more than 9 years of either gender with irreversible pulpitis while including articles published in English from all around the world regarding conventional IANB or IANB & Gow-Gates techniques, and articles published between the duration of 2009-2019 as approved vide final work proposal. The prospective randomized clinical trials or randomized controlled trials were included for the review in which anesthetic efficacy or success was measured. A total of six studies on Cochrane, sixteen studies on PubMed/Medline, two on Ovid and eighty seven studies on Google scholar were primarily identified. After removal of the duplicates (n=111), preliminary screening of titles and abstracts was done, and 103 studies were excluded because they were not meeting the eligibility criteria. A total of 8 articles were selected for full‐text reading. Of these 8 studies, 3 studies were further excluded because focused question was not answered in it. At final stage, five articles were included. Results: The results of the five studies that are reviewed establish that anesthetic efficacy of Gow-Gates nerve block technique is better than IANB technique for irreversible pulpitis. However, the overall quality of the literature assessed is fair to poor. Three studies are randomized clinical trial and two randomized controlled trial. The validity and reliability of the studies included is appropriate. This is due to the appropriate study design and accuracy of the study in measuring the efficacy of the selected anesthetic techniques. Conclusion: Patients who receive either of these two mandibular nerve blocks i.e., there is a difference in the pain experienced i.e. Gow-Gates nerve block or IANB. There is evidence of a higher efficacy of the Gow-Gates technique than the IANB. Each of the two techniques is equally easy to execute with training. The value of knowing how to perform the Gow-Gates nerve block is that the Gow-Gates technique will most likely provide satisfactory anesthesia for a specific patient in situations where the IANB will not. Knowing how to perform only one method to block the inferior alveolar nerve limits the ability of the dentist to provide consistently successful anesthesia and makes it more difficult for all patients to achieve the goal of pain-free dentistry. Knowing how to perform Gow-Gates technique, on the other hand, increases the likelihood that patients may be pain-free when undergoing mandible dental procedures.Introdução: A anestesia local é um medicamento usado para induzir a perda de sensação em uma parte específica do corpo que resulta em terminações nervosas ou obstrução da função nervosa periférica. A injeção anestésica local pode não apenas gerar dor e medo, mas também ser um fator desencadeante relacionado a emergências médicas em consultórios, com síncope vasodepressora e hiperventilação como principais reações psicogênicas. Várias técnicas utilizadas para os dentes inferiores do Bloqueio do nervo alveolar inferior (BNAI) são: • BNAI convencional • bloqueio do nervo mandibular de Gow-Gates (BNMGG) • Bloqueio de Vazirani / Akinosi (bloqueio de boca fechada) Principalmente a técnica de infiltração é usada para anestesiar os dentes superiores (nervo maxilar). Várias abordagens têm suas vantagens e limitações. A taxa de falha do BNAI é bastante alta quando comparada à infiltração do nervo maxilar. Os médicos sempre procuraram uma alternativa anestésica, que pode aumentar as taxas de sucesso bem abaixo de cem por cento na mandíbula posterior, em particular. Portanto, durante o tratamento do bloqueio nervoso, os dentistas devem, portanto, escolher a técnica altamente apropriada do interesse do paciente. Diante do exposto, o objetivo desta revisão foi avaliar a eficácia anestésica do BNAI e BNMGG em pacientes com pulpite irreversível sintomática. Objetivos. • Revisar sistematicamente pesquisas sobre a eficácia anestésica do BNMGG versus BNAI para pulpite irreversível. • Comparar os resultados de BNMGG e BNAI para pulpite irreversível. Metodologia: Foi uma revisão sistemática descritiva de pesquisas quantitativas em que foram adotados os “Itens de Relatórios Preferidos para Revisões Sistemáticas (PRISMA)”, o que garantiu clareza no processo de seleção de artigos selecionados e facilitou a abordagem abrangente para compor a revisão sistemática. Os critérios do PICO, identificando claramente população (P), Intervenção (I), Comparação (C) e Resultado (O), foram utilizados para estruturar a questão de pesquisa: “A técnica de Gow-Gates (I) tem melhor eficácia anestésica (O) comparado ao IANB (C) para pacientes com pulpite irreversível (P) ”? A pesquisa bibliográfica foi realizada na PubMed / Medline, biblioteca Cochrane, Google scholar e Ovid. Os critérios de seleção foram aplicados para a população com idade superior a 9 anos, de ambos os sexos, com pulpite irreversível, incluindo artigos publicados em inglês sobre as técnicas convencionais BNAI ou BNAI & Gow-Gates e artigos publicados entre 2009 -2019. Os ensaios clínicos randomizados prospectivos ou ensaios clínicos randomizados controlados foram incluídos na revisão em que a eficácia ou o sucesso anestésico foi medido. Um total de seis estudos na Cochrane, dezesseis estudos na PubMed / Medline, dois no Ovid e oitenta e sete estudos no Google scholar foram identificados principalmente. Após a remoção das duplicatas (n = 111), foi realizada triagem preliminar de títulos e resumos, e 103 estudos foram excluídos por não atenderem aos critérios de elegibilidade. Um total de 8 artigos foram selecionados para leitura em texto completo. Desses 8 estudos, 3 estudos foram mais excluídos a posterior porque a pergunta focalizada não foi respondida. Na fase final, cinco artigos foram incluídos. Resultado: Os resultados dos cinco estudos revisados estabelecem que a eficácia anestésica da técnica de bloqueio nervoso de Gow-Gates é melhor que a técnica BNAI para pulpite irreversível. No entanto, a qualidade geral da literatura avaliada é justa a ruim. Três estudos são ensaios clínicos randomizados e dois ensaios clínicos randomizados. A validade e a confiabilidade dos estudos incluídos são adequadas. Isso se deve ao desenho e à precisão adequados do estudo na medição da eficácia das técnicas anestésicas selecionadas. Conclusão: Pacientes que firam submetidos as duas técnicas de bloqueio do nervo mandibular, revelaiam uma diferença na dor experimentada, ou seja, bloqueio do nervo Gow-Gates ou BNMGG. Há evidências de uma maior eficácia da técnica de Gow-Gates do que a BNAI. Cada uma das duas técnicas é igualmente fácil de executar com treino. O valor de saber como executar o bloqueio nervoso de Gow-Gates é que esta técnica provavelmente fornecerá anestesia satisfatória para um paciente específico em situações em que a BNAI não o fará. Saber executar apenas um método para bloquear o nervo alveolar inferior limita a capacidade do medico dentista fornecer anestesia com sucesso consistente e torna mais difícil para todos os pacientes alcançar o objetivo da saude oral sem dor. Saber executar a técnica de Gow-Gates, por outro lado, aumenta a probabilidade de os pacientes sentirem-se livres de dor ao serem submetidos a procedimentos dentários mandibulares

What is the Power of Identity? Examining the Moderating Role of Racial Identity Latent Profiles on the Relationship between Race-Related Stress and Trauma Symptomatology among African American Women

The current study investigated the relationship between race-related stress and trauma symptomatology, and the potential for racial identity profiles to mitigate or exacerbate this relationship in a nontreatment-seeking sample of trauma-exposed African American women (N = 222). Bivariate correlation analyses revealed race-related stress was significantly and positively correlated with total PTSD symptoms, hyperarousal symptoms, avoidance symptoms, and reexperiencing symptoms. Racial identity profiles emerged from latent profile analyses and supported a 3-class solution: Undifferentiated, Detached, and Nationalist. The Nationalist profile group experienced significantly higher race-related stress compared to the Detached and Undifferentiated profiles. Moderation analyses revealed racial identity profile type significantly moderated the relationship between race-related stress and total PTSD symptoms and each symptom group, and that the Nationalist profile group buffered the effects of race-related stress on PTSD symptoms. This study illustrates the ways stress from racial discrimination influences PTSD symptomatology and how racial identity may mitigate this relationship

Is Academic Procrastination Still a Problem among Junior High School? The Investigation of Academic Self-Efficacy and Parental Support as Predictor

This research is motivated by the still high incidence of academic procrastination among junior high school students. The purpose of this research is to examine whether academic self-efficacy and parental support contribute to students' academic procrastination. This research used a cross-sectional design, with a sample of 250 students selected through proportional stratified random sampling. The research instruments used included measurements of academic self-efficacy, parental support, and academic procrastination. Data were analyzed using multiple regression with the help of SPSS version 25.00. Research findings show that academic self-efficacy contributes negatively to academic procrastination (standardized beta = -.613, sig = .000), and parental support also shows a significant contribution (standardized beta = -.215, sig = .000). The implications of this research highlight the need to increase students' self-efficacy and parental support through a series of psychological interventions to reduce cases of academic procrastination among students.

The Role of Vitamin D Receptors in Gastric epithelial Homeostasis

The gastric epithelium consists of different types of cells, which are involved in gastric homeostasis by balancing cell proliferation and differentiation. This process involves several signaling molecules such as growth factors, hormones and vitamins. Vitamin D3 (VD3) is engaged in several biological activities. It plays a role in cell differentiation, cell proliferation, immune response and also regulates calcium homeostasis. The biological activities of VD3 are mediated by vitamin D receptor (VDR). Target tissues of VD3 in the gastrointestinal tract were identified earlier in intestine, colon and gastric cancer tissues; however, the normal expression of VDR in stomach is poorly studied. So, the main objectives of this thesis are: 1) to investigate the normal expression, distribution and cellular localization of VDR in gastric epithelium and 2) to study possible role of VDR and VD3 in maintaining gastric stem cells proliferation and differentiation by establishing and analyzing mouse model deficient in VD3. Polymerase chain reaction (PCR) analysis showed that VDR as well as enzymes involved in VD3 metabolism are expressed in the different region of normal mouse stomach. Co-immunostaining analysis showed specific expression of VDR in the acid secreting parietal cells and the different mucus secreting cells. The results suggested that parietal cells and mucous cells are targets for VD3 signaling. To examine the role of VD3 on gastric homeostasis, wild type mice were put on VD3 deficient diet for 3 months. Using Real-Time Polymerase Chain Reaction (Real-Time PCR), stomachs of mice deficient of vitamin D showed significant decrease in expression of parietal cell specific genes (HKα and HKβ) and increase gastrin gene expression. Moreover, quantification for cells in the S-phase of the cell cycle showed significant increase in their number in vitamin D deficient mice compared to controls. Gene expression analysis of VDR signaling genes showed significant decrease in PTHLH, but not other target genes like TRPV6 and p21. This work will add value to the field of stomach biology by providing better understanding of how VD3 and VDR are involved in maintaining gastric epithelial homeostasis and how that is related to some stomach conditions such as low gastric acidity and gastric cancer