Local anesthetics, the most used drugs in dentistry, are
the safest & most effective drugs for the prevention and management of pain.
However the act of receiving an injection – the ‘shot’ – is the most
fear-inducing part of the dental experience for most patients. 75% of all dental
office medical emergencies are ‘stress’ related and therefore preventable in
most situations. Techniques of managing fear including inhalation and oral
sedation are reviewed. The pain reaction threshold (PRT) is introduced followed
by a discussion of the effect of various clinical situations, e.g. pain,
infection and fear, on the PRT. The currently available (in North America) local
anesthetic formulations are discussed with an emphasis on their expected
duration of clinical action.
This program reviews the development of local anesthetics and the drug
formulations that are currently available in dentistry. The effect of fear &
anxiety on local anesthetic effectiveness is discussed along with an
introduction to sedation – a very important ally in the quest for effective pain
control.
The basic armamentarium for the administration of local anesthetics includes
the syringe, cartridge and needle. Proper assembly and use of these items
minimizes the risk of complications arising during injection, such as shattering
of cartridges and needle breakage. Prior to the administration of drugs the
doctor is expected to have knowledge of the health status of the patient
receiving the injection. The medical history questionnaire is reviewed with an
emphasis on local anesthetic-related concerns. As the delivery of ‘painless’
injections is foremost on the patient’s list of dental desires, the basic local
anesthetic injection technique is reviewed.
The basic armamentarium for local anesthetic delivery – the syringe,
cartridge and needle – is reviewed in this program along with evaluation of the
patient prior to receiving an injection. A step-by-step review of the basic
local anesthetic injection technique is provided.
Local anesthetic techniques providing pain control in
the maxillary arch are described in this program following a review of the
anatomy of the trigeminal nerve. Techniques include infiltration
(supraperiosteal), anterior superior alveolar nerve block; middle superior
alveolar nerve block; posterior superior alveolar nerve block; anterior superior
alveolar nerve block; and palatal injection techniques.
Techniques of anesthesia in the mandible are reviewed in
this program, including the traditional inferior alveolar, Gow-Gates,
Vazirani-Akinosi, and incisive nerve blocks as well as several non-traditional
injection techniques including the periodontal ligament injection, intraosseous
anesthesia and the administration of the local anesthetic articaine HCl by
mandibular infiltration in adult
patients.
Complications associated with local anesthetic
administration are rare. This program discusses complications occurring
in and around the site of local anesthetic drug
administration - facial nerve paralysis, hematoma, paresthesia, trismus
and needle breakage, their prevention, recognition and management as well
as the two systemic adverse drug reactions –
allergy and overdose – are reviewed as each relates to the
administration of local anesthetic
drugs.
Articaine HCl was introduced in the USA in 2000 and has become a very popular
anesthetic agent. Though classified as an amide local anesthetic it is actually
a hybrid molecule, possessing both ester and amide characteristics. With
epinephrine, articaine provides approximately 60 minutes of pulpal anesthesia
and between 3 to 5 hours of soft tissue anesthesia. Its unique molecular
characteristics make articaine a preferred anesthetic in the pregnant and the
nursing patient as well as the lighter weight (<30kg) pediatric patient.
However, articaine is used as a 4% solution and there has been some concern
about the possibility of 4% anesthetics possessing a greater risk of producing
paresthesia than local anesthetics used in lesser concentrations.
This program provides an in-depth look at articaine, its advantages and
disadvantages when compared with other commonly used dental local anesthetics.
We also discuss the ‘controversy’ alleging an increased risk of paresthesia
following administration of 4% local anesthetics.
Though local anesthetics are safe and effective, considerable research is
on-going to make them even more effective. Computer-controlled local anesthetic
delivery systems (C-CLAD) and buffered local anesthetic solutions promise to
allow painless injections to be delivered to dental patients almost anywhere in
the oral cavity. Fear of injections is primarily based on the needle. The
development of an intranasal local anesthetic mist has been shown to provide
successful pulpal anesthesia of maxillary teeth – without a needle. Epinephrine
is added to injectable local anesthetics to increase their effectiveness,
duration and safety. However the duration of residual soft tissue anesthesia –
usually unnecessary and occasionally a potential danger – is extended when
epinephrine is used in the anesthetic solution. Self-inflicted soft tissue
injury is a real problem associated with this anesthesia in all patient age
groups but especially pediatric and geriatric patients. Phentolamine mesylate –
an alpha adrenergic antagonist – has been shown to significantly reduce the
duration of residual soft tissue anesthesia when administered at the conclusion
of the traumatic part of dental treatment.
Though local anesthetics are safe and effective, considerable research is
on-going to make them even more effective. Computer-controlled local anesthetic
delivery systems (C-CLAD) and buffered local anesthetic solutions promise to
allow painless injections to be delivered to dental patients almost anywhere in
the oral cavity. Fear of injections is primarily based on the needle. The
development of an intranasal local anesthetic mist has been shown to provide
successful pulpal anesthesia of maxillary teeth – without a needle. Epinephrine
is added to injectable local anesthetics to increase their effectiveness,
duration and safety. However the duration of residual soft tissue anesthesia –
usually unnecessary and occasionally a potential danger – is extended when
epinephrine is used in the anesthetic solution. Self-inflicted soft tissue
injury is a real problem associated with this anesthesia in all patient age
groups but especially pediatric and geriatric patients. Phentolamine mesylate –
an alpha adrenergic antagonist – has been shown to significantly reduce the
duration of residual soft tissue anesthesia when administered at the conclusion
of the traumatic part of dental treatment.
Articaine HCl was introduced in the USA in 2000 and has become a very popular
anesthetic agent. Though classified as an amide local anesthetic it is actually
a hybrid molecule, possessing both ester and amide characteristics. With
epinephrine, articaine provides approximately 60 minutes of pulpal anesthesia
and between 3 to 5 hours of soft tissue anesthesia. Its unique molecular
characteristics make articaine a preferred anesthetic in the pregnant and the
nursing patient as well as the lighter weight (<30kg) pediatric patient.
However, articaine is used as a 4% solution and there has been some concern
about the possibility of 4% anesthetics possessing a greater risk of producing
paresthesia than local anesthetics used in lesser concentrations.
This program provides an in-depth look at articaine, its advantages and
disadvantages when compared with other commonly used dental local anesthetics.
We also discuss the ‘controversy’ alleging an increased risk of paresthesia
following administration of 4% local anesthetics.
Complications associated with local anesthetic
administration are rare. This program discusses complications occurring
in and around the site of local anesthetic drug
administration - facial nerve paralysis, hematoma, paresthesia, trismus
and needle breakage, their prevention, recognition and management as well
as the two systemic adverse drug reactions –
allergy and overdose – are reviewed as each relates to the
administration of local anesthetic
drugs.
August 2018
Clear
aligners have become increasingly popular because of their esthetics and
comfort. The authors’ aim in this systematic review was to compare periodontal
health in patients undergoing orthodontic treatment with clear aligners with
that of those undergoing orthodontic treatment with fixed appliances. The
authors systematically searched the PubMed, Web of Science, Cochrane Library,
and Embase databases to collect related studies. After extracting data and
assessing quality, the authors performed a meta-analysis and trial sequential
analysis. The authors used the Grading of Recommendations Assessment,
Development and Evaluation system to assess the quality of the evidence.
Key Words. Gingivitis; orthodontic appliances; literature
review.
August 2018
The
aim of this study was to assess whether scores assigned to the eyes, nose,
mouth, and chin regions work as predictors of full smiling face scores. In this
cross-sectional study, the authors used the facial photographs of 86 smiling
men. Photographs yielded 5 components: 1 of the face itself and 4 subcomponents
(eyes, nose, mouth, and chin region). Raters assigned the photographs beauty
scores that the authors measured morphometrically. The authors analyzed the
predictive ability of the subcomponents against that of the full face.
August 2018
In this
systematic review, the authors aim to assess the effect of
silver diamine fluoride (SDF) in preventing and arresting caries in exposed
root surfaces of adults. Two reviewers independently searched for controlled
clinical trials with at least 12 months of follow-up, without language
or date of publication restraints, in 8 electronic databases, 5 registries
of ongoing trials, and reference lists of narrative reviews.
Key Words. Root caries; preventive dentistry; cariostatic agents; fluoride;
dental health care for aged; systematic review.
Techniques of anesthesia in the mandible are reviewed in
this program, including the traditional inferior alveolar, Gow-Gates,
Vazirani-Akinosi, and incisive nerve blocks as well as several non-traditional
injection techniques including the periodontal ligament injection, intraosseous
anesthesia and the administration of the local anesthetic articaine HCl by
mandibular infiltration in adult
patients.
November 2017 In this systematic review and metaanalysis, the authors evaluated the pain
during scaling and root planing with use of topical anesthetic versus that with
the use of injected anesthetic in adult patients. The authors searched 6
databases for randomized clinical trials in which the investigators compared the
clinical effectiveness of intrapocket and injectable anesthetics. The primary
outcome was the risk of developing pain or intensity of pain. Quality assessment
followed the guidelines from the Cochrane Collaboration’s risk-of-bias tool. The
authors performed meta-analyses on studies considered at low and unclear risk of
bias.
November 2017 This six article annual JADA supplement explores the
benefits of baking soda and oral health. This supplement has been sponsored by
Church & Dwight Co., Inc. All content has been peer reviewed by the
designated editors of The Journal of the American Dental Association (JADA). The
opinions or views expressed in this supplement are those of the authors, and do
not necessarily reflect the opinions or views of The Journal, Church &
Dwight Co., Inc., or those of the American Dental Association.
November 2017 Objectives were to determine the likelihood that a clinician accepts an
impression for a single-unit crown and document crown remake rates. The authors
developed a questionnaire that asked dentists about techniques used to fabricate
single-unit crowns. The authors showed dentists photographs of 4 impressions and
asked them to accept or reject each impression. The authors correlated answers
with dentist and practice characteristics. Other questions pertained to
laboratory use and crown remake rates.
November 2017 The authors examined the relationship between education debt and career
choice, particularly dentists’ decisions to specialize, participate in public
health insurance programs, and join dental management service organizations
(DMSOs). The authors used data from the American Dental Association 2015 office
database, which contains dentist demographic information and identifies dentists
who participate in public health insurance programs for pediatric dental care
services. The authors merged this database with the 2002-2015 American Dental
Association Survey of Dental Graduates, which contains information about
education debt, to assess the relationship between education debt and career
choices. The authors used probit and multinomial logit models to determine the
relationships among education debt, demographic characteristics, and dentist
career choices.
July 2017
Sugar-sweetened beverages (SSBs) are dietary sources of
sugar that are factors in caries development and tooth loss. Dietary sugar also
is linked to diabetes mellitus (DM). There is limited research related to SSBs
and tooth loss in people with DM. The authors investigated the association
between SSBs and tooth loss as it related to the presence or absence of DM. The
authors used a cross-sectional design with data reported by adults (18 years and
older) who responded to the 2012 Behavior Risk Factor Surveillance System
questionnaire, which was used in 18 states (N =
95,897; 14,043 who had
DM and 81,854 who did not have DM). The
authors conducted c2 and logistic regression analyses to determine associations
related to DM status.
August 2017 Except for a small increase in caries prevalence in young
children from 1999 through 2004, the prevalence of pediatric caries in the
United States has remained consistent for the past 3 decades. The authors used
data from the National Health and Nutrition Examination Survey (NHANES) (from
1999 through 2004 and from 2011 through 2014) to ascertain changes in caries
prevalence in youth aged 2 to 19 years. The authors evaluated changes in the
prevalence of caries experience, untreated caries, and severe caries (3 or more
teeth with untreated caries) in the primary, mixed, and permanent dentition
according to poverty status.
December 2017 A lesion on an
occlusal tooth surface with no cavitation and no radiographic radiolucency but
in which caries is suspected owing to surface roughness, opacities, or staining
can be defined as a suspicious occlusal carious lesion (SOCL). The authors’
objective was to quantify the characteristics of SOCLs and their relationship to
lesion depth and activity after these lesions were opened surgically.
Ninety-three dentists participated in the study. When a consenting patient had
an SOCL, information was recorded about the tooth, lesion, treatment provided,
and, if the SOCL was opened surgically, its lesion depth. The Rao-Scott
cluster-adjusted c2 test was used to evaluate associations between lesion depth
and color, roughness, patient risk, and luster.
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About ADA CE Online
ADA’s Online CE platform provides trusted education to dental professionals at your convenience. Our ever-growing catalog of clinical, practice management, and personal development education offers peer-reviewed continuing education credits to fit your resources and schedule. Credits earned through this platform are maintained for all users in an online transcript that you can access when you need your verification letters.
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