Dental Local Anesthesia

Mandibular infiltration has been routinely avoided in treating mandibular molars because of its questionable adequacy. The purpose of our investigation was to determine the effectiveness of mandibular infiltration compared with mandibular block in treating primary molars in children, and to relate the effectiveness to age and type of treatment performed. The study population consisted of 89 cooperative children, 3 to 9 years old, requiring the same type of treatment on contralateral mandibular molars. The half-mouth study design was used. Dental procedures included class I and II amalgam restorations, stainless steel crowns, formocresol pulpotomies, and extractions. Evaluations of pain and behavior for each anesthesia technique and type of treatment were made using sounds, motor, and ocular changes indicating pain and the Frankl Behavior Rating Scale. Evaluations were made upon probing, rubber dam placement, and during tooth preparation and extraction. No statistically significant d...

Fibroadenomas commonly found by palpation and routine mammography account for approximately 20% of open surgical breast biopsies. Alternatives to open surgery include tumor removal using an automated coring device and tumor ablation using heating or cooling elements. We report our initial experience with cryoablation of biopsy-proven benign fibroadenomas. A table-top cryoablation system employing a 2.4-mm cryoprobe was used to treat biopsy-proven benign fibroadenomas up to 4 cm in maximum diameter in a prospective nonrandomized fashion. The cryoprobe was placed under ultrasound guidance. Using a treatment algorithm based on fibroadenoma size, all tumors were subjected to two freeze cycles with an interposing thaw. Skin appearance and temperature, probe temperature, iceball size, and patient comfort were closely monitored during the procedure. Follow-up examinations including ultrasonography and photographs were scheduled for up to 12 months postablation. Fifty patients with 57 core biopsy-proven benign fibroadenomas were treated. Seven early cases were treated in an ambulatory surgery center setting. The remaining procedures were completely office-based using only local anesthetic. Tumor diameter varied from 7 mm to 42 mm (mean 21 mm). The iceball engulfed the target lesion in each case. Transient postoperative side effects were local swelling and ecchymosis. Postoperative discomfort rarely required medication beyond acetaminophen or ibuprofen. Lesions showed progressive shrinkage and disappearance over 3 to 12 months. No skin injury was noted and appearance remained excellent. Patient satisfaction was excellent. With office-based use of ultrasound-guided cryoablation for fibroadenomas there was little or no pain, target lesions were reduced in size or eliminated, scarring was minimal, cosmesis outstanding, and patient satisfaction was excellent. Cryoablation offers a useful office-based alternative to surgical excision of benign fibroadenomas.

Introduction: Accessory innervation (AI) may account for the persistent sensation perceived after successful mandibular anesthesia in the adult patient. The purpose of this systematic review was to record the quality of evidence pertaining to the cervical plexus (CP) AI in dental anesthesia. Materials and methods: Electronic and manual searches were conducted using Ovid and Medline of articles published from 1922 to March of 2015. Studies written in any language were included as long as they involved: (i) humans, animals, and/or cadavers AND (ii) anatomical and/or research anesthetic-technique approaches and/or clinical approaches. Exclusion criteria were (i) maxillary buccal infiltration, (ii) no abstract/paper available, (iii) studies that do not comprise the description of the branches of the CP branches in dentistry and (iv) duplicated articles. The articles were reviewed and graded by levels of evidence (LOE) through a methodological scoring index (MSI). Results: Forty-four out of 185 papers fulfilled the inclusion criteria. One randomized control trial, 3 comprehensive reviews, 1 cohort study, 5 case series/reports, 16 poor-quality cohort and case series/ reports and 18 reviews/case, reports/expert opinions were found. Of the 44 publications, there were 4 LOE 1, 1 LOE 2, 5 LOE 3, 20 LOE 4 and 14 LOE 5 studies. Conclusions: The MSI helped to classify papers LOE in a standardized and objective approach. The objective evidence quality occurrence recorded was found to be LOE 4 (n = 20) N LOE 5 (n = 14) N LOE 3 (n = 5) N LOE 1 (n = 4) N LOE 2 (n = 1). The anatomy of the CP needs to be reexamined and understood in the anatomical literature.

We compared the efficacy and safety of ultrasound-guided haematoma block with that of procedural sedation and analgesia in patients with acute distal radial fracture reduction pain control. This was a randomised clinical trial on adult patients conducted in two teaching hospitals. Patients received intravenous midazolam plus fentanyl in the procedural sedation and analgesia group, and fracture site injection of lidocaine 10% in the ultrasound guided haematoma block group. We measured pain scores before reduction, during reduction and 5, 10 and 15 min after reduction by a numeric rating scale, and patient and physician satisfaction by a four-level Likert scale. Time to discharge, early adverse effects and late complications were also compared. We enrolled 160 patients with distal radial fracture and randomised 143 patients into two groups (after excluding 17 patients). Pain was effectively controlled in both groups. Pain scores had no statistically significant difference before and d...

Nitrous oxide (N2O) has become a routine intervention in contemporary American dental practice, especially in the management of children. However, routines translate to confidence which in turn may lead to overconfidence, such that possible risks and misuses are insufficiently acknowledged. This article ethically evaluates the use of nitrous oxide as a practice routine in treating children. Nitrous oxide administration is analyzed in reference to three internationally acknowledged principles of dental ethics: nonmaleficence, beneficence, and patient autonomy. In reference to the principle of nonmaleficence, the potential for adverse effects of N2O is discussed, particularly when it is administered in conjunction with other sedatives and anesthetics. The importance of abiding by clinical protocols is emphasized. Next, in reference to the principle of beneficence, the authors address the problematic application of N2O for the benefit of individuals other than the patient (e.g., dentis...

To report ocular perforation that occurred during retrobulbar injection in 7 highly myopic eyes. Seven patients with a diagnosis of globe injury during retrobulbar injection for ocular anesthesia before cataract surgery were managed by vitreoretinal surgery. All injections were performed by ophthalmologists. The surgeon recognized the perforation in 4 cases at the time of injection. The preoperative vision was hand motion perception in 4 eyes and light perception in 3 eyes. All patients underwent vitreoretinal surgery because of the presence of vitreous hemorrhage and/or retinal detachment diagnosed by funduscopy or ultrasonography. At the time of surgery, all eyes had vitreous hemorrhage and 4 eyes had rhegmatogenous retinal detachment. The number of vitreoretinal procedures performed was: 1 procedure in 4 patients, 2 procedures in 2 patients, and 3 procedures in 1 patient. The period of follow-up ranged from 4 months to 4 years, averaging 20 months. At the end of the follow-up per...

Despite the voluminous literature addressing the safety and efficacy of various sedative agents in the pediatric dental setting, the quality literature to form evidence based pediatric dental sedation practice is not available. Our search through PUBMED showed that during 1985-2012, a total of 184 original research papers on pediatric dental sedation were reported, and midazolam clearly dominated with 88 trials on this agent. Despite these large numbers of papers, Cochrane Review was able to pool a weak evidence in favor of midazolam. Data pooling from five heterogeneous high risk of bias trials showed that oral midazolam is associated with more cooperative behavior when compared to a placebo. Further, a very weak evidence regarding efficacy of nitrous oxide was collected from two trials, which could not be pooled. These findings draw attention to the need to address the shortcomings in the current state of pediatric dental sedation research. The present article has been focused on ...

Background Conscious sedation using monitored anesthesia care can provide a clinical spectrum from relaxation to moderate anesthesia. This middle ground between general anesthesia and “pure” tumescent liposuction can help facilitate patient comfort and surgical proficiency during the procedure. Objective To describe a method of liposuction surgery with monitored anesthesia care in which a designated licensed and qualified individual is responsible for administration of supplemental intravenous conscious sedation as well as continuous monitoring of the patient. Methods Conscious sedation is induced with midazolam, and the patient is titrated to level II-V on the Ramsey sedation scale with propofol. The basic surgical technique is that of tumescent liposuction. However, the supplemental conscious sedation allows the tumescent fluid to be infiltrated at higher rates and fat extraction to be completed in a shorter period with minimal or no discomfort. Results In the authors’ experience with more than 5,000 cases of liposuction surgery using this method, safety and efficacy have been proved. No patients have experienced significant adverse effects. Conclusion Tumescent liposuction surgery with monitored anesthesia care provides a middle ground between general anesthesia and purely tumescent liposuction.

BACKGROUND Nonablative fractional photothermolysis has revolutionized the way we treat a number of common skin conditions with laser technology.OBJECTIVE A comprehensive guide is needed for clinicians using this technology to treat specific skin conditions in various skin types.MATERIALS AND METHODS Recommendations were made from a recent round table discussion among experienced physicians and a review of recent literature findings.RESULTS Optimal laser parameters are dependent on patient skin type and condition. We recommended guidelines for the successful treatment of several common skin conditions on and off the face using nonablative fractional photothermolysis. Specific conditions were dyschromia, rhytides, acne scars, surgical scars, melasma, and striae distensae.CONCLUSIONS We developed reproducible guidelines to most effectively treat a variety of skin types and conditions using nonablative fractional photothermolysis. Future large, multicenter trials are indicated for further optimization of treatment parameters.Reliant Technologies paid travel expenses and honorariums to all authors.