• 대한소아치과학회지
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• 제47권2호
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• pp.99-108
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• 2020

이 연구의 목적은 어린이의 구강내 국소마취시 통증을 줄이기 위한 방법으로 고안된 2-단계 자입법(2-step needle insertion technique)의 효과를 평가하기 위하여, 어린이 환자의 구강 내에 양측성으로 국소마취를 시행하고 마취시 느끼는 통증의 정도를 pain scale을 이용, 측정하여 통상적인 자입법(Conventional needle insertion technique)과 비교하는 것이다. 통상적인 자입법과 2-단계 자입법에 의해 어린이가 느낀 통증 점수는 각각 5.82 ± 2.14 and 2.57 ± 2.09로 통계적으로 유의한 차이를 보였다(p < 0.001). 성별, 연령, 그리고 Frankl의 행동평가척도에 따른 두 방법 간의 주관적인 통증의 정도는 2-단계 자입법에서 훨씬 작았다(p < 0.001). 부위별 마취법에 따른 주관적인 통증의 정도는 상악과 하악, 전치부와 구치부 등 모든 부위에서 2-단계 자입법으로 마취하는 동안의 통증이 더 작게 나타났다(p < 0.001). 2-단계 자입법은 치과치료에 긍정적인 태도를 가지는 어린이 뿐만 아니라 부정적인 태도를 가진 어린이 환자들에서도 국소마취시 통증을 감소시킬 수 있는 간단하고 효과적인 방법이며, 도포마취제의 적용이나 주의분산 등과 함께 병용한다면 통증을 더 효과적으로 감소시킬 수 있을 것으로 사료된다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제19권2호
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• pp.101-109
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• 2019

Background: The purpose of this study was to compare the pain perception and anesthetic efficacy of 2% lignocaine with 1:200,000 epinephrine, buffered lignocaine, and 4% articaine with 1:200,000 epinephrine for the inferior alveolar nerve block. Methods: This was a double-blind crossover study involving 48 children aged 5-10 years, who received three inferior alveolar nerve block injections in three appointments scheduled one week apart from the next. Pain on injection was assessed using the Wong-Baker Faces pain scale and the sound eye motor scale (SEM). Efficacy of anesthesia was assessed by subjective (tingling or numbness of the lip, tongue, and corner of mouth) and objective signs (pain on probing). Results: Pain perception on injection assessed with Wong-Baker scale was significantly different between buffered lignocaine and lignocaine (P < 0.001) and between buffered lignocaine and articaine (P = 0.041). The onset of anesthesia was lowest for buffered lignocaine, with a statistically significant difference between buffered lignocaine and lignocaine (P < 0.001). Moreover, the efficacy of local analgesia assessed using objective signs was significantly different between buffered lignocaine and lignocaine (P < 0.001) and between lignocaine and articaine. Conclusion: Buffered lignocaine was the least painful and the most efficacious anesthetic agent during the inferior alveolar nerve block injection in 5-10-year-old patients.

• Journal of Dental Anesthesia and Pain Medicine
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• 제18권4호
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• pp.223-233
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• 2018

Topical anesthetics are commonly used in oral & maxillofacial surgery to control pain in the oral cavity mucosa before local anesthetic injection. These anesthetic agents come in many forms, developed for different usages, to minimize adverse reactions, and for optimal anesthetic efficiency. Earlier studies have revealed that these agents may also limit the growth of microorganisms in the area of anesthetic application. Many topical anesthetic agents show different levels of antimicrobial activity against various bacterial strains and Candida. The dosage of local anesthetic agent used in some clinical preparations is too low to show a significant effect on microbial activity. Efficiency of antimicrobial activity depends on the local anesthetic agent's properties of diffusion within the bloodstream and binding efficiency with cytoplasmic membrane, which is followed by disruption of the bacterial cell membrane. The antimicrobial properties of these agents may extend their usage in patients to both control pain and infection. To develop the topical local anesthetic optimal usage and antimicrobial effect, a collaborating antiseptic agent may be used to benefit the local anesthetic. However, more research is required regarding minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of topical local anesthetic agents with drug interaction between anesthetics and antiseptic agents.

• Journal of Dental Anesthesia and Pain Medicine
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• 제20권4호
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• pp.213-221
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• 2020

Background: Complications following impacted third molar surgery significantly affect patients' quality of life during the immediate postoperative period. This study aimed to achieve the proper anesthesia method by comparing the effect of the application of lidocaine alone with the application of lidocaine and articaine simultaneously in reducing the complications during and following impacted mandibular third molar surgery. Methods: The study design was a split-mouth double-blind randomized clinical trial. The study was conducted on 13 patients (26 samples) referred for elective surgical removal of bilateral impacted mandibular third molar with similar difficulty on both sides. Each patient underwent similar surgical procedures on two separate appointments. Each patient randomly received 2% lidocaine for conventional inferior alveolar nerve block and 4% articaine for local infiltration before the surgery on one side (group A) and 2% lidocaine alone (for both block anesthesia and infiltration) before the surgery on the other side (group B). Intraoperative and postoperative variables for both groups were established and statistically analyzed. Results: The findings showed that pain on the first day after surgery in group A was significantly lower than that in group B. The patients in group A mentioned experiencing less discomfort following the surgery. The increased horizontal swelling on the first and third days following surgery and oblique swelling on the seventh day in patients in group B were statistically significant. Conclusion: Choosing an appropriate anesthetic drug for oral surgery, specifically impacted third molar surgery, is dependent on the clinician's opinion, however; it seems that the combination of lidocaine and articaine may control the patient's pain significantly better than lidocaine alone.

• Journal of Dental Anesthesia and Pain Medicine
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• 제23권3호
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• pp.135-141
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• 2023

Background: The limited studies on the effect of buffering on the clinical efficacy of articaine have reported controversial results. The purpose of this study was to clinically compare the pain of injection, anesthetic success, onset, and duration of pulpal anesthesia of buffered 4% articaine with epinephrine 1:100000 versus a non-buffered 4% articaine with epinephrine 1:100000 formulation for buccal infiltration of the mandibular first molar. Methods: Sixty-three volunteers were enrolled in the study. All volunteers received two injections consisting of a single mandibular first molar buccal infiltration with 1.8 ml of 4% articaine with epinephrine 1:100000 and 1.8 ml of 4% articaine with epinephrine 1:100000 buffered with 8.4% sodium bicarbonate. The infiltrations were applied in two separate appointments spaced at least one week apart. After injection of the anesthetic solution at the examined site, the first molar was pulp-tested every 2 min for the next 60 min. Results: Successful pulpal anesthesia was recorded in 69.8% of cases using non-buffered articaine solution and 76.2% of cases using buffered articaine solution, with no significant difference between the formulations (P = 0.219). The mean time of anesthesia onset for the volunteers with successful anesthetic outcome in both formulations (n = 43) was 6.6 ± 1.6 min for the non-buffered articaine solution and 4.5 ± 1.6 min for the buffered solution, which differed significantly (P = 0.001). In the same volunteers, the mean duration of pulpal anesthesia was 28.4 ± 7.1 min for non-buffered articaine solution and 30.2 ± 8.5 min for buffered articaine solution, with no significant difference between the formulations (P = 0.231). Considering the pain of injection, regardless of the anesthetic success, the mean values of VAS were 11.3 ± 8.2 mm for the non-buffered articaine solution and 7.8 ±6.5 mm for the buffered articaine solution, which differed significantly (P = 0.001 < 0.05). Conclusion: According to the present study, 4% articaine with epinephrine can benefit from buffering and provide better anesthetic behavior, with improved onset and less pain during injection.

• Journal of Dental Anesthesia and Pain Medicine
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• 제22권1호
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• pp.11-18
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• 2022

Background: The vasoconstrictive effect of epinephrine in local anesthetics affects the heart, which leads to hesitation among dentists in injecting local anesthetics into patients with cardiovascular disease. Due to its vasoconstrictive effects, the present study investigated the effects of vasopressin administration on cardiac function in rats. Methods: Experiment 1 aimed to determine the vasopressin concentration that could affect cardiac function. An arterial catheter was inserted into the male Wistar rats. Next, 0.03, 0.3, and 3.0 U/mL arginine vasopressin (AVP) (0.03V, 0.3V, and 3.0V) was injected into the tongue, and the blood pressure was measured. The control group received normal saline only. In Experiment 2, following anesthesia infiltration, a pressure-volume catheter was placed in the left ventricle. Baseline values of end-systolic elastance, end-diastolic volume, end-systolic pressure, stroke work, stroke volume, and end-systolic elastance were recorded. Next, normal saline and 3.0V AVP were injected into the tongue to measure their effect on hemodynamic and cardiac function. Results: After 3.0V administration, systolic blood pressures at 10 and 15 min were higher than those of the control group; they increased at 10 min compared with those at baseline. The diastolic blood pressures at 5-15 min were higher than those of the control group; they increased at 5 and 10 min compared with those at baseline. The preload decreased at 5 and 10 min compared to that at baseline. However, the afterload increased from 5 to 15 min compared with that of the control group; it increased at 10 min compared with that at baseline. Stroke volume decreased at 10 and 15 min compared with that of the control group; it decreased from 5 to 15 min compared with that at baseline. Stroke work decreased from 5 to 15 min compared with that of the control group; it decreased from 5 to 15 min compared with that at baseline. Conclusion: Our results showed that 3.0 U/mL concentration of vasopressin resulted in increased blood pressure, decreased stroke volume and stoke work, decreased preload and increased afterload, without any effect on myocardial contractility.

• 대한장애인치과학회지
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• 제4권1호
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• pp.7-11
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• 2008

치과의사는 혈우병 환자의 치료 시 주의사항에 대해 잘 알고 있어야 한다. 혈우병 환자의 내원 시 소아과 의사 및 혈우재단 등 전문가에게 의뢰하여 환자의 상태에 대한 자문을 얻어야 하고, 치과 치료 시 적절한 계획 하에 최소의 침습적인 치료가 행해지도록 노력해야 하며, 응급 상황을 대비하여 지혈방법을 습득해야 한다. 또 환자와 보호자에게 평소 구강 관리의 중요성을 일깨워 침습적 치과 치료의 빈도를 줄일 수 있도록 해야 한다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제24권1호
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• pp.37-45
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• 2024

Background: The delivery of profound local anesthetics helps children receive successful treatment by reducing fear, anxiety, and discomfort during dental procedures. Local anesthetic injections are the most anticipated stimuli in dental surgery. Children's perceptions of pain can be altered by applying cryotherapy to precool the oral mucosa or by diverting their minds through taste distractions before administering local anesthetic injections. This study aimed to evaluate the efficacy of cryoanesthesia and xylitol sweet-tasting solution at the injection site in 7-10-year-old children. Methods: A total of 42 participants, aged 7-10 years, who underwent dental treatment requiring local anesthesia, were enrolled in the study. The children were randomly divided into three groups. In group I, sterile water was held in the mouth for 2 minutes before anesthetic administration, similar to group II, and in group III, a xylitol sweet-tasting solution was used for 2 minutes before needle insertion. The analysis of pain perception was carried out based on the Visual Analog Scale (VAS) and the Sound, Eyes, and Motor (SEM) scale. For VAS analysis, a one-way analysis of variance (ANOVA) was performed for intergroup comparison, and a post hoc Tukey test was performed for subgroup analysis. For the categorical SEM scale, the Kruskal-Wallis test followed by the post hoc test was performed for intergroup comparison. Where a P value of <0.05 was considered statistically significant at 95% confidence intervals. Results: Cryoanesthesia significantly reduced pain scores on VAS (4.21 ± 1.42) when compared to those on VAS with xylitol sweet-tasting solution (5.50 ± 1.40) and that with sterile water (6.14 ± 2.47). Intergroup comparison of the VAS scores among the three groups was performed using one-way ANOVA, which demonstrated statistically significant differences (P value <0.026) on the VAS scale. Intergroup comparison of the SEM scale was performed using the Kruskal-Wallis test, followed by post hoc comparison, which exhibited statistically significant differences (P < 0.007) among the three groups for the SEM scale. Conclusion: Cryoanesthesia demonstrated higher efficacy in reducing injection pain than that exhibited by the xylitol sweet-tasting solution.

• Journal of Dental Anesthesia and Pain Medicine
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• 제20권6호
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• pp.367-375
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• 2020

Background: Intraosseous anesthesia (IO) allows the anesthetic solution to be injected directly into the cancellous bone. The anesthetic solution immediately reaches the periapical region, and thus the axonal area of the nerve, where it can temporarily disable the sodium pump. The effect is felt almost without any time delay, and only a small amount of anesthetic solution is required. Methods: This study aims to investigate the efficacy of IO using the AnestoⓇ device after infiltration anesthesia (IA) and/or inferior alveolar nerve block anesthesia (IANB) failed to work in symptomatic irreversible pulpitis (hot tooth). The 33 patients included in the study were treated additionally with 1.7 ml articaine hydrochloride with 1:100,000 epinephrine hydrochloride (UltracainⓇ D-S, Sanofi-Aventis, Frankfurt, Germany) IO. Results: The electrical pulp test showed that 95.76% of the volunteers reacted positively to the combination of IANB or IA with the IO. In women, the additive IO was effective at 97.22%. In men, the IO led to pain elimination in 94.00% of cases. The duration of the IO was less than a quarter of an hour (13.03 min). The IO worked longer in women than in men (13.61 min vs. 12.33 min). Overall, more than every third tooth that needed trepanation was located in the posterior area of the mandible (36.4%). Treatment of hot teeth in this area was associated with an increased pulse rate and increased residual pain. There was a moderate correlation (Spearman-Rho [IRI] = 0.280) between the Visual Analog Scale (VAS) score and bone density, and a significant correlation (IRI = 0.612) between subjective residual pain and bone width. The IO resulted in a moderate, transient increase in the pulse rate by approximately 20 bpm. This is similar to the temporary increase in heart rate after conventional anesthesia techniques in non-preloaded patients and can be considered clinically irrelevant. Conclusion: IO with the AnestoⓇ device as an extension and deepening of local pain elimination is recommended for the treatment of hot teeth.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제39권5호
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• pp.251-253
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• 2013

Inferior alveolar nerve block obtained maximum anesthetic effect using a small dose of local anesthetic agent, which also has low a complication incidence. Complications of an inferior alveolar nerve block include direct nerve damage, bleeding, trismus, temporary facial nerve palsy, and etc. Among them, the major iatrogenic complication is dental needle fracture. A fragment that disappears into the soft tissue would be hard to remove, giving rise to a legal problem. A 31-year-old woman was referred for the removal of a broken needle, following an inferior alveolar nerve block. Management involved the removal of the needle under local anesthesia with pre- and peri-operative computed tomography scans.