• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.2
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• pp.87-96
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• 2022

This study aimed to assess the combined use of extraoral vibratory stimulation and extraoral cooling in reducing the pain (subjective and objective) of dental local anesthesia administration in children. PubMed, Cochrane Central Register of Controlled Trials, and Ovid SP databases were searched up to July 2021. Article titles were screened and full-text evaluations of the selected articles were performed. Finally, seven studies (391 children, aged 4 - 12 years) were included in this qualitative and quantitative analysis. The pooled data determined the combined effect of extraoral vibration and extraoral cooling as a single measure. Extraoral vibration or cooling alone were not compared. The measured primary and secondary outcomes were pain perception and subjective and objective pain, respectively. When compared with the control, extraoral vibration and cooling resulted in significant differences in the mean combined data for the variables, pain perception, and pain reaction. Children's subjective pain as measured by pain scores were reduced when extraoral vibration and cooling was used during local anesthesia administration (mean difference -3.52; 95% confidence interval [-5.06 - 1.98]) and objective pain (mean difference -1.46; 95% confidence interval [-2.95 - 0.02] ; mean difference -1.93; 95% confidence interval [-3.72 - 0.14]). Within the confines of this systematic review, there is low-quality evidence to support the use of combined extraoral vibration and cooling for reducing pain (subjective and objective) during intraoral local anesthesia administration in children.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.6
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• pp.357-365
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• 2020

Background: To evaluate the effectiveness of vibration as a counter-stimulatory measure in reducing subjective pain due to local anesthesia administration in children. Methods: Electronic databases (PubMed, Ovid SP, Cochrane Central Register of Controlled Trials) were searched until April 2020. Studies were screened by titles and abstracts, followed by full text evaluation of the included studies. Results: A total of seven studies involving 376 children aged 5-17 years were included in the systematic review and meta-analysis. The meta-analysis compared vibration as a counter-stimulatory measure with no vibration as a comparator. The primary outcome evaluated was pain perception or subjective pain reported by the child. The secondary outcome evaluated was objective pain evaluated in each study. The pooled mean difference favored vibration to be effective for the first outcome. Conclusion: Within the limits of this systematic review, low quality evidence suggests that vibration as a counter-stimulatory measure is effective in reducing the subjective pain reported by children during local anesthesia administration.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.1
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• pp.41-47
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• 2021

Background: This study was designed to compare the efficacy of DentalVibe against 2% lidocaine gel in reducing pain during the administration of local anesthetic injection in the adult population. Methods: This was a split-mouth open-label, randomized, controlled clinical study conducted in the Department of Oral and Maxillofacial Surgery of a dental institute. Fifty patients who were scheduled for bilateral dental extractions requiring an inferior alveolar nerve block were enrolled in the study. Site A (n = 50) was coated with 2% lidocaine gel followed by a local anesthetic injection, and DentalVibe with local anesthetic injection was used for Site B (n = 50). The primary outcome was pain, which was recorded immediately after the administration of anesthetic injection using the Visual Analogue Scale [VAS 0 - 10]. Results: The VAS pain scores ranged from 4 to 10 for site A and 0 to 6 for site B. Comparison between the two sites showed a statistically significant difference [Mann-Whitney U test value = 51.50, P < 0.001] favoring site B. Conclusion: This study showed that DentalVibe reduces pain during injection of local anesthesia compared to topical anesthetic gel.

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.1
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• pp.1-10
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• 2019

Periodontal procedures require adequate anesthesia not only to ensure the patient's comfort but also to enhance the operator's performance and minimize chair time. In the maxilla, anesthesia is often achieved using highly traumatic nerve blocks, apart from multiple local infiltrations through the buccal vestibule. In recent years, anterior middle superior alveolar (AMSA) field block has been claimed to be a less traumatic alternative to several of these conventional injections, and it has many other advantages. This critical review of the existing literature aimed to discuss the rationale, mechanism, effectiveness, extent, and duration of AMSA injections for periodontal surgical and non-surgical procedures in the maxilla. It also focused on future prospects, particularly in relation to computer-controlled local anesthetic delivery systems, which aim to achieve the goal of pain-free anesthesia. A literature search of different databases was performed to retrieve relevant articles related to AMSA injections. After analyzing the existing data, it can be concluded that this anesthetic technique may be used as a predictable method of effective palatal anesthesia with adequate duration for different periodontal procedures. It has additional advantages of being less traumatic, requiring lesser amounts of local anesthetics and vasoconstrictors, as well as achieving good hemostasis. However, its effect on the buccal periodontium appears highly unpredictable.

• Journal of Dental Anesthesia and Pain Medicine
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• v.16 no.2
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• pp.137-140
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• 2016

Spinal muscular atrophy (SMA) is an autosomal recessive, severe neuromuscular disorder in which degeneration of alpha motor neurons in the spine progressively weakens and ultimately paralyzes the proximal muscles. It occurs in one per 6,000-10,000 infants, and is a genetic disorder with the second-highest mortality rate worldwide. An 18-year-old male patient with SMA was referred for general anesthesia for difficulty in performing dental treatment due to limited mouth opening caused by temporomandibular joint (TMJ) pain. However, the patient had a high risk of general anesthesia complications, so TMJ pain during mouth opening was reduced through local anesthesia of the TMJ. Fortunately, the anesthesia was successful in reducing pain during mouth opening, enabling the patient to receive dental treatment with an adequate mouth opening.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.6
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• pp.507-525
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• 2021

Local anesthesia is indispensable in dentistry. Worldwide, millions of local anesthetic injections are administered annually, and are generally considered safe invasive procedures. However, adverse effects are possible, of which dentists should be aware of. This scoping review aimed to provide an extensive overview of the reported literature on the adverse effects of dental local anesthesia. The types of papers, what is reported, and how they are reported were reviewed. Additionally, the incidence and duration of adverse effects and factors influencing their occurrence were also reviewed. An electronic search for relevant articles was performed in PubMed and Embase databases from inception to January 2, 2020. The titles and abstracts were independently screened by two reviewers. The analysis was narrative, and no meta-analysis was performed. This study included 78 articles. Ocular and neurological adverse effects, allergies, hematomas, needle breakage, tissue necrosis, blanching, jaw ankylosis, osteomyelitis, and isolated atrial fibrillation have been described. Multiple adverse effects of dental local anesthesia have been reported in the literature. The results were heterogeneous, and detailed descriptions of the related procedures were lacking. Vital information concerning adverse effects, such as the dosage or type of anesthetic solution, or the type of needle used, was frequently missing. Therefore, high-quality research on this topic is needed. Finally, the adverse effects that are rarely encountered in real-world general practice are overrepresented in the literature.

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.1
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• pp.35-40
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• 2018

Background: The sight of dental injection can bring about severe anxiety in children. Therefore, an alternative method that is convenient, effective, and keeps the needle hidden making it child friendly is necessary. The objective of the study was to compare the efficacy of a camouflaged syringe and conventional syringe on behavior and anxiety in 6-11-year-old children during local anesthesia administration. Methods: The study was a randomized, crossover clinical study including 30 children. Children were separated into two groups. Group 1 consisted of 15 children aged 6-8 years while group 2 consisted of 15 children aged 9-11 years. This study involved two sessions wherein all the children were injected using conventional and camouflaged syringes in separate sessions. Their behavior was assessed using the Faces, Legs, Activity, Cry, Consolability (FLACC) behavior pain scale and anxiety was assessed by measuring changes in pulse rate. Patient and operator preferences were compared. Results: The results showed a lower mean change in pulse rate and FLACC scores in the camouflaged group, suggesting a positive behavior and lesser anxiety with camouflaged syringes than with conventional syringes. Conclusions: The use of camouflaged syringes for anesthesia was demonstrated to be effective in improving the behavior of children and decreasing their anxiety, and is therefore recommended as an alternative to the use of conventional syringes for local anesthesia.

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.5
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• pp.295-300
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• 2019

Complex regional pain syndrome (CRPS) is rare, characterized by pain from diverse causes, and presents as extreme pain even with minor irritation. General anesthesia may be required for dental treatment because the pain may not be controlled with local anesthesia. However, treatment under general anesthesia is also challenging. A 38-year-old woman with CRPS arrived for outpatient dental treatment under general anesthesia. At the fourth general anesthesia induction, she experienced severe pain resulting from her right toe touching the dental chair. Anesthesia was induced to calm her and continue the treatment. After 55 minutes of general anesthesia, the patient still complained of extreme toe pain. Subsequently, two administrations for intravenous sedation were performed, and discharge was possible in the recovery room approximately 5 h after the pain onset. The pain was not located at the dental treatment site. Although the major factor causing pain relief was unknown, ketamine may have played a role.

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.4
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• pp.197-204
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• 2018

Pain control by means of local anesthesia is an intrinsic part of clinical practice in dentistry. Several studies evaluated intraligamental anesthesia using a computer-controlled anesthetic device in children. There is a need to provide a clinical guide for the use of computerized intraligamental anesthesia in children. Intraligamental anesthesia using a computer-controlled anesthetic device was found to cause significantly lower pain perception scores and lower pain-related behavior than traditional techniques. This device proven to be effective in restorative and pulp treatment in children; however, its effectiveness in primary teeth extraction is controversial. It is important to withdraw recommendations necessity of future studies concerning the side effects of computerized intraligamental anesthesia in children. The present study aims to review different clinical aspects of computerized intraligamental anesthesia in children along with the side-effects, type of local anesthesia and postoperative pain of this technique. This study provides dentists with a clinical guide for the use of computerized intraligamental anesthesia.

• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.3
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• pp.225-229
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• 2017

The inferior alveolar nerve block is the most common method of local anesthesia for intraoral surgery at the posterior mandibular region. However, unexpected complications may occur when administering the local anesthesia. One of these uncommon complications is the fracture of the needle. If the injection needle is broken during the surgery, it should be removed immediately. However, this is one of the most difficult procedures. In this report, we present two cases of needle fracture during the procedure, and its successful removal under general/local anesthesia administration.