• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.4
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• pp.285-295
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• 2024

Background: In human dentition, the most commonly impacted teeth are the mandibular third molars (M3M). The removal or extraction of these teeth often causes anxiety in patients due to the perceived pain involved in the process. Therefore, pain must be effectively managed using anesthesia. The use of newer local anesthetic drugs can help minimize side effects and drug interactions. Traditionally, adrenaline is used as a vasoconstrictor along with lignocaine. When combined with lignocaine, the alpha agonists dexmedetomidine and clonidine can extend the duration of anesthesia, thereby reducing the need for additional pain-relieving medications. Methods: This study used a randomized, triple-blind, parallel-arm design. Sixty patients were screened, and 45 systemically healthy patients requiring unilateral surgical removal of impacted mandibular third molars with similar difficulty (moderate-to-difficult according to the Modified Pederson's Index) were included in the study. Patients were allocated into three groups as follows: Group A: 2% Lignocaine Hydrochloride with 1:100,000 Adrenaline, Group C: 2% Lignocaine Hydrochloride with 15 ㎍/mL Clonidine, and Group D: 2% Lignocaine Hydrochloride with 1 ㎍/mL Dexmedetomidine. The evaluated parameters were the time of onset of anesthesia, depth of anesthesia, hemodynamic parameters, and duration of postoperative analgesia. Results: Group D had a faster onset of action and prolonged duration of postoperative analgesia compared with Groups A and C. No statistically significant differences were observed between the three groups in terms of the depth of anesthesia and hemodynamic parameters. Conclusion: Group D exhibited a significantly more rapid onset of anesthesia than Groups A and C, and the postoperative analgesic effect in Group D was significantly prolonged (7.22 hours) compared with that in Groups A (4.54 hours) and C (2.1 hours). Patients receiving the Group D solution experienced an extended period of comfort without the need for analgesics for up to 7.22 hours post-procedure.

• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.4
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• pp.265-270
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• 2017

Background: Endotracheal intubation during anesthesia induction may increase airway resistance ($R_{aw}$) and decrease dynamic lung compliance ($C_{dyn}$). We hypothesized that prophylactic treatment with a transdermal ${\beta}2$-agonist tulobuterol patch (TP) would help to reduce the risk of bronchospasm after placement of the endotracheal tube. Methods: Eighty-two American Society of Anesthesiologists (ASA) category I or II adult patients showing obstructive patterns were divided randomly into a control and a TP group (n = 41 each). The night before surgery, a 2-mg TP was applied to patients in the TP group. Standard monitors were recorded, and target controlled infusion (TCI) with propofol and remifentanil was used for anesthesia induction and maintenance. Simultaneously, end-tidal carbon dioxide, $R_{aw}$, and $C_{dyn}$ were determined at 5, 10, and 15 min intervals after endotracheal intubation. Results: There was no significant difference in demographic data between the two groups. The TP group was associated with a lower $R_{aw}$ and a higher $C_{dyn}$, as compared to the control group. $R_{aw}$ was significantly lower at 10 min (P < 0.05) and 15 min (P < 0.01), and $C_{dyn}$ was significantly higher at 5 min (P < 0.05) and 15 min (P < 0.01) in the TP group. A trend towards a lower $R_{aw}$ was observed showing a statistically significant difference 5 min after endotracheal intubation (P < 0.01) in each group. Conclusions: Prophylactic treatment with TP showed a bronchodilatory effect through suppressing an increase in $R_{aw}$ and a decrease in $C_{dyn}$ after anesthesia induction without severe adverse effects.

• International Journal of Oral Biology
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• v.37 no.3
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• pp.121-129
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• 2012

Previous clinical studies have demonstrated that gabapentin, a drug that binds to the voltage-gated calcium channel ${\alpha}2{\delta}1$ subunit proteins, is effective in the management of neuropathic pain, but there is limited evidence that addresses the participation of glial cells in the antiallodynic effects of this drug. The present study investigated the participation of glial cells in the anti-nociceptive effects of gabapentin in rats with trigeminal neuropathic pain produced by mal-positioned dental implants. Under anesthesia, the left mandibular second molar was extracted and replaced by a miniature dental implant to induce injury to the inferior alveolar nerve. Mal-positioned dental implants significantly decreased the air-puff thresholds both ipsilateral and contralateral to the injury site. Gabapentin was administered intracisternally beginning on postoperative day (POD) 1 or on POD 7 for three days. Early or late treatment with 0.3, 3, or 30 ${\mu}g$ of gabapentin produced significant anti-allodynic effect in the rats with mal-positioned dental implants. On POD 9, in the mal-positioned dental implants group, OX-42, a microglia marker, and GFAP, an astrocyte marker, were found to be up-regulated in the medullary dorsal horn, compared with the naive group. However, the intracisternal administration of gabapentin (30 ${\mu}g$) failed to reduce the number of activated microglia or astrocytes in the medullary dorsal horn. These findings suggest that gabapentin produces significant antinociceptive effects, which are not mediated by the inhibition of glial cell function in the medullary dorsal horn, in a rat model of trigeminal neuropathic pain.

• Journal of the Korean Society of Physical Medicine
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• v.3 no.4
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• pp.247-254
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• 2008

Purpose : The purpose of this study was to analyze some factors that can cause incidence of the muscle and skeletal system trouble, by which Dental Hygiene Students examine the pain and the inconvenient feeling according to kinds in manual implements and the usability in the level of manipulating and maintaining the manual implement, in the actual training of the intra oral cavity along with mannequin given the scaling practice. Methods : Targeting 18 female juniors for the department of dental hygiene, who had directly practiced oral prophylaxis for 2 years, the questionnaire research was carried out right after the mutual practice in the intra oral cavity along with mannequin. Results : It was indicated that there is no big difficulty both in intra oral cavity and mannequin in terms of manipulating implement with a method of maintaining the rightly hand fixing or of grasping the trans formative pencil and of controlling force given manipulating the implement. How to grasp a trans formative pencil was indicated to be more difficult in the intra-oral manipulation(p<.05). Pain and inconvenient-feeling level, which occur in muscle and skeletal system during practicing the scaling in mannequin, were indicated to be in order of shoulder, wrist, neck, waist, elbow, and headache. Conclusion : There was no big difference in the pain and the inconvenient feeling in muscle and skeletal system according to mannequin and intra-oral environment given manipulating tile manual implement. However, there was difference in manipulating the implement with a method of grasping transformative pencil. The pain and inconvenient feeling in muscle and skeletal system were the highest both in shoulder and wrist.

• Journal of The Korean Dental Society of Anesthesiology
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• v.14 no.2
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• pp.107-114
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• 2014

Background: Angiogenesis has been recognized an essential precondition for osteogenesis. Because reduction and disruption of the blood supply to tissue cause tissue hypoxia, pathological bone loss affected by hypoxia often can occur in various clinical conditions. The effects of propofol on the process of osteogenesis have received little direct attention. Therefore, we investigated the effect of propofol on the growth and function of osteoblasts under hypoxic condition. Methods: After propofol (3, 30, $300{\mu}M$) preconditioning for 2 hours, hFOB 1.19 human osteoblast cells were cultured under 1 % oxygen tension for 48 hours. Using real time PCR and western blot analysis, we analyzed the expression of, BMP-2, TGF-${\beta}1$, type I collagen, osteocalcin, HIF-1s and Akt. Cell viability was also determined by MTT assay. Results: Propofol preconditioning on hypoxic-cultured osteoblast promoted the expressions of BMP-2, TGF-${\beta}1$, type I collagen and osteocalcin and induced hypoxia-mediated HIF-1 activation and the expression of Akt protein. Propofol with $300{\mu}M$ significant decreased cell viability compared to control. Conclusions: Clinically relevant concentrations of propofol are not cytotoxic to hypoxic osteoblasts in vitro. Propofol preconditioning on hypoxic-cultured osteoblast stimulates proliferation and differentiation of osteoblast through induced expression of BMP-2, TGF-${\beta}1$, type I collagen and osteocalcin. Propofol might promote angiogenesis and bone regeneration under hypoxic condition.

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.6
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• pp.379-388
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• 2019

Background: In dentistry, pain is a factor that negatively affects treatments and drug use. The aim of this study was to evaluate the correlations of the postoperative analgesic use with pain catastrophizing and anxiety in patients who underwent removal of an impacted mandibular third molar. Methods: We recruited 92 patients who underwent the extraction of impacted mandibular third molar. In this study, the Pederson index was used to preoperatively determine the difficulty of surgical extraction. Patients were asked to note the number of analgesics used for 7 postoperative days. Patients were divided into two groups based on the Pain Catastrophizing Scale: low and high score groups. State-Trait Anxiety Inventory-trait and State-Trait Anxiety Inventory-state questionnaires were used to determine the anxiety levels of the patients. The obtained data were examined to evaluate the correlations of pain catastrophizing and anxiety with the postoperative analgesic use. Results: In this study, 92 patients, including 60 women and 32 men, were recruited. The analgesic use was higher in women than in men but with no significant difference (P > 0.05). Pain Catastrophizing Scale scores were higher in women than in men but with no significant difference (P > 0.05). The analgesic use was higher in patients with high pain catastrophizing than in those with low pain catastrophizing but with no significant difference (P > 0.05). State-Trait Anxiety Inventory-trait scores were higher in women than in men but with no significant difference. However, state-Trait Anxiety Inventory-state scores were significantly higher in women than in men (P < 0.05). Conclusion: The postoperative analgesic use may be higher in patients who catastrophize pain than in others. Knowing the patient's catastrophic characteristics preoperatively would contribute to successful pain management and appropriate drug selection.

• Journal of Oral Medicine and Pain
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• v.43 no.2
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• pp.41-51
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• 2018

Purpose: The aim of this study was to evaluate the possibility of utilizing blood tests for the diagnosis of temporomandibular disorders (TMDs) by investigating the hematologic characteristics of TMD patients according to the main source and level of TMD pain and analyzing their interrelationship. Methods: Clinical examination following the research diagnostic criteria for TMD and hematological and psychological evaluations were conducted in 357 TMD patients. Patients were divided into groups according to the main source of pain (myogenous, arthrogenous, and combined pain) and the degree of pain according to the graded chronic pain scale (GCPS). Hematological differences among the groups were statistically analyzed. Results: The C-reactive protein (CRP) level was significantly higher in the arthrogenous pain group compared to the combined pain group (p=0.032). There was no significant difference according to the GCPS classification. There were significant correlations between some of the TMD pain indices and the hematologic indices, and also between the psychological indices and the hematologic indices. Conclusions: This study suggests the possibility of applying blood tests to the diagnosis, treatment and prevention of TMD. Further research should be conducted focusing on the role of CRP in TMD pain with more refined methodology and a longitudinal study design.

• Journal of The Korean Dental Society of Anesthesiology
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• v.14 no.4
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• pp.221-225
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• 2014

External beam radiotherapy (EBRT) causes anxiety and claustrophobia in pediatric patients. To provide exact figures and radiation amounts, an appropriate sedation or anesthesia can be supplied. Alpha 2 agonist dexmedetomidine has been used for sedation and anesthesia in pediatric imaging. Dexmedetomidine has an advantage because it has minimal respiratory depression and no direct effects on myocardial function. We report repeated sedation with dexmedetomidine for 33 consecutive radiation therapies in 5 years old children.

• Journal of Oral Medicine and Pain
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• v.41 no.2
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• pp.76-79
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• 2016

Angina bullosa hemorrhagica (ABH) is a rare oral mucosal disorder characterized by blood blisters which is not related to hematologic or immunopathologic abnormalities. ABH is most common in middle-aged and elderly people and associated with local trauma, diabetes and long-term use of inhaled steroids. Diagnosis is generally based on reviewing history and clinical presentation and it is important to distinguish it from other serious disorders. Usually, ABH is benign condition which requires no treatment. We present a case of 81-year-old female with ABH.

• Journal of Oral Medicine and Pain
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• v.46 no.4
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• pp.155-160
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• 2021

The masticatory muscle disorder is the most common problem that patients with temporomandibular disorder often complain. For such complaints, treatment is directed towards reducing hyperactivity of muscles or effects of the central nervous system. However, if nonspecific occlusal change or pain persists, it is necessary to consider that muscle weakness might be the cause of the persistence of temporomandibular disorder. Stabilization of occlusion and improvement of the pain symptoms were achieved in both cases through the chewing gum exercise. This exercise may enable masticatory movements done in normal function by using muscle engram and achieve reinforcement of the masticatory muscles with balanced, simultaneous contacts of the teeth. In addition, it may be a viable method for treating temporomandibular disorders that do not respond well to conventional mandibular stabilization therapies.