A Randomized Controlled Trial Comparing Mandibular Local Anesthesia Techniques in Children Receiving Nitrous Oxide-Oxygen Sedation. METHODS Part 2

In: Health

11 Sep 2009


All children were given 40% nitrous oxide via a nasal mask. After 3 minutes, the site of the injection was dried with a cotton tip applicator, and topical anesthetic (Hur-ricaine, 20% benzocaine gel) was applied for 60 seconds. The dental hygienist then opened an envelope giving the anesthetic assignment, and local anesthetic was administered. The same dental hygienist gave all the injections. Local anesthetic was administered without the dentist present. Children were randomly assigned to either the infiltration or block group using a computer algorithm (Microsoft Excel RAND function).

Two dentists performed all of the dental treatment in this study. The dentists were blind to anesthetic condition.

For the infiltration, a 27-gauge short needle was directed toward the apex of the tooth in the mucobuccal fold, and most of 1 cartridge (1.8 mL) of 2% lidocaine,

1:100,000 epinephrine was used. In addition, intra-papillary injections mesial and distal to the tooth were given. Get smart and save money! Buy cialis super active online

For the inferior alveolar block, a 27-gauge short needle was placed medial to the internal oblique ridge with the barrel angled over the primary molars on the opposite side of the arch and advanced approximately 15 mm. Approximately 1.6 mL of 2% lidocaine, 1: 100,000 epinephrine were administered. The remaining 0.2 mL was used for the long buccal injection. For the long buccal, the tip of the needle was inserted distal and buccal to the most posterior tooth in the arch.

After the initial anesthetic, the rubber dam clamp was applied to the tooth to be treated and the pain score recorded from the child (CAS2). If the child reported any pain, additional anesthetic was given consistent with the original assignment. If the child reported any pain during tooth preparation, the procedure was immediately stopped and additional anesthetic was given according to the assignment, in half cartridge increments (0.9 mL). The CAS3 pain report was obtained after tooth preparation was completed. Can’t afford your medication? Buy levitra professional canada


The CAS was used at 4 stages of treatment. The dental assistant asked the child to rate the pain of injection (CAS1). A minimum time of 3 minutes elapsed between the injection and when the rubber dam clamp was applied (CAS2). A clamp was used in all cases. If the child reported pain, additional anesthetic was given as described earlier. After the minimum time of 3 minutes had elapsed, the dentist approached the child to begin tooth preparation. If at any point during the treatment the dentist felt that the pain control was ineffective, the treatment was stopped and more local anesthetic was administered (Anesthetic 2). The tooth was prepared for a pulpotomy and for subsequent placement of a stainless steel crown. After entry into the pulp chamber and placement of medication, the child once again assessed pain (CAS3). The dental hygienist now returned to fit the stainless steel crown, and once the treatment was complete the child rated pain for the overall visit (CAS4). Each time the child was asked to report his or her pain, the research assistant said, “Slide the marker up the scale to show how much pain or hurt you felt. Remember the bottom is no pain or hurt at all and the top is the most pain or hurt imaginable.” All cases were videotaped to keep check for violations of the protocol.

At the completion of treatment, the dentist rated the effectiveness of pain control and also guessed which type of injection he or she thought the child had. The dentist also completed the Frankl scale. Dental assistants called the parent the next day regarding their child’s behavior or problems after dental treatment.  Save on your pharmacy bills. Buy female pink viagra online

Data Analysis

A Student’s t test was used to test the primary hypothesis that children who receive infiltration/intrapapillary anesthesia will have a higher CAS score (that is, report greater pain during treatment) than children who receive block/long buccal infiltration anesthesia. The 101 ana-lyzable subjects in this study make it adequately powered to detect a treatment group difference in CAS score of 1.5, which was deemed a clinically significant difference by study investigators. Assuming a common standard deviation of 2.7 and a significance (alpha) level equal to .05, the study has 79.7% power to detect a CAS score difference of 1.5. Fisher’s exact test was used to test the secondary hypothesis that supplementary anesthetic will be given more often in the infiltration/intrapapillary group than the block/long buccal group. Similarly, a t test was used to examine the hypothesis that children with high preoperative dental anxiety (CFSS-DS) report higher CAS scores overall than children with low or moderate anxiety. The data were analyzed using SPSS 10.0 for Windows.

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Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.