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

In: Health

12 Sep 2009

RESULTS

The mean age of children in both groups was 78 months (SD =12 months). Thirty girls were randomized into the block group and 25 girls to the infiltration group. There was no difference in the average age or proportion of girls in each group (both P > .05). Eight children (15.4%) in the block group had previous symptoms from the tooth being treated, and again 8 children (16.7%) from the infiltration group had previous symptoms (P = .9). Roughly half of all pulpotomies were on the first primary molar only, one quarter of all pulpotomies were on the second molar only, and the remaining involved both molars. There was a good distribution of all 3 combinations of teeth treated in both groups (P = .3). The average time interval from the injection to start of the tooth preparation was 14 minutes (SD = 5 minutes) in the block group and 15 minutes (SD = 4 minutes) in the infiltration group (P = .3).

Table 1. Mean Self-reported Pain After Rubber Dam Clamp Application (CAS2) for Children Who Received an Inferior Alveolar Block/Long Buccal Infiltration Versus Infiltration/intrapapillary Injection

Treatment Group n

Mean CAS2

SD

P value

Block 52

2.83

2.89

.10

Infiltration 49

1.89

2.89

Overall pain levels reported by the children were low, and there were no differences between conditions at any point in the procedure. There were no differences in the results for children treated by the 2 different dentists. The data are in Tables 1 and 2. Similarly, there was no difference in injection pain reported by the groups (CAS1; see Table 3). Make your pharmacy dollar go further and buy Levaquin 500 mg online

Table 2. Mean Self-reported Pain After Drilling (CAS3) for Children Who Received an Inferior Alveolar Block/Long Buccal Infiltration Versus Infiltration/intrapapillary Injection

Treatment Group n

Mean CAS3

SD

P value

Block 52

2.02

2.48

.74

Infiltration 49

1.84

2.86

Nine children (9%) required additional anesthetic: 4 of 52 (7.7%) children were in the block/long buccal anesthesia group, and 5 of 49 children (10.2%) were in the infiltration/intrapapillary injection group (P = .7). No child received more than 1 additional cartridge of anesthetic. As with the CAS self-report measure, the hypothesis that a larger proportion of children in the infiltration/intrapapillary group would require supplemental anesthesia was not supported. Six of 9 children requiring additional anesthetic were boys. Don’t be left without your medication get celecoxib 200 cheaper online.

Table 3. Mean Self-reported Pain of Injection (CAS1) for Children Who Received an Inferior Alveolar Block/Long Buccal Infiltration Versus Infiltration/intrapapillary Injection

Treatment Group n

Mean CAS1

SD

P value

Block 52

2.13

2.74

.77

Infiltration 49

1.98

2.66

About 18% of the children who did not receive additional anesthetic were reported by parents as having pain prior to the appointment, whereas none of the 9 children who did receive additional anesthetic had parents report previous pain. Similarly with previous medication, 7.7% of the children who did not require addi¬tional anesthetic were reported by parents to have received medication for infection/pain prior to the appointment, whereas none of the 9 children who required additional anesthetic had received medications. The CAS3 and CAS4 scores were analyzed again after removing the children who needed additional anesthetic, and no differences between the groups were found. There were no differences between the groups for CFSS-DS, previous pain symptoms, or type of tooth or teeth treated. When parents were called the next day, there were no differences between the groups and no adverse reports of cheek or lip biting. Get smart and save money! Buy omnicef 300mg online

Table 4. Dentist Ratings of Pain Effectiveness Related to Child Overall Self-report (CAS4) at the Conclusion of Treatment

Mean
Dentist Rating N* CAS4 SD

P value

Effective 89 1.88 2.37

.03

Partially effective 10 5.28 4.06

Table 4 gives the dentist ratings of anesthesia effectiveness. When the dentist rated the anesthetic as partially effective, the child CAS4 ratings (overall assessment of pain during the appointment) were significantly higher than when the dentist rated the treatment as effective (P = .03). However, the significance of this result disappears when you exclude from the analysis the children who received additional anesthetic (P = .2), although the direction of the relationship remains the same. No child was rated as having “ineffective” pain control. Analyses also showed that the dentist blinding was effective. The dentist guessed block anesthesia 72% of the time, showing bias toward the block being a more effective anesthetic method. When dentists guessed a block, they were correct 56.3% of the time, and when they guessed infiltration, they were correct 57.1% of the time (P = .23).  Your life is worth living. Buy atomoxetine hydrochloride online

Overall the proportion of children who were fearful (CFSS-DS > 37) was relatively high (32.6%). There was no difference in CAS4 (after drilling) between children who were rated as fearful and those who were rated as less fearful, and overall CAS scores were not higher for children who rated themselves as fearful (P = .7).


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