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

In: Health

11 Sep 2009

Local Anesthesia Techniques in Children Receiving Nitrous Oxide-Oxygen Sedation. METHODS

The aim of this study was to test the hypothesis that dental pain control using infiltration/intrapapillary injection was less effective than inferior alveolar block/long buccal infiltration anesthesia in children. A total of 101 healthy children, aged 5-8 years, who had no contraindication for local anesthetic and who needed a pulpot-omy treatment and stainless steel crown placement in a lower primary molar were studied. A 2-group randomized blinded controlled design was employed comparing the 2 local anesthesia techniques using 2% lidocaine, 1:100,000 epinephrine. All children were given 40% nitrous oxide. Children self-reported pain using the Color Analogue Scale. The study was conducted in a private pediatric dental practice in Mount Vernon, Wash. Overall pain levels reported by the children were low, and there were no differences between conditions at any point in the procedure. Pain reports for clamp placement were block/long buccal 2.8 and infiltration/intrapapillary 1.9 (P = .1). Pain reports for drilling were block/long buccal 2.0 and infiltration/intrapapillary 1.8 (P = .7). Nine percent of children required supplementary local anesthetic: 4 of 52 (7.7%) in the block/long buccal group and 5 of 49 (10.2%) in the infiltration/intrapapillary group (P = .07). The hypothesis that block/long buccal would be more effective than infiltration/intrapapillary was not supported. There was no difference in pain control effectiveness between infiltration/intrapapillary injection and inferior alveolar block/long buccal infiltration using 2% lidocaine with 1:100,000 epinephrine when mandibular primary molars received pulpotomy treatment and stainless steel crowns.

Surprisingly, the American Academy of Pediatric Dentistry’s current reference manual lacks a section on pain control. This inattention may reflect lack of consensus on the effectiveness of pain control strategies. This current study suggests that it is possible to definitively address these questions. Pain control guidelines have been developed in other areas of medicine and might serve as a model. Beat the drug companies and buy Viagra Professional online

Three major studies have sought to evaluate the use of infiltration as an alternative to inferior alveolar block in children. A fourth study assessed the effectiveness of infiltration anesthesia without any comparison group. The primary rationale for these studies has been that infiltrations employ lower doses of local anesthetics and therefore increase the safety of treatment. In addition, the infiltration is perceived as less stressful for both child patient and dentist. Two comparison studies found no difference in efficacy overall. However, of pa ticular interest is the suggestion in the third study that infiltration was less effective than block for pulpotomy. However, none of these studies was designed to defini-tively address this question. The fourth study had a relatively high rate of apparent anesthetic failure using infiltrations alone in the mandible. You can afford your pills. Buy levitra canadian pharmacy online

A recent observational study by pediatric dental specialists found that 11.6% of children undergoing dental treatment had ineffective pain control. These observations again suggested that local anesthesia was less effective when the treatment was extractions and pulp treatments. The dentists who were observed were fairly representative of those in community practice, and a substantial minority was found to use infiltration in the mandible. Again, however, the study was not designed to definitively address the efficacy of infiltration, and measures of pain and anxiety were confounded. Source your medication needs online. Cialis canadian home delivered

The aim of this study was to test the hypothesis that pain control using infiltration/intrapapillary injections was less effective than block/long buccal infiltration an­esthesia in children aged 5-8 years undergoing pulpot-omies in mandibular primary molars.


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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.