Used for Gingival Anesthesia in Children: MATERIALS AND METHODS

In: Anesthesia

9 Nov 2009

All subjects were patients of record at the University of Minnesota School of Dentistry Pediatric Dental Clinic. The parent signed a consent form, which described the procedure, for each subject. Subjects who were 8 years and older had to sign a child’s assent form, which described the procedure.

The inclusion criteria mandated that subjects be med­ically healthy and cooperative and between 5 and 17 years of age. The dental progress notes for each subject were reviewed to determine cooperative behavior. The teeth to be sealed included first and second premolars and permanent molars. Subjects who had 2 contralateral teeth in the same arch (maxillary or mandibular) that needed sealants were included and subjects who had 4 contralateral teeth (2 in each arch, maxillary and mandibular) that needed sealants. Resealing of previously sealed teeth was allowed.
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The exclusion criteria excluded children who had restored first or second premolars or permanent molars and children who had decay in their first or second premolars or permanent molars that required a conservative composite restoration covered with a sealant (preventive resin restoration). Children were also excluded if they had orthodontic bands on the teeth that needed sealants.

A split-mouth design was used, which allowed subjects to be their own controls. Every subject had sealants placed on either 2 teeth in 1 arch or 4 teeth in 2 arches (2 teeth in each arch). Both the DP and the Hurricaine Dry Handle Swab (topical anesthetic swab) were used on each subject. The DP contained 46.1 mg of lidocaine in a bioadhesive matrix. The topical anesthetic swab contained 0.25 mg of 20% benzocaine. The DP was cut in half using a Miltex lis scissors. The gingival tissues were dried with cotton gauze, and half of a DP was applied approximately 1 mm below the facial gingiva, whereas the other half was applied approximately 1 mm below the lingual gingiva of the same tooth. The DP was left in place for 5 minutes and then removed. The rubber dam clamp was placed on the tooth and firmly pushed downward (impinging) to the gingival tissue. The rubber dam was stretched over the clamp, isolating the tooth, and secured with the rubber dam frame. The sealant was applied. For the contralateral tooth, 1 topical anesthetic swab was applied to both the facial and lingual gingiva in equal amounts by alternating it for 1 minute. When 4 teeth were treated, the 2 treatments were randomized separately in each arch. Suffer no more! Buy Viagra Professional online at a price you can afford.

Enameloplasty was performed using a half-round bur in a high-speed handpiece to clean any suspicious-appearing stained grooves. A bristle brush was used to clean the tooth. Ultra-Etch 35% phosphoric acid was applied to the tooth for 30 seconds; the tooth was rinsed with water and dried with air. The etched tooth had a frosted appearance. A Dycal applicator was used to place the Delton Plus Pit and Fissure Sealant material into the grooves. The sealant material was cured with the curing lamp. If any voids were present, additional sealant material was applied and cured.

Clamp trouble was defined as any time the clamp popped off the tooth. Clamp trouble was usually related to difficulty associated with determining the correct clamp that fit the tooth. There are minor variations in the size and shape of each individual’s tooth. The correct size referred to whether the clamp fit properly on the tooth. The clamp should fit the tooth but not rock back and forth. Clamp trouble was also related to the amount of eruption of the tooth. Generally, the clamp slightly impinges on the gingival tissue, but this is also dependent on the type of clamp used. Some clamps impinge more on the gingival tissue than others. In all cases, the rubber dam clamp was pushed downward to the gingiva, so that it was fully seated and rested on the gingiva; therefore, the clamp could potentially cause discomfort.
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The DP was applied according to the manufacturer’s instructions. After the DP was firmly held in place for 30 seconds, the finger pressure was reduced to see if the patch adhered to the gingival area. Usually the patch began to drift immediately away. When this happened, the DP was held firmly in place with finger pressure or with a cotton forceps in the case of mandibular lingual gingiva. All of the patches that adhered to the gingival tissue after the initial 30 seconds adhered for the entire 5-minute period. These patches adhered to the gingival tissue and did not require finger pressure to hold them in place.

A visual analog scale (VAS), a 100-mm line that has a happy face on the left end point and a sad face on the right end point, was used to record the pain scores for the subjects (Figure 1). This device was modified with 5 additional faces that were equally spaced and showed varying degrees of happiness and sadness. Before every reading, the pointer was set to 50 mm. Patients were given the pain scale slide rule (with the faces facing up) and asked to move the pointer to represent how they were feeling. The pain scale slide rule was turned over to record the VAS result to the nearest 0.5 mm. The VAS results were recorded at the following times (a) when patient was seated in the dental chair, (b) after the rubber dam clamp was placed on the first tooth, (c) after the sealant was finished and rubber dam clamp was removed from the first tooth, (d) after the rubber dam clamp was placed on the second tooth, (e) after the sealant was finished and rubber dam clamp was removed from the second tooth, (f) after the rubber dam clamp was placed on the third tooth, (g) after the sealant was finished and rubber dam clamp was removed from the third tooth, (h) after the rubber dam clamp was placed on the fourth tooth, and (i) after the sealant was finished and rubber dam clamp was removed from the fourth tooth.

Figure 1. Pain scale slide rule

Figure 1. Pain scale slide rule.

The operator evaluated the subject’s behavior during the treatment of each tooth, using the Frankl scale. The Frankl scale has 4 categories, although not everyone using this scale may interpret the categories in the same manner. The 4 categories are as follows (a) rating 1 equals definitely negative, refusal of treatment, crying forcefully, fearful, or any other overt evidence of extreme negativism, (b) rating 2 equals negative: reluctant to accept treatment, uncooperative, some evidence of negative attitude but not pronounced; (c) rating 3 equals positive: acceptance of treatment; at times cautious, willingness to comply with the dentist at times with reservation, but patient follows the dentist’s directions cooperatively, and (d) rating 4 equals definitely positive: good rapport with the dentist, interested in the dental procedures, laughing, and enjoying the situation.
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The data were analyzed using simple and multiple linear regressions and according to a mixed linear model. A simple linear regression was used to evaluate whether a patch’s chance of sticking is related to the operator’s experience. Multiple linear regression was used to assess whether the subject’s age and sex are related to the chance of a patch sticking. A mixed linear model was used to compare the VAS responses for the 2 treatments, taking into account various aspects of the subjects and procedures.


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