Discover the world's research
- 20+ million members
- 135+ million publications
- 700k+ research projects
Join for free
Journal of
Pharmacology & Clinical Research
ISSN: 2473-5574
Review Article
Volume 5 Issue 1 - January 2018
DOI: 10.19080/JPCR.2018.05.555652
J of Pharmacol & Clin Res
Copyright © All rights are reserved by Mamta Kaushik
Local Anaesthesia and Inferior Alveolar Nerve
Block - A Never Ending Saga
Mamta Kaushik*1 and Kishore Moturi2
1Department of Conservative Dentistry and Endodontics, Army College of Dental Sciences, India
2Department of Oral and Maxillofacial Surgery, Vishnu Dental College, India
Submission: : January 02, 2018; Published: January 11, 2018
*Corresponding author: Mamta Kaushik, Professor and Head, Department of Conservative Dentistry and Endodontics, Army College of Dental
Sciences, Secunderabad, Telangana, India, Tel: ; Email:
Introduction
experience associated with actual or potential t issue damage"
by the International Association for the Study of Pain [1]. Dental
pain is one of the most dreaded experiences cited by most
the dentist [2]. One population study has shown that 73.4% of
patients report pain during dental treatment [3]; while another
different population study with 1086 individuals has shown that
42.5% of them have reported pain during dental treatment [4].
This is a major reason for the patient to not visit the doctor for
dental treatment. Although local anaesthetic injections are an
important aspect of treatment, fear of injection also deters the
follow up as well as primary visit [5,6]. Various local anaesthetic
agents (LA), topical and inject able are available to counter the
dental pain and make the dental treatment a pleasant experience.
agents and anaesthetic techniques used in dentistry,
concentrating on failure of inferior alveolar nerve block (IANB),
the reasons for failure and methods to overcome it.
Anaesthetic Agents
The agents used for local anaesthetics are either esters or
amides; the difference is the means by which the body biologically
transforms the active drug into one that is pharmacologically
inactive. Metabolism or biotransformation of local anaesthetic
is important because the overall toxicity of a drug depends on a
balance between its rate of absorption in the blood stream at the
site of injection and its rate of removal from the blood through
the process of tissue uptake and metabolism [7]. The ester group
(metabolised in plasma) contains chloroprocaine, procaine and
tetracaine. The amide group (metabolised primarily in the liver)
contains more commonly used local anaesthetics Articaine,
Prilocaine, Lidocaine, Mepivacaine, Bupivaciane etc. [7].
Practitioners prefer the amide local anaesthetic agents to the
esters as the amides produce more profound anaesthesia, more
rapidly and reliably; with fewer sensitizing reactions than ester
anaesthetics [8].
All clinically effective injectable LA possesses some degree
of vasodilating activity. This may vary from minimal (prilocaine,
with both the injection site and individual patient response.
The vasodilation may lead to an increased absorption of the
local anaesthetic agent from the local injection site into the
Cardiovascular system, may increase the plasma levels, may
increase the risk of local anaesthetic toxicity, decrease the depth
and duration of anaesthesia and increase the bleeding at the site
of injection [8]. Vasoconstrictors are added to local anaesthetic
solution to oppose these vasodilatory actions and counter the
problems associated with it. Most commonly used and accepted
and available vasoconstrictor is epinephrine (used in dilution of
1:50000, 1:80000, 1:100000, 1:200000).
J of Pharmacol & Clin Res 5(1): JPCR.MS.ID. 555652 (2018) 001
Abstract
There is an increased incidence of pain and use of local anaesthesia in Dentistry. In the mandibular teeth the type of anaesthesia administered
is the inferior alveolar nerve block. The success rate of this anaesthesia, especially in regards with restorative dentistry and endodontics is
very poor. This paper reviews the various reasons for failure of the inferior alveolar nerve block and discusses various strategies used and
Keywords: Inferior Alveolar Nerve Block; Local Anaesthesia; Irreversible Pulpitits; Pulpal Anaesthesia; Lidocaine with epinephrine
Abbreviations: IANB: Inferior alveolar Nerve Block; LA: Local Anestheisia
Journal of Pharmacology & Clinical Research
How to cite this article: Mamta K, Kishore M. Local Anaesthesia and Inferior Alveolar Nerve Block - A Never Ending SagaJ of Pharmacol & Clin Res. 2018;
5(1): 555652. DOI: 10.19080/JPCR.2018.05.555652.
002
Routes of Administration
Various routes of administration in the oral cavity for
Alveolar Nerve Block, Middle Superior Alveolar Nerve Block
(primarily for Premolars and First Molars), Intraoral Infra Orbital
Nerve Block, Extraoral Infra Orbital Nerve Block, Second division
Nerve Block and Palatal Anterior Superior Alveolar Nerve Block
most advocated for routine restorative procedures. Mandibular
anaesthesia on the other hand has a high failure rate. Because of
the innervations and thickness of the mandible the techniques
used are Conventional Inferior Alveolar Nerve Block, which
may or may not be supplemented with a Mental Nerve Block or
Inferior Alveolar Nerve Block
When anaesthetising the mandible for Restorative Dentistry,
58% in central incisors even thought the patient has profound
lip numbness [10-12]. Clinical studies in Endodontics in patients
with irreversible pulpitis have found success (mild or no pain
upon Endodontic Access or Initial instrumentation) with IANB
between 15%-57% of time [13-16]. Why does mandibular
anaesthesia fail for both healthy pulp and even more for diseased
pulp?
Various suggested reasons are:
Psychological: Anxiety and Fear It was found that anxious
patients feel more pain than less anxious patients [5,6]. In
addition to overestimation of anticipated pain [17], anxious
patients also have reduced pain tolerance [18].
Anatomical: Accessory Innervation by the Mylohyoid Nerve:
A Clinical and Anatomic study suggests that mylohyoid nerve is
the accessory nerve which may be responsible for the failure of
mandibular anaesthesia. But various studies [19,20] to validate
this have proved that the mandibular anaesthesia failed even
though the mylohyoid nerve was properly anaesthetised. Cross
Innervation has also been suggested as a reason for failure but
studies have proved that this happens only in the mandibular
incisor region and giving contra-lateral block also doesn't help in
in the mandible, however this needs further investigation.
Iatrogenic: Accuracy of the Injection: It has been theorized
that an inaccurate injection may contribute to failure of the
mandibular anaesthesia. This has again been countered
by various studies using ultrasound [24], peripheral nerve
stimulators [25] as well as radio opaque dyes [26,27]. Once lip
numbness is achieved, failure of pulpal anaesthesia is not due to
inaccuracy of injection for the IANB. Depth of Needle Placement
for IANB [25] ranging between 17- 20 mm seems not to affect
orientation of the Needle Bevel [29].
Pathological: For diseased teeth or teeth exhibiting
irreversible pulpitis, aside from the ones cited above, a few more
reduces the amount of base form of the anaesthetic to penetrate
the nerve membrane [30]. When local anaesthetic is injected at
a physiologic pH, the anaesthetic dissociates and equilibrium is
established:
The uncharged basic form is an active form of local
anaesthetics. The pKa of the anaesthetic describes the amount
of uncharged form versus cationic is present at a given pH.
Local anaesthetics have pKas ranging from 7.7 to 8.9. As the pH
equilibrium shifts and there is less availability of the uncharged
base form of LA [31]. There is less ionised form within the
nerve to attain anaesthesia [32]. This may explain the failure
as the injection site is very far away from the place of local
potentials and decreased excitability thresholds [30]. Substances
the neurons and also alter their structural properties [32]. There
is also a suggestion that terminals of peripheral nerves sprout
tissue [33]. Another theory, tetrodotoxin-resistant (TTX-r)
class of sodium channels have been shown to be resistant to
the action of local anaesthetics [30,32]. There is evidence of
increased expression of sodium channels in pulps diagnosed
with irreversible pulpitis. TTX-resistant class of sodium channels
represents a logical mechanism for local anaesthetic failures; the
channels are relatively resistant to lidociane, they are expressed
[32]. These and many more create a perplexing situation for
the operator when his/her IANB doesn't work for restorative
dentistry and endodotnics.
Methods to Improve Ecacy of IANB
There is a lot of deliberation on various methods to improve
the anaesthetic solution for IANB: For Anxiety and Fear, oral
conscious sedation with triazolam [34], and aromatherapy [35]
did not improve pain control in anxious patients. Educating the
patient about the advances in pain management and countering
the fear and anxiety comprises a large part in the dental practice.
Positive and professional attitude of the doctor, his caring
attitude and avoiding defensiveness aid in patient satisfaction
despite of the pain [36,37]. Conscious sedation with nitrous
procedures [38].
Alternative anaesthetic agent, other than the commonly used
lidocaine. Various other anesthetic solutions are available and
Journal of Pharmacology & Clinical Research
How to cite this article: Mamta K, Kishore M. Local Anaesthesia and Inferior Alveolar Nerve Block - A Never Ending SagaJ of Pharmacol & Clin Res. 2018;
5(1): 555652. DOI: 10.19080/JPCR.2018.05.555652.
003
have been tried and experimented over the years. Mepivacaine
and Prilocaine either plain or with vasoconstrictors did not
improve the success of an IANB for achieving pulpal anaesthesia
[39,40]. Combinations of plain solutions of Mepivacaineo or
Prilocaine with 2% lidocaine with 1:100,000 epinephrine
also have not yielded any better success when compared to
2% lidocaine with 1:100,000 epinephrine [39]. Though in
medical conditions where epinephrine/vasoconstrictors are
contraindicated, plain 3% mepivacaine may be a safe alternative
to 2% lidocaine with 1:100,000 epinephrine. But as a plain
solution there will be vasodilation and these drugs should be
used with caution and should not be used in large amounts [41].
Articaine – after a lot of controversy surrounding it, articaine
gained a reputation of being a drug with improved anaesthetic
an IANB, articaine is as effective as any other local anaesthetic
agent [43,44]. Premedication with a oral non steroidal anti-
moderately effective. Not strong enough to conclusively support
the premedication for success of IANB [45].
Alternate Injection Locations - Higher injection sites which
are used by the Gow-Gates or Vazirani-Akinosi techniques
though suggested, are not more successful than conventional
IANB technique [46]. Increasing the volume of the anaesthetic
solution [47], form 1.8ml to 3.6ml or Increasing/Decreasing
the concentration of the vasoconstrictors [48,49] 1:50,000,
1:80,000, 1:100,000 or 1:200,000 epinephrine does not increase
the incidence of pulpal anaesthesia with inferior alveolar
nerve block. Buffering the LA with a basic agent like Sodium
Bicarbonate was suggested to make it more effective. However,
studies have suggested that buffering the lidocaine formulation
does not increase its success for IANB [50]. Hyaluronidase
[51] and Carbonated Anaesthetic solutions [52] are other
tried techniques and unsuccessful techniques which offer
no additional advantage of the traditional 2% lidocaine with
1:100,000 epinephrine.
Successful Methods to Increase the Success of the IANB
to the conventional IANB seems to be promising for increasing the
pulpal anaesthesia with IANB [13]. Supplemental intraosseous
injections [53], lidocaine and mepivaciane formulations with
vasoconstrictors demonstrate increases success of pulpal
anaesthesia in IANB. As do supplemental intraligamentary
injections of 2% lidocaine with 1:100,000 epinephrine [54].
Conclusion
Even after so much advancement in Local Anaesthetics
and the failure of the IANB is one the most embarrassing and
challenging situations faced by the operator in a Dental Practice.
Further research is still indicated to improve the success of the
inferior alveolar nerve block.
References
1. IASP Taxonomy.
2. Liddell A, Locker D (2000) Changes in levels of dental anxiety as a
function of dental experience. Behav Modif 24(1): 57-68.
3. Locker D, Shapiro D, Liddell A (1996) Negative dental experiences and
their relationship to dental anxiety. Community Dent Health 13(2): 86-
92.
4. Maggirias J, Locker D (2002) Psychological factors and perceptions
of pain associated with dental treatment. Community Dent Oral
Epidemiol 30(2): 151-159.
5. Van Wijk AJ, Hoogstraten J (2005) Experience with dental pain and
fear of dental pain. J Dent Res 84: 947-950.
6. Van Wijk AJ, Hoogstraten J (2009) Anxiety and pain during dental
injections. J Dent Res 37: 700-704.
7. Malamed SF (2013) Handbook of local anaesthesia. (6 th edn). St. Louis,
Missouri, USA.
8. Moore PA, Hersh EV (2010) Local anaesthetics: Pharmacology and
toxicity. Dent Clin North Am 54: 587-599.
9. Reader A, Nusstein J, Melissa D (2011) Successful local anaesthesia for
restorative dentistry and endodontics. (1st edn.) Quintessense Books.
10.
of lidocaine/meperidine for inferior alveolar nerve blocks. Anesth
Prog 53: 131-139.
11. Lai TN, Lin CP, Kok SH (2006) Evaluation of mandibular block using
a standardized method. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 102: 462-468.
12.
nerve block. Anesth Prog 49: 49-55.
13. Haase A, Reader A, Nusstein J, Beck M, Drum M (2008) Comparing
nerve block. J Am Dent Assoc 139: 1228-1235.
14. Nuzum FM, Drum M, Nusstein J, Reader A, Beck M (2010) Anaesthetic
36: 952-956.
15. Walton RE, Abbott BJ (1981) Periodontal ligament injection: a clinical
evaluation. J Am Dent Assoc 103: 571-575.
16. Cohen HP, Cha BY, Spanberg LS (1993) Endodontic anaesthesia in
mandibular molars: a clinical study. J Endod 19: 370-373.
17.
Attentional and attributional mediators. Pain 56: 307-314.
18. Vika M, Raadal M, Skaret E, Kvale G (2006) Dental and medical
injections: Prevalence of self-reported problems among 18-yr-old
subjects in Norway. Eur J Oral Sci 114: 122-127.
19.
the mylohyoid nerve block and combination inferior alveolar nerve
block/mylohyoid nerve block. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 87: 557-563.
20.
alveolar nerve block in mandibular posterior teeth. Anesth Prog 54:
163-169.
21.
of unilateral and bilateral inferior alveolar nerve blocks to determine
Journal of Pharmacology & Clinical Research
How to cite this article: Mamta K, Kishore M. Local Anaesthesia and Inferior Alveolar Nerve Block - A Never Ending SagaJ of Pharmacol & Clin Res. 2018;
5(1): 555652. DOI: 10.19080/JPCR.2018.05.555652.
004
cross innervations in anterior teeth. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod 92: 132-135.
22. Kuribayashi A, Watanabe H, Imaizumi A, Tantanapornkul W, Katakami
tomography evaluation. Dentomaxillofac Radiol 39: 235-239.
23. Lew K, Townsen G (2006) Failure to obtain adequate anaesthesia
86-90.
24. Hannan L, Reader a, Nist R, Beck M, Meyers WJ (1999) The use of
ultrasound for guiding needle placement for inferior alveolar nerve
block. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 87: 658-665.
25. Simon F, Reader A, Drum M, Nusstein J, Beck M (2010) A prospective,
alveolar nerve block administered with a peripheral nerve stimulator.
J Endod 36: 429-433.
26. Berns JM, Sadove MS (1962) Mandibular block injection: A method of
study using an injected radiopaque material. J Am Dent Assoc 65: 735-
745.
27. Galbreath JC (1970) Tracing the course of the mandibular block
injection. Oral Surg Oral Med Oral Pathol 30: 571-582.
28. Hochman M, Friedman (2000) In vitro
linear insertion technique versus a bidirectional rotation insertion
technique. Quintessence Int 31: 33-38.
29. Steinkruger G, Nusstein J, Reader A, Beck M, Weaver J (2006) The
nerve block. J Am Dent Assoc 137: 1685-1691.
30. Potocnik I, Bajrovic F (1999) Failure of inferior alveolar nerve block in
endodontics. Endod Dent Traumatol 15: 247-25.
31. Boyce RA, Kirpalani T, Mohan N (2016) Updates of topical and local
anaesthesia agents. Dent Clin North Am 60: 445-471.
32. Hargreaves KM, Keiser K (2002) Local anaesthetic failue in
endodontics: mechanisms and management. Endod Top 1: 26-39.
33. Byers MR, Taylor PE, Khayat BG, Kimberly Cl (1990) Effects of injury
34. Lindemann M, Reader A, Nusstein J, Drum M, Beck M (2008) Effect of
sublingual triazolam on the success of inferior alveolar nerve block in
patients with irreversible pulpitis. J Endod 34: 1167-1170.
35. Kiecolt-Glaser JK, Graham JE, Malarkey WB, Porter K, Lemeshow S, et
and immune function. Psychoneuroendocrinology 33: 328-339.
36. Gale EN, Carlsson SG, Ericksson A, Jontell M (1984) Effects of dentists'
behaviour on patients' attitudes. J Am Dent Assoc 09: 444-446.
37. Schouten BC, Eijkman MA, Hoogstraten J (2003) Dentists' and patients'
communicative behaviour and their satisfaction with the dental
encounter. Community Dent Health 20: 11-15.
38. Babl Fe, Oakley E, Puspitadewi A, sharwood LN (2008) Limited
Emerg Med J 25: 717-721.
39. McLean C, Reader A, Beck M, Meyers WJ (1993) An evaluation of
4% prilocaine and 3% mepivacaine compared with 2% lidocaine
(1:100000 epinephrine) for inferior alveolar nerve block. J Endod 19:
146-150.
40. Hinkley SA, Reader A, Beck M, Meyers WJ (1991) An evaluation of
4% prilocaine with 1:200,000 epinephrine and 2% mepivacaine with
1:20,000 levonordefrin compared with 2% lidocaine with 1:100,000
epinephrine for inferior alveolar nerve block. Anesth Prog 38: 84-89.
41. Chin KL, Yagiela JA, Quinn Cl, Henderson KR, Duperon Df (2003)
Serum mepivacaine concentrations after intraoral injections in young
children. J Calif Dent Assoc 31: 757-764.
42.
amide local anaesthetic. J Am Dent Assoc 131: 635-642.
43. Miksell P, Nusstein J, Reader A, Beck M, Weaver J (2005) A comparison
of articaine and lidocaine for inferior alveolar nerve blocks. J Endod
31: 265-270.
44. Tortamano IP, Siviero M, Costa CG, Buscariolo IA, Armonia PL (2009)
patients with irreversible pulpitis. J Endod 35: 165-168.
45. Lapidus D, Goldberg J, Hobbs EH, Ram S, Clark GT, et al. (2016) Effect
of premedication to provide analgesia as a supplement to inferior
alveolar nerve block in patients with irreversible pulpitis. J Am Dent
Assoc 147(6): 427-437.
46. Goldberg S, Reader A, Drum M, Nusstein J, Beck M (2008) Comparison
Gates, and Vazirani-Akinosi techniques. J Endod 34: 1306-1311.
47.
volumes of lidocaine with epinephrine for inferior alveolar nerve
block. Gen Dent 50: 372-377.
48. Dagher FB, Yared GM, Machtou P (1997) An evaluation of 2% lidocaine
with different concentrations of epinephrine for inferior alveolar
nerve block. J Endod 23: 178-180.
49. Tofoli GR, Ramacciato JC, de Oliveira PC, Volpata MC, Groppo FC, et
1:100,000 or 1:200,000 epinephrine in inferior alveolar nerve block.
Anesth Prog 50: 164-168.
50. Whitcomb M, Drum M, Reader A, Nusstein J, Beck M (2010) A
of sodium bicarbonate buffered 2% lidocaine with 1:100,000
epinephrine in inferior alveolar nerve blocks. Anesth Prog 57: 59-66.
51.
of a combination of hyaluronidase and lidocaine with epinephrine in
inferior alveolar nerve blocks. Anesth Prog 48: 9-15.
52. Chaney MA, Kerby R, Reader A, Beck FM, Meyers MJ, et al. (1991)
An evaluation of lidocaine hydrocarbonate compared with lidocaine
hydrochloride for inferior alveolar nerve block. Anesth Prog 38: 212-
216.
53. Dunbar D, Reader A, Nist R, Beck M, Meyers BJ (1996) Anaesthetic
J Endod 22: 481-486.
54. Childers M, Reader A, Nist R, Beck M, Meyers BJ (1996) Anaesthetic
nerve block. J Endod 22: 317-320.
Journal of Pharmacology & Clinical Research
How to cite this article: Mamta K, Kishore M. Local Anaesthesia and Inferior Alveolar Nerve Block - A Never Ending SagaJ of Pharmacol & Clin Res. 2018;
5(1): 555652. DOI: 10.19080/JPCR.2018.05.555652.
005
Your next submission with Juniper Publishers
will reach you the below assets
• Quality Editorial service
• Swift Peer Review
• Reprints availability
• E-prints Service
• Manuscript Podcast for convenient understanding
• Global attainment for your research
• Manuscript accessibility in different formats
( Pdf, E-pub, Full Text, Audio)
• Unceasing customer service
Track the below URL for one-step submission
https://juniperpublishers.com/online-submission.php
This work is licensed under Creative
Commons Attribution 4.0 License
DOI:
10.19080/JPCR.2018.05.555652
... The endodontic therapy used when there is infection or inflammation in dental pulp which contains neurons and capillaries (Siqueira 2003), so during inflammatory processes vasodilation and increased vascular permeability occur (Siqueira 2003, Vergnolle 2003. The vasodilation may lead to an increased absorption of the local anesthetic agent from the local injection site into the cardiovascular system which may increase the plasma levels and subsequently increase the risk of local anesthetic toxicity (Bill et al. 2004, Kaushik andMoturi 2018). ...
-
![Neven Nihal]()
- Sakran Kasim
Background: Local anesthetic injections are the most common drugs used during dental treatment to inhibit pain sensation. Although these drugs are generally safe; though side effects occurs. Many side effects of anesthesia and anxiety associated dental treatment have been reported, yet their incidence and factors that modulate them were not studies extensively. Objectives: The objectives of the study was to: 1-Determine the incidence rate of dental local anesthetic complications. 2-Analyze the effect of different risk factors on the incidence of local anesthetic adverse effects, anxiety and nicotine withdrawal syndrome in smoker and non-smokers. Methodology: Three hundred fifty five dental patients enrolled in this Cross-Sectional study, those patients attended a private clinic for different dental complaints. The patients were given-lidocaine-hamein 2% with 1:80,000 epinephrine-by either infiltration or inferior alveolar nerve block (IANB) injection techniques to induce anesthesia, then underwent different dental procedures. Questionnaire was constructed to obtain patients information after formal consent. We focused on the sixteen well known signs and symptoms of local anesthesia side effect. The anxiety evaluated by using10-cm anxiety visual analog scale (VAS-A). Additionally, we searched for other dental complications and for nicotine withdrawal symptoms. Statistical Analysis: Data analyzed by using SigmaPlot (11.0) program. One sample t-test, ANOVA Test and a linear regression analysis were used. The p value of < 0.05 was considered to be statistically significant. Results: The commonest side effect was Post-operative sensory paralysis (235/355, ~66%) followed by palpitation (215/355, ~60%). Most patients had more than one side effect concomitantly. Gender, injection technique, dental procedure, age, BMI and smoking were significantly associated with a higher incidence of adverse reactions. The incidence rate of Post-operative sensory paralysis (66.2%) followed by palpitation (60.5%) and pallor (15.5%). Each of Tremor, confusion and hyperventilation were identified in less than 5% of the study population. The incidence rate of anxiety was high (340/355, ~95%).The level of anxiety was significantly affected by different dental procedure, smoking, age and BMI. The systolic and diastolic blood pressure was significantly increased after local anesthetic injections with p<0.001. Conclusions: The present study reports high incidence rate of local anesthetic adverse effects and anxiety which is associated with the some risk factors controlling these factors might minimize the side effects of the anesthesia.
... The endodontic therapy used when there is infection or inflammation in dental pulp which contains neurons and capillaries (Siqueira 2003), so during inflammatory processes vasodilation and increased vascular permeability occur (Siqueira 2003, Vergnolle 2003. The vasodilation may lead to an increased absorption of the local anesthetic agent from the local injection site into the cardiovascular system which may increase the plasma levels and subsequently increase the risk of local anesthetic toxicity (Bill et al. 2004, Kaushik andMoturi 2018). ...
Background: Local anesthetic injections are the most common drugs used during dental treatment to inhibit pain sensation. Although these drugs are generally safe; though side effects occurs. Many side effects of anesthesia and anxiety associated dental treatment have been reported, yet their incidence and factors that modulate them were not studies extensively. Objectives: The objectives of the study was to: 1-Determine the incidence rate of dental local anesthetic complications. 2-Analyze the effect of different risk factors on the incidence of local anesthetic adverse effects, anxiety and nicotine withdrawal syndrome in smoker and non-smokers. Methodology: Three hundred fifty five dental patients enrolled in this Cross-Sectional study, those patients attended a private clinic for different dental complaints. The patients were given-lidocaine-hamein 2% with 1:80,000 epinephrine-by either infiltration or inferior alveolar nerve block (IANB) injection techniques to induce anesthesia, then underwent different dental procedures. Questionnaire was constructed to obtain patients information after formal consent. We focused on the sixteen well known signs and symptoms of local anesthesia side effect. The anxiety evaluated by using10-cm anxiety visual analog scale (VAS-A). Additionally, we searched for other dental complications and for nicotine withdrawal symptoms. Statistical Analysis: Data analyzed by using SigmaPlot (11.0) program. One sample t-test, ANOVA Test and a linear regression analysis were used. The p value of < 0.05 was considered to be statistically significant. Results: The commonest side effect was Post-operative sensory paralysis (235/355, ~66%) followed by palpitation (215/355, ~60%). Most patients had more than one side effect concomitantly. Gender, injection technique, dental procedure, age, BMI and smoking were significantly associated with a higher incidence of adverse reactions. The incidence rate of Post-operative sensory paralysis (66.2%) followed by palpitation (60.5%) and pallor (15.5%). Each of Tremor, confusion and hyperventilation were identified in less than 5% of the study population. The incidence rate of anxiety was high (340/355, ~95%). The level of anxiety was significantly affected by different dental procedure, smoking, age and BMI. The systolic and diastolic blood pressure was significantly increased after local anesthetic injections with p<0.001. Conclusions: The present study reports high incidence rate of local anesthetic adverse effects and anxiety which is associated with the some risk factors controlling these factors might minimize the side effects of the anesthesia.
Introduction: An inferior alveolar nerve block is dental anesthesia produced by the local injection of lidocaine plus epinephrine; however, its administration could cause cardiovascular side effects. We aimed to assess the changes in blood pressure and pulse rate following the injection of 2% lidocaine with epinephrine 1:80000 for an inferior alveolar nerve block. Materials and methods: Seventy-one patients without any systemic disease were enrolled in this study. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate were measured using an automatic digital blood pressure monitor in four stages as follows: at the rest time (Stage 1), prior to injection (Stage 2), immediately after injection (Stage 3), and 10 min after the administration of anesthetic agents (Stage 4). All injections and measurements were carried out by a single operator to minimize the variability. Results: SBP and DBP in all stages were within the normal range (lower than 130 and 80 mmHg, respectively), and none of the patients showed evidence of arterial hypertension. Although the pulse rate increased significantly at Stages 2, 3, and 4 compared with Stage 1 (P < 0.05), no evidence of bradycardia or tachycardia was seen. Discussion: Local anesthesia with 2% lidocaine plus epinephrine 1:80000 for an inferior alveolar nerve block would be safe for patients without any systemic diseases.
The development of safe and effective local anesthetic agents has possibly been the most important advancement in dental science to occur in the last century. The agents currently available in dentistry are extremely safe and fulfill most of the characteristics of an ideal local anesthetic. These local anesthetic agents can be administered with minimal tissue irritation and with little likelihood of inducing allergic reactions. A variety of agents are available that provide rapid onset and adequate duration of surgical anesthesia. This introductory article provides a brief update of the clinical pharmacology of local anesthetic agents and formulations used in dentistry at present.
As described in this article, there are many advances in topical and local anesthesia. Topical and local anesthetics have played a great role in dentistry in alleviating the fears of patients, eliminating pain, and providing pain control. Many invasive procedures would not be performed without the use and advances of topical/local anesthetics. The modern-day dentist has the responsibility of knowing the variety of products on the market and should have at least references to access before, during, and after treatment. This practice ensures proper care with topical and local anesthetics for the masses of patients entering dental offices worldwide.
Background: The authors' objective was to determine whether scientific evidence supports the use of oral premedication to increase the efficacy of inferior alveolar nerve block (IANB) and to decrease endodontic treatment pain in patients with diagnosed irreversible pulpitis. Types of studies reviewed: The authors included randomized controlled trials that involved enteral premedication and 2% lidocaine IANB for adults with irreversible pulpitis compared with placebo. In particular, the authors reviewed studies comparing nonsteroidal anti-inflammatory drugs (NSAIDs), benzodiazepines, acetaminophen, and corticosteroids with placebo. The authors searched the following electronic databases: the Cochrane Library, MEDLINE, and Web of Science. Results: The authors analyzed 9 randomized controlled clinical trials. Patients who took the NSAIDs under study, including ibuprofen, ketorolac, diclofenac, indomethacin, and lornoxicam, 1 hour before endodontic treatment showed statistically significant improvement in the outcome of having "little or no pain" during endodontic treatment compared with patients who took a placebo 1 hour before endodontic treatment (risk ratio [RR], 1.989; 95% confidence interval [CI], 1.495-2.646; P < .001). Benzodiazepines were not as well represented in the literature, but the 2 included studies did not show a significant improvement in patients' having "little or no pain" during endodontic treatment over placebo (RR, 0.989; 95% CI, 0.677-1.444; P = .954). Conclusions and practical implications: There is moderate evidence to support the use of oral NSAIDs-in particular, ibuprofen (600 milligrams)-1 hour before the administration of IANB local anesthetic (1.8-3.6 milliliters of 2% lidocaine) to provide additional analgesia to the patient.
- Kenneth M Hargreaves
- Karl Keiser
Many patients fear endodontic procedures due to a concern about pain. Although pain treatment is well managed in many endodontic patients, there exists a group of patients who do not receive adequate local anesthesia. This article reviews the mechanisms of local anesthetic failure and focuses on available evidence for developing effective and efficient approaches in local anesthesia.
- Michael Whitcomb
- Melissa Drum
-
![Al Reader]()
- Mike Beck
The authors, using a crossover design, randomly administered, in a double-blind manner, inferior alveolar nerve (IAN) blocks using a buffered 2% lidocaine with 1:100,000 epinephrine/sodium bicarbonate formulation and an unbuffered 2% lidocaine with 1:100,000 epinephrine formulation at 2 separate appointments spaced at least 1 week apart. An electric pulp tester was used in 4-minute cycles for 60 minutes to test for anesthesia of the first and second molars, premolars, and lateral and central incisors. Anesthesia was considered successful when 2 consecutive 80 readings were obtained within 15 minutes, and the 80 reading was continuously sustained for 60 minutes. For the buffered 2% lidocaine with 1:100,000 epinephrine/sodium bicarbonate formulation, successful pulpal anesthesia ranged from 10-71%. For the unbuffered 2% lidocaine with 1:100,000 epinephrine formulation, successful pulpal anesthesia ranged from 10-72%. No significant differences between the 2 anesthetic formulations were noted. The buffered lidocaine formulation did not statistically result in faster onset of pulpal anesthesia or less pain during injection than did the unbuffered lidocaine formulation. We concluded that buffering a 2% lidocaine with 1:100,000 epinephrine with sodium bicarbonate, as was formulated in the current study, did not statistically increase anesthetic success, provide faster onset, or result in less pain of injection when compared with unbuffered 2% lidocaine with 1:100,000 epinephrine for an IAN block.
- Frederick Micah Nuzum
- Melissa Drum
- John Nusstein
- Mike Beck
Previous studies have shown higher success rates when using an articaine formulation versus a lidocaine formulation for buccal mandibular first molar infiltrations. However, there is little information on articaine's effect in mandibular anterior teeth. The authors conducted a prospective, randomized, single-blind, crossover study comparing the degree of pulpal anesthesia obtained with 2 sets of mandibular lateral incisor infiltrations given in 2 separate appointments in 82 adult subjects. One set of infiltrations consisted of an initial labial infiltration of a cartridge of 4% articaine with 1:100,000 epinephrine plus a lingual infiltration of the same anesthetic and dose. The other set of infiltrations consisted of an initial labial infiltration of a cartridge of 4% articaine with 1:100,000 epinephrine plus a mock lingual infiltration. The authors used an electric pulp tester to test the lateral incisor for pulpal anesthesia in 2-minute cycles for 60 minutes after the injections. The labial plus lingual infiltration significantly improved the success rate (no response to 2 consecutive 80 readings with the pulp tester) to 98% when compared with a labial infiltration of a cartridge of the same articaine formulation (76% success). The combination labial and lingual infiltrations did not provide pulpal anesthesia for an hour.
-
![Arjen van Wijk]()
- Johan Hoogstraten
The aim of this study was to study the relationship between anxiety and pain felt during a dental injection in a sample of 'normal' patients about to undergo 'invasive' dental treatment. Duration and intensity of pain during a dental injection were measured within a sample of 247 patients. In addition, data on dental anxiety, fear of dental pain, type of treatment, amount of anesthetic fluid, injection location and the use of surface anesthesia were also collected. Anxious patients felt more pain and of longer duration than less anxious patients. 28% of variance on the duration of pain felt could be accounted for by fear of dental pain, the use of surface anesthesia and gender. For the intensity of pain felt, 22% of variance could be accounted for by anxiety felt for the injection and dental anxiety. Pain felt during dental injections is dependent on dental anxiety, fear of dental pain, fear for the injection, gender and amount of injection fluid (rather than the use of surface anesthesia). In other words, some patients are expected to feel elevated levels of pain during dental injection and would benefit from extra attention and care from the dentist.
Source: https://www.researchgate.net/publication/325409626_Local_Anaesthesia_and_Inferior_Alveolar_Nerve_Block_-_A_Never_Ending_Saga
Posted by: elvisfette0199041.blogspot.com
Post a Comment