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ABSTRACT: Abstract The purpose of this trial was to assess the effect of soft tissue massage on the efficacy of the mental and incisive nerve block (MINB). Thirty-eight volunteers received MINB of 2.2 mL of 2% lidocaine with 1 : 80,000 epinephrine on 2 occasions. At one visit the soft tissue overlying the injection site was massaged for 60 seconds (active treatment). At the other visit the crowns of the mandibular premolar teeth were massaged (control treatment). Order of treatments was randomized. An electronic pulp tester was used to measure pulpal anesthesia in the ipsilateral mandibular first molar, a premolar, and lateral incisor teeth up to 45 minutes following the injection. The efficacy of pulp anesthesia was determined by 2 methods: (a) by quantifying the number of episodes with no response to maximal electronic pulp stimulation after each treatment, and (b) by quantifying the number of volunteers with no response to maximal pulp stimulation (80 reading) on 2 or more consecutive tests, termed anesthetic success. Data were analyzed by McNemar, Mann-Whitney, and paired-samples t tests. Anesthetic success was 52.6% for active and 42.1% for control treatment for lateral incisors, 89.5 and 86.8% respectively for premolars, and 50.0 and 42.1% respectively for first molars (P = .344, 1.0, and .508 respectively). There were no significant differences in the number of episodes of negative response to maximum pulp tester stimulation between active and control massage. A total of 131 episodes were recorded after both active and control massage in lateral incisors (McNemar test, P = 1.0), 329 (active) versus 316 (control) episodes in the premolars (McNemar test, P = .344), and 119 (active) versus 109 (control) episodes respectively for first molars (McNemar test, P = .444). Speed of anesthetic onset and discomfort did not differ between treatments. We concluded that soft tissue massage after MINB does not influence anesthetic efficacy.
Anesthesia Progress 01/2013; 60(1):15-20.
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ABSTRACT: To compare the effectiveness of buccal and lingual local anaesthetic injections in the mandibular first molar region in obtaining pulpal anaesthesia in mandibular teeth.
Twenty healthy volunteers received 1.8 mL of 4% articaine with 1 : 100,000 epinephrine as a buccal or lingual infiltration in the mandibular first molar region in a randomized double-blind cross-over design. The responses of the first molar, a premolar and the lateral incisor teeth were assessed using an electronic pulp tester over a 47-min period. Successful anaesthesia was defined as no response to maximum stimulus from the pulp tester on two or more consecutive tests. Success between techniques was analysed using the McNemar test and variations between teeth were compared with Chi-square.
The number of no responses to maximum stimulation from an electronic pulp tester was significantly greater for all test teeth after the buccal injection compared with the lingual approach (P < 0.001). Successful anaesthesia was more likely following the buccal infiltration compared with the lingual method for molar (65% and 10%, respectively) and premolar (90% and 15%, respectively) teeth. There was no difference in anaesthetic success for the lateral incisor.
Buccal infiltration at the first mandibular molar is more effective than lingual infiltration in the same region in obtaining anaesthesia of the mandibular first molar and premolar teeth.
International Endodontic Journal 03/2011; 44(7):676-81. · 2.18 Impact Factor
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ABSTRACT: To compare the efficacy of 2% lidocaine and 4% articaine both with 1:100,000 adrenaline in anaesthetising the pulps of mandibular incisors.
Thirty-one healthy adult volunteers received the following local anaesthetic regimens adjacent to a mandibular central incisor: 1) buccal infiltration of 1.8 mL lidocaine plus dummy lingual injection (LB), 2) buccal plus lingual infiltrations of 0.9 mL lidocaine (LBL), 3) buccal infiltration of 1.8 mL articaine plus dummy lingual injection (AB), 4) buccal plus lingual infiltrations of 0.9 mL articaine (ABL). Pulp sensitivities of the central incisor and contralateral lateral incisor were assessed electronically. Anaesthetic efficacy was determined by two methods: 1) Recording the number of episodes with no responses to maximal electronic pulp tester stimulation during the course of the study period, 2) recording the number of volunteers with no response to maximal pulp tester stimulation within 15 min and maintained for 45 min (defined as sustained anaesthesia). Data were analysed by McNemar, chi-square, Mann-Whitney and paired t-tests.
For both test teeth, the number of episodes of no sensation on maximal stimulation was significantly greater after articaine than lidocaine for both techniques. The split buccal plus lingual dose was more effective than the buccal injection alone for both solutions (p <0.001). 4% articaine was more effective than 2% lidocaine when comparing sustained anaesthesia in both teeth for each technique (p <0.001), however, there was no difference in sustained anaesthesia between techniques for either tooth or solution.
4% articaine was more effective than 2% lidocaine (both with 1:100,000 adrenaline) in anaesthetising the pulps of lower incisor teeth after buccal or buccal plus lingual infiltrations.
British dental journal official journal of the British Dental Association: BDJ online 11/2010; 209(9):E16. · 1.09 Impact Factor
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ABSTRACT: Dental practitioners will encounter patients who have been affected by cancer or who are current cancer patients. Dentists play an important role in the overall healthcare of such patients, particularly in those with head and neck malignancy. This paper gives an overview of the impact of cancer and its treatment on dental management.
British dental journal official journal of the British Dental Association: BDJ online 07/2010; 209(2):65-8. · 1.09 Impact Factor
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ABSTRACT: There are a significant number of patients in society who have some form of psychiatric disorder. It is important that dental practitioners have an awareness of the more common psychiatric disorders and their potential implications as they are likely to encounter them in clinical practice.
British dental journal official journal of the British Dental Association: BDJ online 07/2010; 209(1):11-6. · 1.09 Impact Factor
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ABSTRACT: Aim: To determine if predicted difficulty of exposure of palatally displaced, unerupted canines assessed by radiographic score had influenced the choice between a local or a general anaesthetic procedure in adolescents.Materials and methods: This was a retrospective analysis of patients undergoing surgical exposure of palatal canines between December 2005 and June 2008 in a dental hospital setting. A total of 56 subjects, for whom complete records were available, aged 16 years or under and assessed and treated by one surgeon, were included. The predicted degree of difficulty of exposure was graded from preoperative radiographs based on three criteria; the horizontal and vertical position of the crown, and the canine angulation (possible score range 3–11: higher score = more difficulty). The radiographic scores and patient age for the local anaesthetic and general anaesthetic groups were compared using Student's unpaired t-tests. Other variables including gender, other surgical treatment required and unilateral or bilateral exposure were evaluated by chi-squared analysis.Results: Thirty-one (55%) patients were treated with local anaesthetic and 25 (45%) with general anaesthetic, the mean age was 13.7 years. The mean radiographic scores did not differ between groups being 7.53 and 7.36 for the local anaesthetic and general anaesthetic groups, respectively. Chi-squared analysis showed concurrent other surgical treatment to be the only statistically significant factor in anaesthetic choice.Conclusions: Difficulty of canine exposure is not a significant factor in anaesthetic choice for adolescents, other concurrent surgical treatment appears a more significant factor in anaesthetic choice in this group.
Oral Surgery 06/2010; 3(1‐2):11 - 15.
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ABSTRACT: Skin disorders are potentially important to dentists in diverse ways. The skin disease itself might have oral manifestations, and drugs used to treat skin disorders may impact on dental management. This second paper on skin disorders continues with a consideration of those disorders, and aspects of their treatment, which could have relevance to dental practitioners.
British dental journal official journal of the British Dental Association: BDJ online 06/2010; 208(11):515-8. · 1.09 Impact Factor
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ABSTRACT: Skin disorders are potentially important to dentists in diverse ways. The skin disease itself might have oral manifestations, and drugs used to treat skin disorders may impact on dental management. This first paper considering skin disorders examines points to look out for in the history and considers specific groups of conditions. Further conditions will be discussed in part B.
British dental journal official journal of the British Dental Association: BDJ online 05/2010; 208(10):453-7. · 1.09 Impact Factor
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ABSTRACT: It is important for dental practitioners to have a basic knowledge of the more common metabolic disorders as some may impact on the practice of dentistry. Many of these disorders do not have overt clinical signs. Taking a thorough medical history and where necessary, liaising with the patient's physician, is particularly important.
British dental journal official journal of the British Dental Association: BDJ online 05/2010; 208(9):389-92. · 1.09 Impact Factor
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ABSTRACT: This paper is the start of a series on general medicine and surgery for dental practitioners. It follows on from a previous series, published in the British Dental Journal in 2003. The proportion of older people in the UK population has been on the increase for several years. Dental practitioners who treat the general public often see older patients on a regular basis. This paper considers aspects of clinical management in the older patient with particular reference to the presentation of disease and factors to be considered in prescribing medication.
British dental journal official journal of the British Dental Association: BDJ online 04/2010; 208(8):339-42. · 1.09 Impact Factor
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J G Meechan
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ABSTRACT: This paper describes clinical and laboratory investigations concerned with the delivery, comfort, systemic effects and efficacy of dental local anaesthesia. Factors influencing the aspirating ability of dental local anaesthetic delivery systems are discussed. The effects of adrenaline in dental local anaesthetic solutions on plasma potassium levels and on the transplanted heart are described. The use of an infiltration technique as an alternative to the inferior alveolar nerve block in the mandible is discussed.
The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 12/2009; 7(6):358-61. · 1.41 Impact Factor
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J G Meechan
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ABSTRACT: This is to review the factors involved in administering local analgesia (LA) to children.
This paper describes those aspects that a dentist can control and considers strategies to reduce injection discomfort. The main factors affecting successful use of LA in children are detailed. These include equipment factors, such as needles, syringes and cartridges and patient factors focussing on expectation of pain and anxiety of a child, area of the mouth to be injected, and the appropriate LA technique. In addition safety aspects of using LA in children are discussed.
A number of factors that are under the influence of the dentist can affect the discomfort of LA. Knowledge of safe LA doses is important to ensure that toxic reactions do not occur.
European Archives of Paediatric Dentistry. Official Journal of the European Academy of Paediatric Dentistry. 07/2009; 10(2):71-6.
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ABSTRACT: To compare mandibular tooth pulpal anaesthesia and reported discomfort following lidocaine inferior alveolar nerve block (IANB) with and without supplementary articaine buccal infiltration.
In this prospective randomized double-blind cross-over study, thirty-six healthy adult volunteers received two IANB injections of 2 mL lidocaine 2% with epinephrine 1 : 80,000 over two visits. At one visit, an infiltration of 2 mL of articaine 4% with epinephrine 1 : 100,000 was administered in the mucobuccal fold opposite a mandibular first molar. At the other visit, a dummy injection was performed. Injection discomfort was recorded on 100 mm visual analogue scales. Pulpal anaesthesia of first molar, premolar, and lateral incisor teeth was assessed with an electronic pulp tester until 45 min post-injection. A successful outcome was recorded in the absence of sensation on two or more consecutive maximal pulp tester stimulations. Data were analysed using McNemar and Student's t-tests.
The IANB with supplementary articaine infiltration produced more success than IANB alone in first molars (33 volunteers vs. 20 volunteers respectively, P < 0.001), premolars (32 volunteers vs. 24 volunteers respectively, P = 0.021) and lateral incisors (28 volunteers vs. 7 volunteers respectively, P < 0.001). Buccal infiltration with articaine or dummy injection produced less discomfort than IANB injection (t = 4.1, P < 0.001; t = 3.0, P = 0.005 respectively).
The IANB injection supplemented with articaine buccal infiltration was more successful than IANB alone for pulpal anaesthesia in mandibular teeth. Articaine buccal infiltration or dummy buccal infiltration was more comfortable than IANB.
International Endodontic Journal 04/2009; 42(3):238-46. · 2.18 Impact Factor
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ABSTRACT: The present study investigated the magnitude and duration of postoperative pain after apicectomy under local anaesthesia in 80 patients. Multiple regression analysis was used to determine the relationship between certain preoperative and operative variables with both the pain experience on the day of surgery and the overall pain experience throughout the 7-day investigation period. The results showed that postoperative pain after apicectomy is of short duration and reaches its maximum intensity in the early postoperative period. The magnitude of pain does not appear to be dependent upon the operator, sex of the patient or surgical trauma. However, a previous history of acute periapical infection is an important determinant of the postoperative pain experience.
International Endodontic Journal 09/2007; 19(5):242 - 247. · 2.18 Impact Factor
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ABSTRACT: All Higher Education Institutions in the UK are now required to provide transcripts of student activity and outcomes of summative assessments. In addition, the student should be able to reflect on their learning and plan their own development. This article reports on the staff evaluation of the use of a reflective portfolio facilitating the production of highly individualised personal development plans within an existing tutor system. A number of significant issues are highlighted; tutor systems adopting this approach must maintain flexibility for managing student crises when they arise, the difference between appraisal and assessment needs clear definition for both students and tutors, training in basic mentoring skills should be provided for all tutors, tutors should be aware of the difficulties many students experience with reflection and also be alert to the over reflective learner.
European Journal Of Dental Education 12/2006; 10(4):217-25. · 1.18 Impact Factor
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ABSTRACT: This paper describes developments in the field of dental local anaesthesia. Recently introduced injectable agents, advances in the field of topical anaesthesia and new delivery systems are discussed.
SADJ: journal of the South African Dental Association = tydskrif van die Suid-Afrikaanse Tandheelkundige Vereniging 11/2006; 61(9):396-8, 400, 402.
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ABSTRACT: To compare the efficacy of buccal and buccal plus lingual infiltration anaesthesia for permanent mandibular first molars.
Thirty one healthy adult volunteers received each of the following methods of anaesthesia for a mandibular first molar tooth in a randomised order, 1) Buccal infiltration of 1.8 mL and needle penetration lingually. 2) Buccal infiltration of 0.9 mL, plus lingual infiltration of 0.9 mL. Two percent lidocaine with 1:100,000 epinephrine was used. Electrical pulp testing was performed before, and every 2 minutes for 30 minutes after injection. A successful outcome was recorded as the absence of pulp sensation on two or more consecutive maximal pulp tester stimulations (80 microA). Injection discomfort was assessed using visual analogue scales. Data were compared with McNemar and Wilcoxon Signed Ranks tests.
Buccal infiltration was successful in 38.7% of cases compared to 32.3% after combined infiltrations; the difference was not significant (P = 0.63). Buccal infiltration produced more episodes of no response to maximum stimulation than buccal and lingual infiltrations (129 and 114 respectively), this difference was not significant (P = 0.11). Peak anaesthetic effect occurred around 10-14 minutes after injection. There was no difference in injection discomfort between buccal injections of 0.9 mL and 1.8 mL of solution (P = 0.90). Lingual injection was more uncomfortable than lingual penetration (P = O.O02).
Buccal and buccal plus lingual infiltrations did not differ in their efficacy in producing anaesthesia of permanent first molar teeth.
International Endodontic Journal 11/2006; 39(10):764-9. · 2.18 Impact Factor
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ABSTRACT: To compare the ability of re-usable and partly disposable dental cartridge syringes to aspirate in vitro.
A laboratory investigation comparing two re-usable (Astra and Rotor) and one partly disposable (Ultra Safety-plus) dental cartridge syringes. Forces needed to move the cartridge plunger and forces required to produce aspiration of Bonney's Blue dye were measured using an Instron testing machine.
There were significant differences in the forces needed to produce aspiration in the different systems (F = 194, p<0.001). The Astra system needed the least force to produce aspiration. The forces required to aspirate in the Rotor and Ultra Safety-plus systems did not differ. Each system aspirated effectively in vitro at the initial aspiration manoeuvre. The forces available for subsequent aspiration attempts varied with the speed of cartridge plunger movement. The volume of local anaesthetic cartridge used did not affect the force needed to produce aspiration in the Ultra Safety-plus syringe. The method of testing free-flow of solution through the needle affected the force generated at subsequent plunger movements.
The re-usable and partly disposable syringes investigated aspirated effectively at the initial aspiration manoeuvre. The force available to produce aspiration at subsequent attempts varies with the speed of injection. The method of testing free-flow of solution through the needle in a loaded syringe affects the force available at the first aspiration manoeuvre.
Journal of Dentistry 01/2006; 34(1):41-7. · 2.95 Impact Factor
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ABSTRACT: The aim of this study was to identify which local anaesthetic solutions were used by general dental practitioners in the United Kingdom and to determine selection criteria. In addition, differences in anaesthetic choice between recent graduates (< or = 5 years) and more experienced practitioners were investigated.
Five hundred and six general dental practitioners attending postgraduate courses on pain control in dentistry completed a questionnaire. Participants were asked to indicate year and place of qualification, anaesthetic solutions available in their surgeries and criteria used in the choice of anaesthetic. In addition, the respondents were asked to indicate choice of local anaesthetic in a number of common medical conditions. Questionnaires were distributed and collected immediately prior to the start of the course presentation and participants were not asked to indicate whether the selection decisions were teaching, experience or evidence based. Data were analysed by using the Chi-square test.
Lidocaine with epinephrine was the most widely available solution among this group of practitioners (94%), the second most common solution was prilocaine with felypressin (74%). The majority of practitioners had two or more solutions available. Practitioners who qualified within the last five years (14%) were more likely to have articaine available, the most recently introduced local anaesthetic into the UK (p = 0.04, one degree of freedom). Common medical conditions lead to a modification in anaesthetic selection: the use of prilocaine/felypressin increases in the majority of circumstances, although it is avoided in pregnant females by recent graduates.
Lidocaine/epinephrine continues to be the most common anaesthetic solution used by this group of UK general practitioners. The primary criterion for selection of an anaesthetic agent was perceived efficacy. Prilocaine/felypressin is commonly selected as an alternative solution in the presence of common medical conditions.
British dental journal 12/2005; 199(12):784-7; discussion 778. · 0.92 Impact Factor
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ABSTRACT: To test the hypothesis that the Stabident intraosseous injection is a potentially high-pressure technique, which carries serious risks of anaesthetic cartridge failure.
A standard Astra dental syringe was modified to measure the internal pressure of local anaesthetic cartridges during injection. Intra-cartridge pressures were measured at 1 s intervals during slow (approximately 15 s) and rapid (<10 s) injections of 2% Xylocaine with 1:80,000 adrenaline (0.25 cartridge volumes) into air (no tissue resistance), or into freshly prepared Stabident perforation sites in the anterior mandible of freshly culled young and old sheep (against tissue resistance). Each injection was repeated 10 times over 3 days. Absolute maximum pressures generated by each category of injection, mean pressures at 1 s intervals in each series of injections, and standard deviations were calculated. Curves of mean maximum intra-cartridge pressure development with time were plotted for slow and rapid injections, and one-way anova (P<0.05) conducted to determine significant differences between categories of injection.
Pressures created when injecting into air were less than those needed to inject into tissue (P<0.001). Fast injection produced greater intra-cartridge pressures than slow delivery (P<0.05). Injection pressures rose more quickly and to higher levels in small, young sheep mandibles than in larger, old sheep mandibles. The absolute maximum intra-cartridge pressure developed during the study was 3.31 MPa which is less than that needed to fracture glass cartridges.
Stabident intraosseous injection conducted in accordance with the manufacturer's instructions does not present a serious risk of dangerous pressure build-up in local anaesthetic cartridges.
International Endodontic Journal 06/2005; 38(5):291-6. · 2.18 Impact Factor
