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Distraction anaesthesia: Applying the gate control theory in delivering painless anaesthesia
... This is also one of the main reasons why patients avoid regular checkups with their dentists 3 . Among the methods used to manage this situation we find the use of troncular injections, injection speeds below 1 tube per minute 4,5 , and the compression of the tissue surrounding the puncture site 5 . However, all these methods are operator-dependent and may be ineffective in a local infiltration technique. ...
... This is also one of the main reasons why patients avoid regular checkups with their dentists 3 . Among the methods used to manage this situation we find the use of troncular injections, injection speeds below 1 tube per minute 4,5 , and the compression of the tissue surrounding the puncture site 5 . However, all these methods are operator-dependent and may be ineffective in a local infiltration technique. ...
... These results are a contribution to the different mechanisms used in dentistry to manage pain and anxiety in patients during dental treatment. A reduction in the perception of pain by injecting anesthetic solutions at temperatures equal to or greater than the body has been shown in different areas of medicine 5,7 . It dentistry it is particularly important since most dental procedures require local anesthesia. ...
Aim: To determine the effectiveness of anesthesia warming control pain feeling during the administration of anesthesia in maxillary infiltration technique nerve block. Methods: A double-blind clinical trial study was designed. Fifty-six volunteers students (mean age 23.1±2.71 years) of Universidad Austral de Chile Dental School (Valdivia, Chile) were participated. They were given 0.9 ml of 2% lidocaine with 1: 100,000 epinephrine (Alphacaine®; Nova DFL - Brazil) by two punctions at buccal vestibule of lateral incisor. In a hemi-arch a warm anesthesia of 42ºC (107.6°F) was administered; and after one week in to contralateral side a room temperature (21ºC; 69.8°F) was administered. In both times with a standard speed. The level of intensity pain perceived during injection was registered and compared by visual analog scale (VAS) of 100mm (Wilcoxon test p
... The use of local anesthesia in dentistry is a critical component in dental treatment given patients' fear of injections and pain caused during the injection of anesthesia. 1 This act causes inherent tissue damage during penetration of the needle and injection of anesthetic fluid, 2 releasing proinflammatory mediators and increasing the pressure in the submucosal tissue that activates nociceptor terminals, sensitizing the puncture site. 3 The methods studied to control this situation include the use of nerve block injections, lower injection speeds at 1 cartridge/min 4,5 and the compression of tissues adjacent to the puncture site. 5 However, all these methods are operator-dependent. ...
... 3 The methods studied to control this situation include the use of nerve block injections, lower injection speeds at 1 cartridge/min 4,5 and the compression of tissues adjacent to the puncture site. 5 However, all these methods are operator-dependent. One method proven to reduce the perception of pain is to warm local anesthetics. ...
Background
The purpose of this study is to determine the effectiveness of warming anesthesia on the control of the pain produced during the administration of dental anesthesia injection and to analyze the role of Transient Receptor Potential Vanilloid-1 nociceptor channels in this effect.
Patients and methods
A double-blind, split-mouth randomized clinical trial was designed. Seventy-two volunteer students (22.1±2.45 years old; 51 men) from the School of Dentistry at the Universidad Austral de Chile (Valdivia, Chile) participated. They were each administered 0.9 mL of lidocaine HCl 2% with epinephrine 1:100,000 (Alphacaine®) using two injections in the buccal vestibule at the level of the upper lateral incisor teeth. Anesthesia was administered in a hemiarch at 42°C (107.6°F) and after 1 week, anesthesia was administered by randomized sequence on the contralateral side at room temperature (21°C–69.8°F) at a standardized speed. The intensity of pain perceived during the injection was compared using a 100 mm visual analog scale (VAS; Wilcoxon test p<0.05).
Results
The use of anesthesia at room temperature produced an average VAS for pain of 35.3±16.71 mm and anesthesia at 42°C produced VAS for pain of 15±14.67 mm (p<0.001).
Conclusion
The use of anesthesia at 42°C significantly reduced the pain during the injection of anesthesia compared to its use at room temperature during maxillary injections. The physiological mechanism of the temperature on pain reduction could be due to a synergic action on the permeabilization of the Transient Receptor Potential Vanilloid-1 channels, allowing the passage of anesthetic inside the nociceptors.
... [5] There are numerous techniques to mitigate pain during injections, including distractions, topical anesthetics, applying lignocaine patches to the gingiva, using electronic dental anesthesia, or utilizing certain computerized tools such as the Wand. [6][7][8] Operator-defined approaches have also been employed, notably troncular injections or the Halstead technique, injection delivery at speeds below one cartridge per minute, and compression of the tissue close to the puncture site. [9][10][11][12] These methods, which depend on the operator, have not been able to totally eradicate the fear and anxiety related to dental care among children. ...
Background
Both precooling the site and injecting a warm anesthetic solution have proven to be efficient in reducing pain individually. However, there is insufficient data on evaluating the efficiency of precooling the site of injection along with the simultaneous administration of a warm local anesthetic solution on the same site in a single patient.
Aim
The aim of this study was to evaluate and compare the efficacy, pain perception, hemodynamic changes, and adverse effects of a warm local anesthetic solution injected on precooled injection sites using 2% lignocaine with the conventional local anesthetic technique during inferior alveolar nerve block in 7–9-year-old children.
Methods
A split-mouth, double-blinded, randomized clinical trial was conducted on 70 children who received 2% lignocaine with either technique A or B during the first or second appointment of the treatment procedure. The pain perception, anesthetic efficacy, pulse rate, oxygen saturation levels, and adverse events were evaluated.
Results
Pain during injection and treatment after administration of the warm local anesthesia (LA) technique was less as compared to the conventional block technique. Anesthetic success was observed with a faster onset of action (212.57 ± 32.51 s) and shorter duration of LA (165.16 ± 33.09 min) in the warm local technique as compared to the conventional technique. No significant differences were found with regard to heart rate and oxygen saturation levels between the two techniques. Administrating warm LA solutions at precooled injection sites revealed fewer adverse events.
Conclusion
Injecting warm LA solution on precooled injection sites causes less discomfort and anxiety in children, which makes it more suitable for the child as well as the pediatric dentist.
... 12 The palatal mucosa is compacted and firmly assured to its fundamental periosteum also its copious nervous accompaniment; inoculations in the palate are always very tender. 13 For numerous patients, palatal injections show to be an actual painful involvement, so they need palatal anesthesia. 14 In the present study, admission of lidocaine HCl to the oral vestibule and 8 minutes inactivity time without palatal injection displayed like consequences with using palatal injection removal of long-lasting maxillary teeth. ...
Background: Pain-free operation is an additional advantage to the patient and assists the dentist in managing the patient in a peaceful, slow style. Injection in the palate is more painful of entirely oral cavity injections due to its abundant nervous supply and the tight binding of the palatal mucosa to its underlying periosteum. Aim: This current research aimed to assess the efficacy of 2% lidocaine and 1:80,000 epinephrine with buccal vestibular infiltration injections without palatal infiltration injections compared with the buccal vestibular infiltration injections with palatal infiltration injections. Materials and methods: This study was done in the College of Dentistry at the Iraqi university through 2021. The study sample included 100 patients, age range from 17 years old to 69, and all Iraqi nationality. There were 23 females and 77 males, with the diagnosis for any cases that indicated for extraction (necrotic pulp, chronic pulpitis etc.). It was splinted into two groups group 1 (50 patients, 11 female, and 39 male), which receive only full cartilage (1.8 mL) labial/buccal anesthesia injection and waiting for 8 minutes before extraction and didn't obtain palatal injection in the palate for removal of long-lasting teeth of maxillary and group 2 (50 patients, 12 female, and 38 male) which receives labial/buccal and palatal anesthesia for extraction of permanent maxillary teeth. All patients receive local anesthesia 1.8 mL carpule lidocaine local anesthetic agent concentration 2% with epinephrine vasoconstrictor concentration 1:80,000. Results: In this study, deposition of lidocaine HCl to the buccal vestibule and 8-min latency period without palatal injection showed similar statistical results with using palatal injection n extraction of permanent maxillary teeth. Conclusion: Pain control during a surgical procedure is one of the most important factors for reducing the fear and anxiety associated with a dental procedure. This approach reduces the discomfort and can be used as an alternative to palatal infiltration as the LA can diffuse through tissues more efficiently and give clinicians a chance to avoid painful palatal injections. It is recommended to use in all cases of uncomplicated maxillary exodontia to improve the patient's experience.
The objective of this study was to determine the effect of time on the clinical efficacy of topical anesthetic in reducing pain from needle insertion alone as well as injection of anesthetic. This was a randomized, double-blind, placebo-controlled, split-mouth, clinical trial which enrolled 90 subjects, equally divided into 3 groups based upon time (2, 5, or 10 minutes) of topical anesthetic (5% lidocaine) application. Each group was further subdivided into 2: needle insertion only in the palate or needle insertion with deposition of anesthetic (0.5 mL 3% mepivacaine plain). Each subject received drug on one side and placebo on the other. Subjects recorded pain on a 100-mm visual analog scale (VAS). The results showed that for needle insertion only, 5% lidocaine reduced pain as determined by a significant difference in mean VAS after 2 minutes (20.1 mm, P < .002), 5 minutes (15.7 mm, P < .022), and 10 minutes (13.7 mm, P < .04), as analyzed by paired t tests. For needle insertion plus injection of local anesthetic, a significant difference in mean VAS was noted only after 10 minutes (14.9 mm, P < .031), yet pain scores for both topical anesthetic and placebo were elevated at this time point resulting in no reduction in actual pain. Time of application did not result in a significant difference in effect for either needle insertion only or needle insertion plus injection of local anesthetic, as analyzed by 1-way analysis of variance (ANOVA). In conclusion, topical anesthetic reduces pain of needle insertion if left on palatal mucosa for 2, 5, or 10 minutes, but has no clinical pain relief for anesthetic injection.
This investigation compared the use of a 5% eutectic mixture of local anesthetics (EMLA) cream to a "standard" intraoral topical anesthetic (5% lidocaine) as a means of anesthetizing the gingival sulcus in a double-blind, split-mouth study with human volunteers. A 5-min application of EMLA in a customized intraoral splint resulted in a significant increase in the depth of probing of the gingival sulcus without discomfort compared to a similar application of 5% lidocaine. Following application of EMLA, the pain-free probing depth measured at three sites in the upper premolar region increased by a mean total of 2.8 mm compared to an increase of 1.9 mm with lidocaine. This study suggests EMLA may be advantageous in providing periodontal anesthesia where manipulation of the gingiva is necessary.
Local anaesthetics (LAs) are used by medical practitioners in a number of clinical settings. The choice of agent and mode of administration is influenced by their experience, speciality and knowledge of the evidence base. Patients often express concern about the discomfort experienced during injection. Although short lived, the pain of LA administration in some patients is severe enough for them to decline future surgery. Methods to minimise the pain of LA administration relate to (1) the patient, (2) the LA, and (3) the injection technique (table 1). This article aims to provide a practical guide to doctors of all specialities who use LAs.
Most cutaneous surgeries are performed under local anaesthesia. It is important the process of administration of local anaesthetics is pain free. This article suggests simple tips to make local anaestesia less painful.
The injection of local anaesthetic solutions is painful. We report the results of a blinded randomised controlled trial comparing the pain of injection of local anaesthetics at room temperature and body temperature. The results show that local anaesthetic solution injected at body temperature produces significantly less pain than local anaesthetic injected at room temperature.
One hundred and thirty-six patients attending for local anaesthetic procedures in the trigeminal area were assigned to four groups. Each group was injected with the anaesthetic solution at temperatures 10 degrees C, 18 degrees C, 37 degrees C and 42 degrees C, respectively. Measurement of pain during injection was made on a numeric scale. The results show a strong relationship between the temperature of the anaesthetic solution and the pain of the injection (p < 0.001). This demonstrates that warming the anaesthetic solution significantly reduces the pain felt by the patient during injection, especially at 42 degrees C.
The injection of local anaesthetic solutions is frequently a painful and unpleasant experience for patients. A double-masked randomised controlled trial was performed to study the potential benefit of warming lignocaine during local anaesthetic minor surgical procedures on the eyelids. The pain of subcutaneous injection of 1.5 ml of 2% lignocaine at room temperature (cold) and body temperature (warm) was compared in 60 patients during the surgical incision of solitary meibomian cysts of one eyelid. Patients were randomly allocated to receive either warm or cold lignocaine. Pain was assessed subjectively by the use of a linear analogue pain scale ranging from 0 to 100. The median pain score for the group receiving cold anaesthetic (19.5) was found to be greater than that for the warm group (10.0; p = 0.02). In conclusion, the simple process of warming lignocaine to 37 degrees C was found to reduce the pain associated with its injection significantly. It is recommended that this technique be more widely adopted in order to minimise patients' discomfort.