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Clinical Assessment of ScandonestⓇin Pediatric Dentistry A Comparative Study among Five Local Anesthetics
Abstract
ScandonestⓇ, a short-action dental local anesthetic, is supplemented without vasoconstrictor, preservative or antioxidant. Therefore, the anesthetic could be useful for pediatric patients. However,only a few clinical studies have been reported to date in Japan.In this study, we aimed to investigate the clinical utility of ScandonestⓇin pediatric dentistry. The subjects of this study comprised 148 patients in need of local anesthesia for dental treatment at the Dental Hospital, Tokyo Medical and Dental University. We administered a questionnaire to the patients and their dentists. Each dentist chose and used one of the following five kinds of local anesthetic : ScandonestⓇ, CitanestⓇ, Citanest with OctapressinⓇ, XylocaineⓇand ORAⓇInj. Cartridge.The results indicate that the anesthetic effect and pain during dental treatment are comparable among these anesthetics. There were significant differences in discomfort level after dental treatment,and the discomfort from ScandonestⓇtended to be less compared to the other anesthetics.These results suggest that ScandonestⓇcould be used as an effective local anesthetic, performing similarly to other anesthetics. Therefore, except for invasive treatments and dental treatments lasting longer than 30 minutes, ScandonestⓇwould be useful in pediatric dentistry.
... Local anesthesia by insertion with a small needle into gingival tissue is often employed, though most child patients feel anxiety and refuse local anesthesia prior to undergoing dental surgery. In addition, it has been reported that a local anesthetic containing a vasoconstrictor should be used with extreme caution in pediatric patients who have a medical history or physical evaluation results suggesting the existence of heart disease [11]. Based on the findings in that study, we used Scandonest® (3% mepivacaine) without a vasoconstrictor in the present patient, as it was considered to have no effect on cardiac function. ...
Left ventricular noncompaction (LVNC) is a recently described rare type of congenital cardiomyopathy with a poor long-term prognosis. We performed dental extraction for a 6-year-old female patient with LVNC who had risk of endocarditis due to dental disease along with a history of being uncooperative with dental care. For this case, we utilized intranasal (IN) midazolam conscious sedation, which enables a rapid sedation onset and is considered appropriate for child patients with a high level of anxiety, as movement is effectively decreased, making dental surgery possible. In cases with a small number of teeth, IN midazolam conscious sedation provides a safe condition for high-risk or anxious children undergoing treatment.
From January to December 2003, the Showa University Pedodontics Department carried out checkups of 1065 cleft lip and palate patients; facts regarding the tooth extraction cases are as follows:
1. From the total number of patient visits (2320) during the one-year period, 110 cases involved tooth extraction.
2. Patients in this study ranged from 4 to 18 years of age. The greatest number of extractions was carried out on the 8-year-olds.
3. As for the reasons for tooth extraction, the largest number of cases were requests from orthodontists.
4. For those cases involving bone graftings, an average of 1.33ml anesthesia was used, and for the other cases involving persistence of deciduous teeth, an average of 0.73ml anesthesia.
5. Of the 133 teeth extracted from 110 patients, 5 teeth showed extreme tooth decay while 27 cases involved persistence of deciduous teeth most of which were of the upper jaw. From the bone grafting patients, there were 25 incisor deciduous teeth extractions located near the alveolar cleft. From the 76 extractions requested by orthodontists, most involved maxillary decidious teeth followed by permanent premolars.
Anaeject® is an electric injector which was recently designed to control the injection speed in order to reduce pain during local anesthesia. An electric music can also be played to comfort the patient during the procedure (melody mode). The purpose of this investigation was to clinically verify the efficacy of Anaeject® using Scandonest®, a local anesthesia was given to 49 young patients (20 boys, 29 girls) using Anaeject® and Scandonest® prior to dental treatment. A questionnaire survey was collected from these patients. The average dose of Scandonest® was 0.9ml during the average treatment time of 19 minutes. Few patients complained of pain or discomfort during and after treatment. Majority of the patients felt less pain and fear from local anesthesia compared to a manually operated injector. Based on these findings, it was suggested that local anesthesia using Anaeject® and Scandonest® was useful and effective in daily pediatric dentistry.
Lidocaine and propitocaine with vasoconstrictor are currently often used as local anesthetics in not only geriatric dentistry but also pediatric dentistry. In 1969. D. Bradley and N. Martin described that mepivacaine 3% offered the advantage of being well tolerated and of providing satisfactory anesthesia of considerably shorter duration of effect. The purpose of this investigation was to clinically examine the efficacy of the Scandonest® cartridge 3%. Among 80 cases, there were 53 complete responses with no pain (66.2%), 19 incompatibilities (23.8%), and 8 minor responses (10%). No cases were judged to be ineffective. Among 59 cases in the restorative treatment group, there were 58 effective responses (98.1%), and 1 minor response (1.996). Side effects were not observed in all cases. Based on these findings, the Scandonest® cartridge 3% is considered to be effective for restorative treatment in pediatric dentistry.
We report a rare case of anaphylactic shock during tooth extraction. The patient had atopic dermatitis for about 20 years. Although the serine IgE level was high, the results of drug lymphocyte stimulation tests (DLST) against all ingredients in the local anesthetics were negative.However, when we performed skin-tests against sodium metabisulfite and para-oxy benzoic acid methyl, small amounts of which were contained in the local anesthetics, sodium metabisulfite induced an allergic reaction.We conclude that this was a rare case of anaphylaxis caused by sodium metabisulfite in a patient with atopic dermatitis.We should be especially cautious when we use local anesthetics in patients with atopic dermatitis.