E R Young’s research while affiliated with University of Toronto and other places

Claims that labial infiltration of the local anesthetic articaine HCl (Ultracaine DS) results in anesthesia of mandibular pulpal as well as maxillary and mandibular lingual soft tissue have never been scientifically substantiated. The aim of this investigation was to evaluate these claims, by comparing articaine to a standard anesthetic, prilocaine HCl (Citanest Forte). To investigate this, a double blind, randomized study was conducted in healthy adult volunteers. In each volunteer, the ability to induce maxillary and mandibular anesthesia following labial infiltration with articaine was compared to prilocaine given contralaterally. Anesthesia was determined by measuring sensation to electrical stimulation at the tooth, labial and lingual soft tissue for each of the 4 non-carious, non-restored, canines. Results showed that mandibular canine pulpal anesthesia had a success rate of 65% for articaine and 50% for prilocaine. Success rates for palatal and lingual anesthesia averaged 5% for each agent. As determined by chi-square analysis, no statistically significant differences were found between articaine and prilocaine for any tissue at any of the 6 sites (P greater than 0.05). A time-course assessment also failed to demonstrate a difference between the two drugs. Therefore these data are not consistent with superior anesthesia efficacy being produced by articaine at any site, including the mandibular pulpal, lingual or maxillary palatal tissues, in the canine teeth studied.

Acute chest pain is one of the most common and potentially serious medical emergencies seen in hospital emergency departments. Because the elderly population is generally living to an older age, is more ambulatory, and is seeking more sophisticated dental care, an acute episode of chest pain in the dental office is a potential possibility. This paper will discuss a typical case report with emphasis not only on prevention, but on a step-by-step method for stabilizing any emergency situation that may occur in the dental environment.

This study utilizes healthy volunteers to determine, via electronic pulp tester, such basic clinical parameters as time of onset and duration of action for an infiltration and mandibular block utilizing the recently available local anesthetic preparation, 2 per cent lidocaine with 1:200,000 epinephrine (Octocaine 200). This study showed Octocaine 200 to be both safe and efficacious, producing times of onset and duration within the clinically useful range. The rationale for vasoconstrictor use in dentistry is also reviewed.

Flumazenil is an imidazobenzodiazepine that binds specifically to the central benzodiazepine receptor and antagonizes the actions of diazepam and other benzodiazepines. Previous studies in Europe have shown flumazenil at doses of 2 to 30 mg IV to reverse sedation in patients sedated with flunitrazepam, midazolam, and diazepam when evaluated by subjective criteria. The purpose of this study was to determine if flumazenil at 0.015 mg/kg IV was efficacious in shortening the recovery time of young, healthy dental patients sedated with diazepam (0.15 mg/kg IV) and restoring their psychomotor function to presedation levels. A total of 21 patients were randomized to placebo or flumazenil, sedated with diazepam, underwent a restorative dental procedure, and were then administered the test drug. Evaluations of psychomotor function by the Trieger test, Digit-Symbol Substitution test, Romberg test, and nurse questioning were carried out before sedation and at 10-minute intervals after test drug. Observations by the patients and nurses were not significantly different before versus after test drug. The investigator, however, found that flumazenil resulted in more rapid awakening. Patients treated with placebo exhibited significantly greater deficits in the number of dots missed and sum of deviations on the Trieger test than flumazenil-treated patients. Similar time-related deficits were recorded for the Digit-Symbol Substitution test. Flumazenil, at a dose of 0.015 mg/kg, was found to be efficacious in reducing the recovery time after diazepam sedation in dental patients.