The challenge of sedation with adolescents: case studies and clinical recommendations.
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Adolescent dental patients pose a unique challenge to providers, particularly when intravenous sedation is introduced to the treatment plan. Surveys show many adolescents are afraid of the dentist. Five to six per cent overall are fearful of dental injections and may avoid care or have irregular attendance. At the same time, adolescents may assert their independence by refusing to cooperate with providers' and parents' requests even while accepting that the goal of better health is reasonable. Successful treatment of--and rapport with--the adolescent dental patient, however, can ensure that adolescents' oral needs are met. Successful providers recognise that adolescents alternate between childlike and mature coping strategies during the course of dental treatment. Identifying an adolescent's current coping style can help the dental team select appropriate strategies to help treatment proceed more smoothly for the adolescent and clinical team. Working with adolescents' individual coping styles, rather than expecting consistently adult behaviour, will ideally help decrease frustration and improve treatment outcome. (+info)
Principles of brain plasticity in improving sensorimotor function of the knee and leg in healthy subjects: a double-blind randomized exploratory trial.
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Comparison of two different anesthesia techniques for tourniquet pain with the use of forearm tourniquet.
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PURPOSE: The purpose of this prospective, randomized study was to compare the effectiveness of two different anesthesia techniques for tourniquet pain in minor surgeries of the hand with the use of the forearm tourniquet. METHODS: In group 1, the area under the tourniquet was anesthetized circumferentially using a cream composed of 5% lidocaine and 5% prilocaine (Emla Astra). In group 2, the area under the tourniquet was anesthetized with a ring-type infiltration of the skin and subcutaneus tissues using 50% diluted Citanest solution using 22 G x 3 1/2'' size spinal needle (Sujia) with three injections. RESULTS: There were no statistically significant differences between the means of the two groups with respect to both tests (p value = 0.18 [t-test], p = 0.951 [Mann-Whitney test]). Tourniquet related anesthesia technique discomfort was higher in group 2 (p = 0.001). CONCLUSIONS: The tourniquet placed at the distal forearm is an effective, safe, and useful technique for hand surgery. Anesthesia using Emla cream is equally effective and less disturbing than using the injection technique (subcutaneus ring anesthesia). (+info)
Retrospective review of voluntary reports of nonsurgical paresthesia in dentistry.
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OBJECTIVE: Paresthesia is an adverse event that may be associated with the administration of local anesthetics in dentistry. The purpose of this retrospective study was to analyze cases of paresthesia associated with local anesthetic injection that were voluntarily reported to Ontario"s Professional Liability Program (PLP) from 1999 to 2008 inclusive, to see if the findings were consistent with those from 1973 to 1998 from this same source. MATERIALS AND METHODS: All cases of nonsurgical paresthesia reported from 1999 to 2008 were reviewed; cases involving surgical procedures were excluded. Variables examined included patient age and gender, type and volume of local anesthetic, anatomic site of nerve injury, affected side and pain on injection or any other symptoms. RESULTS: During the study period, 182 PLP reports of paresthesia following nonsurgical procedures were made; all but 2 were associated with mandibular block injection. There was no significant gender predilection, but the lingual nerve was affected more than twice as frequently as the inferior alveolar nerve. During 2006-2008 alone, 64 cases of nonsurgical paresthesia were reported to PLP, a reported incidence of 1 in 609,000 injections. For the 2 local anesthetic drugs available in dental cartridges as 4% solutions, i.e., articaine and prilocaine, the frequencies of reporting of paresthesia were significantly greater than expected (chi2, exact binomial distribution; p < 0.01) based on their level of use by Ontario dentists. These data suggest that local anesthetic neurotoxicity may be at least partly involved in the development of postinjection paresthesia. (+info)
Effectiveness of nitrous oxide and analgesic cream (lidocaine and prilocaine) for prevention of pain during intramuscular botulinum toxin injections in children.
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Survey of local anesthetic use by Ontario dentists.
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OBJECTIVE: Local anesthetics are believed to be the most frequently used drugs in clinical dentistry, and although they are generally regarded as safe, some adverse reactions can be expected and do occur. The purpose of this study was to obtain, by means of a mail survey, information on the types and amounts of local anesthetics used by Ontario dentists during 2007. MATERIALS AND METHODS: A survey requesting data on the annual use of injectable local anesthetics was mailed to all 8,058 dentists licensed by the Royal College of Dental Surgeons of Ontario in 2007. RESULTS: The effective response rate to the single mailing was 17.3% (1,395 respondents). By extrapolation, the estimated use of local anesthetics by all Ontario dentists during 2007 was determined to be about 13 million cartridges, which represents an average of 1,613 cartridges per dentist per year. Lidocaine with epinephrine 1:100,000 was the most commonly used formulation with 37.31% of total anesthetic use, followed by articaine with 1:200,000 epinephrine (27.04%) and articaine with 1:100,000 epinephrine (17.16%). Overall, local anesthetics combined with a vasoconstrictor accounted for more than 90% of total anesthetic use. A minority of survey respondents (15.68%) indicated that their pattern of anesthetic use had changed significantly in the past few years. Patterns of use were similar for early and late survey respondents. These data provide a current account of the use of local anesthetics by Ontario dentists. (+info)
A double-masked evaluation of lignocaine-prilocaine cream (EMLA) used to alleviate the pain of retrobulbar injection.
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A randomised, placebo controlled, double-masked study was undertaken in 115 patients undergoing cataract surgery to assess the efficacy of the anaesthetic cream EMLA (eutetic mixture of local anaesthetic, lignocaine-prilocaine) in alleviating the pain of retrobulbar injection. Sixty three patients received the EMLA cream and 52 the placebo cream. The pain was assessed objectively by the anaesthetist, who observed the reaction of the patient on needle insertion, and subjectively by the patient. Significantly lower pain scores were recorded in patients treated with EMLA cream (anaesthetist's observation: p less than 0.01, patient's assessment: p less than 0.006). No patients experienced serious side effects in either treatment group. (+info)