It was the purpose of the present investigation to determine if there were differences in soft-tissue anesthesia in the palate following infiltration and greater palatine nerve block anesthesia and to compare lidocaine with lidocaine plus epinephrine as palatal soft tissue anesthetics. Two studies using 10 volunteers were performed. In one trial, volunteers received a palatal infiltration opposite the second maxillary bicuspid on one side and a greater palatine nerve block on the other. Response to sharp probing and pain-pressure thresholds were measured on each side over a 1-hour census period. In the second trial, volunteers received 2% plain lidocaine as a palatal infiltration on one side and a similar infiltration of 2% lidocaine with 1:80,000 epinephrine on the other in a double-blind randomized fashion. Response to sharp probing was assessed over a 55-minute period. Data were analyzed using Student's paired t tests. The response to sharp probing and pressure-pain thresholds did not differ between palatal infiltration and greater palatine nerve block over the 1-hour period. Lidocaine with epinephrine provided longer lasting anesthesia than plain lidocaine following palatal infiltration (P < .001). Greater palatine nerve block and palatal infiltration provide similar soft-tissue anesthesia. Lidocaine with epinephrine produces longer-lasting soft-tissue anesthesia than plain lidocaine following palatal infiltration.

. Comparison of the Duration of Insensitivity to Sharp Pain Between Infiltration and Block Anesthesia in the Palate (Census End Point = 60 Minutes)
. Comparison of the Duration of Insensitivity to Sharp Pain Between 2% Lidocaine With and Without 1: 80,000 Epi- nephrine Following Infiltration Anesthesia in the Palate (Cen- sus End Point = 55 Minutes)

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SCIENTIFIC

REPORT

Local

Anesthesia

in

the

Palate:

A

Comparison

of

Techniques

and

Solutions

J.

G.

Meechan,

BSc,

BDS,

PhD,

FDSRCPS,*

P. F.

Day,

BDS,

MFDSRCS*

and

A.

S.

McMillan,

BDS,

PhD,

FDSRCPS,

FDSRCS**

*Department

of Oral

and

Maxillofacial

Surgery,

The

Dental

School,

University

of

Newcastle

upon

Tyne,

United

Kingdom,

and

**Oral

Rehabilitation,

Faculty

of

Dentistry,

University

of

Hong

Kong,

Hong

Kong,

SAR

It

was

the

purpose

of

the

present

investigation

to

determine

if

there

were

differences

in

soft-tissue

anesthesia

in

the

palate

following

infiltration

and

greater

palatine

nerve

block

anesthesia

and

to

compare

lidocaine

with

lidocaine

plus

epinephrine

as

palatal

soft

tissue

anesthetics.

Two

studies

using

10

volunteers

were

performed.

In

one

trial,

volunteers

received

a

palatal

infiltration

opposite

the

second

maxillary

bicuspid

on

one

side

and

a

greater

palatine

nerve

block

on

the

other.

Response

to

sharp

probing

and

pain-pressure

thresholds

were

measured

on

each

side

over

a

1-hour

census

period.

In

the

second

trial,

volunteers

received

2%

plain

lidocaine

as

a

palatal

infiltration

on

one

side

and

a

similar

infiltration

of

2%

lidocaine

with

1:

80,000

epinephrine

on

the

other

in

a

double-blind

randomized

fashion.

Response

to

sharp

probing

was

assessed

over

a

55-minute

period.

Data

were

analyzed

using

Student's

paired

t

tests.

The

response

to

sharp

probing

and

pressure-pain

thresholds

did

not

differ

between

palatal

infiltration

and

greater

palatine

nerve

block

over

the

1-hour

period.

Lidocaine

with

epinephrine

provided

longer

lasting

anesthesia

than

plain

lidocaine

following

palatal

infiltration

(P

<

.001).

Greater

palatine

nerve

block

and

palatal

infiltration

provide

similar

soft-tissue

anesthesia.

Lidocaine

with

epinephrine

produces

longer-lasting

soft-tissue

anesthesia

than

plain

lidocaine

following

palatal

infiltration.

Key

Words:

Lidocaine;

Epinephrine;

Palatal

mucosa;

Local

anesthetic.

There

is

a

considerable

amount

of

information

avail-

able

concerning

the

efficacy

and

duration

of

local

anesthetics

following

intraoral

injection.lA

The

efficacy

and

duration

of

intraoral

anesthesia

varies

between

dif-

ferent

local

anesthetic

solutions

and

techniques.lA

The

addition

of

a

vasoconstrictor

to

a

local

anesthetic

solu-

tion

increases

both

efficacy

and

duration

of

pulpal

an-

esthesia.

1

Similarly,

the

duration

of

soft

tissue

anesthesia

varies

between

regional

block

and

infiltration

tech-

niques.2

However,

there

is

little

information

concerning

the

duration

of

palatal

anesthesia

following

either

infil-

tration

or

regional

block

administration.

In

addition,

Received

September

26,

2000;

accepted

for

publication

January

4,

2001.

Address

correspondence

to

Dr

J.

G.

Meechan,

Department

of

Oral

and

Maxillofacial

Surgery,

The

Dental

School,

University

of

Newcastle

upon

Tyne,

Framlington

Place,

Newcastle

upon

Tyne,

UK;

J.

G.

Mee-

chan@ncl.ac.uk.

Anesth

Prog

47:139-142

2000

C)

2000

by

the

American

Dental

Society

of

Anesthesiology

there

are

no

published

data

concerning

the

effect

of

a

vasoconstrictor

on

the

duration

of

palatal

soft-tissue

an-

esthesia.

The

aim

of

the

present

study

was

to

compare

the

quality

of

palatal

anesthesia

following

infiltration

and

greater

palatine

nerve

blocks

and

to

compare

the

du-

ration

of

anesthesia

produced

by

2%

lidocaine

with

and

without

1:

80,000

epinephrine.

MATERIALS

AND

METHODS

Ten

subjects

(5

male,

5

female)

aged

20-21

years

took

part

in

the

study.

Subjects

were

healthy,

with

complete

natural

dentitions

and

no

history

of

oral

dysesthesia.

The

experimental

procedure

was

approved

by

the

local

ethics

committee.

Subjects

agreeing

to

participate

pro-

vided

informed,

written

consent.

Each

volunteer

attended

on

2

occasions.

On

the

first

ISSN

0003-3006/00/$9.50

SSDI

0003-3006(00)

139

Anesth

Prog

47:139-142

2000

occasion,

a

randomized,

double-blind,

split-mouth,

pla-

cebo-controlled

design

was

used.

The

following

protocol

was

performed.

Local

anesthetic

was

administered

as

follows:

1.

Following

aspiration,

an

injection

of

0.2

ml

2%

li-

docaine

with

1:

80,000

epinephrine

in

the

palatal

mucosa

distal

to

the

maxillary

second

bicuspid

on

one

side

was

administered

over

a

period

of

10

sec-

onds.

2.

Needle

penetration

only

in

the

palatal

mucosa

distal

to

the

maxillary

second

bicuspid

on

the

opposite

side

was

done

for

a

period

of

10

seconds

(mock

infiltra-

tion)

3.

Following

aspiration,

an

injection,

over

a

period

of

10

seconds,

of

0.2

ml

2%

lidocaine

with

1:

80,000

epinephrine

was

administered

at

the

greater

palatine

foramen

on

the

side

that

had

received

the

mock

in-

filtration.

4.

Needle

penetration

only

at

the

greater

palatine

fo-

ramen

on

the

side

that

received

the

local

anesthetic

as

an

infiltration

injection

was

done

(mock

greater

palatine

block).

The

side

at

which

the

mock

infiltration

injection

was

performed

was

randomized.

This

was

achieved

by

hav-

ing

the

side

that

was

to

receive

the

dummy

injection

written

inside

a

sealed

envelope

(envelopes

contained

either

the

word

right

or

left).

The

envelope

was

selected

randomly from

a

batch

and

was

opened

at

the

time

of

injection.

All

injections

and

needle

penetrations

were

administered

by

1

operator

using

30-gauge

needles

at-

tached

to

an

aspirating

syringe.

Two

sites

on

the

palate

(1

on

each

side)

were

selected

for

sensory

testing.

The

sites

were

located

on

the

palatal

mucosa

adjacent

(10

mm)

to

the

midpoint

of

the

palatal

gingivae

of

the

maxillary

second

bicuspid

teeth.

The

op-

erator

performing

these

tests

was

blinded

to

the

sites

of

the

active

injections

(a

different

investigator

gave

the

in-

jections).

The

term

active

injection

means

the

site

at

which

lidocaine

with

epinephrine

was

deposited.

The

methods

for

recording

perception

of

pain

have

been

described

previously.5

Briefly,

pain

sensation

was

measured

at

the

palatal

sites

using

a

pressure-sensitive

probe

(Vivacare

TPS

probe,

Vivadent

Co,

Schaan,

Liechtenstein).

This

probe

is

a

round-ended

periodontal

probe

with

a

force-indicator

line

that

registers

that

a

force

of

20

g

has

been

applied.

This

force

of

20

g

was

applied

perpendicular

to

the

test

site

to

determine

whether

any

sensation

was

perceived.

A

sensation

of

pain

was

defined

as

a

sharp,

distinct

pin

prick.

The

or-

der

of

measurement

was

alternated

between

left

and

right

sides

throughout

the

visit.

Two

trials

were

made

at

each

site.

The

pressure-pain

threshold

(PPT)

was

measured

at

the

2

recording

sites

using

a

calibrated

algometer.6

The

spherical

tip

of

the

device

(4.8-mm

diameter)

was

aligned

perpendicular

to

the

test

site.

The

applied

pres-

sure

was

controlled

at

20-40

g/s

throughout

the

test

series

by

a

rate

meter

incorporated

in

the

algometer.

Subjects

indicated

when

the

pressure

applied

had

changed

from

a

pressure

sensation

to

one

of

pain

by

raising

the

left

hand.7

The

recording

device

was

then

removed

from

the

site.

Two

trials

were

made

at

each

site.

A

maximum

pressure

of

900

g

was

applied

during

local

anesthesia

to

ensure

no

trauma

to

the

test

site.

The

timing

and

randomization

of

measurement

was

the

same

as

for

pain

sensation

measurements.

Pain

sensation

and

PPT

recordings

were

made

before

the

local

anesthetic

was

administered,

immediately

after

injections,

then

at

5-minute

intervals

up

to

the

end

cen-

sus

point

of

60

minutes

or

until

2

successive

pain

sen-

sation

tests

were

recorded

as

sharp

(whichever

was

sooner).

At

the

second

experimental

session,

baseline

pain

sensation

testing

was

performed

as

before,

then

the

fol-

lowing

local

anesthetic

treatment

performed.

On

this

occasion,

a

randomized,

double-blind

design

was

used,

which

included

injection

1-following

aspiration,

0.2

ml

of

solution

was

injected

into

the

palatal

mucosa

distal

to

the

second

bicuspid

on

the

right-hand

side

over

a

period

of

10

seconds;

and

injection

2-following

aspiration,

0.2

ml

of

solution

was

injected

into

the

palatal

mucosa

distal

to

the

second

bicuspid

on

the

left-hand

side

over

a

period

of

10

seconds.

The

solutions

injected

on

this

occasion

were

either

2%

lidocaine

or

2%

lidocaine

containing

1:

80,000

epi-

nephrine.

The

operator

and

the

subject

were

blinded

to

the

identity

of

the

solutions.

Blank

cartridges

identifiable

only

by

a

coded

number

(1-20)

were

used.

The

inves-

tigator

administering

the

injections

was

unaware

of

the

coding

system.

Each

volunteer

received

each

solution

and

the

distribution

between

sides

was

randomized.

In

this

case,

the

investigator

who

coded

the

cartridges

de-

termined

the

order

of

use

of

the

cartridges

by

the

toss

of

a

coin

(the

operator

performing

the

injections

being

blinded

to

the

coding).

Pin-prick

testing

was

performed

as

described

above

using

the

pressure-sensitive

probe.

In

this

part

of

the

study,

the

census

end

point

was

55

minutes.

Data

on

the

pain

sensation

and

PPT

obtained

from

the

2

stimulus

trials

at

the

2

recording

sites

were

ana-

lyzed.

Statistical

analysis

was

performed

using

the

paired

t

test.

Probabilities

of

less

than

.05

were

accept-

ed

as

significant.

RESULTS

The

results

are

shown

in

Tables

1

and

2

and

the

Figure.

There

was

no

difference

in

duration

of

pin-prick

an-

140

Palatal

Anesthesia

Anesth

Prog

47:139-142

2000

Table

1.

Comparison

of

the

Duration

of

Insensitivity

to

Sharp

Pain

Between

Infiltration

and

Block

Anesthesia

in

the

Palate

(Census

End

Point

=

60

Minutes)

Duration

of

Infiltration

Duration

of

Block

Anesthesia

Anesthesia

Subject

(Minutes)

(Minutes)

1

60

60

2

60

60

3

60

50

4

60

60

5

60

60

6

60

60

7

60

50

8

60

60

9

40

45

10

30

45

Mean

±

standard

deviation

55

±

10.8

55

±

6.7

esthesia

between

greater

palatine

nerve

block

and

pal-

atal

infiltration

over

the

census

period

of

60

minutes

(P

>

.05),

the

mean

durations

being

identical

(Table

1).

The

total

area

under

the

graph

for

pain

pressure

thresh-

old

recordings

(the

Figure)

did

not

differ

significantly

dur-

ing

the

census

period

(P

>

.05).

However,

the

effect

produced

by

the

block

technique

was

less

profound

at

the

limit

of

the

census

period.

Lidocaine

with

epinephrine

produced

longer

lasting

soft-tissue

anesthesia

of

the

palate

compared

with

plain

lidocaine

(t

=

5.4;

P

<

.001)

(Table

2).

DISCUSSION

Palatal

anesthesia

is

important

in

allowing

pain-free

ma-

nipulation

of

the

soft

tissues

on

the

palatal

side

of

the

tooth.

In

addition,

accessory

nerve

supply

to

the

dental

pulps

may

arise

from

the

greater

and

naso-palatine

nerves.8

Therefore,

palatal

injections

are

sometimes

re-

quired

to

allow

painless

operative

procedures

on

the

teeth.

Soft-tissue

anesthesia

in

other

parts

of

the

mouth,

eg,

lower

lip

anesthesia

lasts

longer

following

regional

block

compared

with

infiltration

anesthesia.2

In

the

present

study,

there

was

no

difference

in

duration

of

anesthesia

in

the

palate

between

deposition

of

the

solution

at

the

greater

palatine

foramen

or

in

the

region

of

the

tooth

during

the

1-hour

census

period.

This

may

not

be

sur-

prising

because

deposition

in

the

palatal

mucosa

may

produce

a

regional

block

anterior

to

the

point

of

injec-

tion.

Nevertheless,

to

our

knowledge,

this

has

never

been

confirmed

experimentally.

Infiltration

anesthesia

was

as

effective

as

a

block

in

eliminating

pin-prick

pain

for

the

60-minute

census

period.

In

addition,

the

trend

Table

2.

Comparison

of

the

Duration

of

Insensitivity

to

Sharp

Pain

Between

2%

Lidocaine

With

and

Without

1:

80,000

Epi-

nephrine

Following

Infiltration

Anesthesia

in

the

Palate

(Cen-

sus

End

Point

=

55

Minutes)

Duration

of

2%

Lidocaine

With

Duration

of

2%

1:80,000

Plain

Lidocaine

Epinephrine

Anesthesia

Anesthesia

Subject

(Minutes)

(Minutes)

1

30

55

2

20

55

3

40

55

4

10

50

5

10

15

6

15

55

7

15

55

8

55

50

9

30

55

10

15

55

Mean

±

standard

deviation

24

±

14.7

50

±

12.5

was

for

the

PPT

to

decline

earlier

following

the

regional

block

method

compared

with

the

infiltration.

Thus,

in-

filtration

may

be

preferred

because,

as

a

general

rule,

less

soft

tissue

anaesthetized

is

less

unpleasant

for

the

patient.

It

should

be

pointed

out

that

the

results

of

this

study

covered

a

period

of

1

hour

after

the

injection.

This

is

a

time

period

consistent

with

patient

cooperation

for

treatment

under

local

anesthesia

and

is

therefore

rele-

vant

to

clinical

practice.

It

is

possible

that

a

longer

cen-

sus

period

might

detect

differences

between

the

meth-

ods.

The

addition

of

a

vasoconstrictor

to

dental

local

an-

esthetic

solutions

has

been

shown

to

improve

efficacy

and

duration

of

pulpal

anesthesia.'

Therefore,

it

might

be

expected

that

the

presence

of

a

vasoconstrictor

in-

fluences

the

duration

of

oral

soft-tissue

anesthesia.

How-

ever,

previous

investigations9"10

studying

both

infiltration

and

regional

block

intraoral

injections

have

shown

the

-

a.

a.

900

800

700

600

500

400

300

-P-Block

|,-

Infiltration|

-5

5

15

25

35

45

55

Time

(minutes)

Time

plotted

against

median

pain

pressure

threshold

(PPT,

g)

for

the

2

local

anesthetic

techniques:

triangles,

infiltration;

cir-

cles,

block.

Baseline

PPTs

before

local

anesthetic

administra-

tion

were

made

at

time

-5

and

the

first

recording

after

local

anesthesia

at

time

point

0.

Meechan

et

al

141

142

Palatal

Anesthesia

Anesth

Prog

47:139-142

2000

duration

of

oral

soft-tissue

anesthesia

is

not

affected

by

the

addition

of

a

vasoconstrictor

such

as

epinephrine

to

local

anesthetic

solutions.

Oikarinen

et

a19

showed

that

the

addition

of

epinephrine

to

3%

mepivicaine

injected

into

the

maxillary

buccal

sulcus

in

the

bicuspid

area

did

not

influence

the

duration

of

soft-tissue

anesthesia.

Hersh

et

alU0

reported

no

difference

in

the

duration

of

lip

and

tongue

anesthesia

between

epinephrine-free

and

epinephrine-containing

local

anesthetics

following

infe-

rior

alveolar

block

injections

in

volunteers.

The

results

of

the

present

study

clearly

show

that

the

duration

of

soft-tissue

anesthesia

in

the

palate

following

infiltration

injection

is

increased

when

a

vasoconstrictor-containing

solution

is

used.

These

data

confirm

a

clinical

impres-

sion

that

the

epinephrine-containing

solution

provides

longer

lasting

palatal

anesthesia.

Thus,

for

surgical

pro-

cedures

in

this

region,

the

use

of

the

vasoconstrictor

solution

is

recommended

because

there

are

benefits

in

addition

to

hemorrhage

control.

CONCLUSIONS

The

duration

of

palatal

anesthesia

did

not

differ

over

a

60-minute

census

period

between

infiltration

and

block

techniques.

The

use

of

an

epinephrine-containing

lido-

caine

solution

provided

longer

lasting

palatal

anesthesia

after

infiltration

injection

compared

with

the

use

of

a

plain

lidocaine

solution.

REFERENCES

1.

Jastak

JT,

Yagiela

JA.

Vasoconstrictors

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Jastak

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Malamed

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Br

J

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6.

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AS.

Pain-pressure

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J

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1994;8:384-390.

7.

Fischer

AA.

Pressure

algometery

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Standard

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Pain.

1987;30:115-126.

8.

Phillips

WH.

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sia.

J

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1943;1:112-121.

9.

Oikarinen

VJ,

Ylipaavalnpemi

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and

temperature

sensations

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to

local

analgesia.

Int

J

Oral

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1975;4:151-156.

10.

Hersh

EV,

Hermann

DG,

Lamp

CL,

Johnson

PD,

MacAfee

DMD.

Assessing

the

duration

of

mandibular

soft

tis-

sue

anesthesia.

J

Am

Dent

Assoc.

1995;

126:1531-1536.

... It is metabolized to monoethylglycine and xylidide in the liver by microsomal oxidases. Since 1948, lidoaine HCL has been the first and most common local anesthetic drug employed in dentistry, and is considered the gold standard because of its acceptable performance in most situations and rare side effects and toxicity [5]. ...

  • Zahra Bahrololoomi
  • Maedeh Rezaei

Background: Inferior alveolar nerve block (IANB) using lidocaine 2% is commonly used for anesthetizing primary mandibular molars; however, this technique has the highest level of patient discomfort compared to other local anesthesia techniques. Therefore, alternative anesthesia techniques are necessary. The aim of this study was to evaluate the efficacy of a single buccal infiltration of 4% articaine with IANB using 2% lidocaine, for the bilateral extraction of primary mandibular molars. Methods: The present study was conducted on 30 patients aged between 6 and 9 years, who required the extraction of bilateral primary mandibular molars. The patients were randomly divided into two groups as follows: In the first session, Group A received IANB with lidocaine 2% and group B received infiltration with articaine 4%. In the second session, another injection method was performed on the opposite side. The Wong-Baker Facial Pain scale (WBFPS), Face Leg Activity Cry, and Consolability (FLACC), and physiologic parameters were used to assess pain perception. Results: The independent t-test showed no statistically significant difference in blood pressure and heart rate before and after extraction (P > 0.05). The mean FLACC index in the lidocaine and articaine groups was 0.89 and 1.36, respectively; there was no statistically significant difference between them (P > 0.05). According to the results of the chi-square test, there was no statistically significant difference between the groups for WBFPS (P > 0.05). Conclusion: The articaine infiltration technique may be an alternative to the IANB for the extraction of primary mandibular molars.

... 2% lidocaine HCL is considered as the reference standard for comparing the other local anesthetics till date. In the succeeding years, other amide local anesthetics (prilocaine, bupivacaine, etc.) were introduced [3]. At present, the local anesthetic armamentarium consists of anesthetic agents whose duration of action ranges from 20 min (mepivacaine) to 3 h (bupivacaine with adrenaline) [2]. ...

Objective: The objective of this study is to compare the anesthetic efficiency of conventional 2% lidocaine with 4% articaine when infiltrated in the maxillary arch for pediatric patients during pulp therapy and extraction.Methodology: A randomized control trial was done with 45 children (n=45) of the age group 4–8 years. The children were randomly allotted to two experimental groups. Group A – Children received 2% Lidocaine HCL infilteration both buccally and palatally, Group B – Children received 2% Lidocaine infilteration buccally and Group C – Children received 4% Articaine infilteration baccally as local anesthetic agent. Post treatment, pain assessment was done using visual analog scale.Results: Articaine group had significantly lower pain scores when compared to the lidocaine group.Conclusion: Articaine infiltration can be considered as an effective alternative for the conventional lidocaine infiltration.

... teeth [1].The nasopalatine nerve passes through the Incisive fossa which is posteroinferior to anterior nasal spine and finally enters the oral cavity via the incisive foramen and innervates the anterior palate, maxillary central incisors and nasal floor ( Figure 1). [1][2][3] Labial tissues are anaesthetized by labial infiltration. Obtaining anesthesia for the relevant palatal soft tissue is however, not possible this way and necessitates direct injection of an anesthetic agent in the palatal area (incisive papilla). ...

... teeth [1].The nasopalatine nerve passes through the Incisive fossa which is posteroinferior to anterior nasal spine and finally enters the oral cavity via the incisive foramen and innervates the anterior palate, maxillary central incisors and nasal floor ( Figure 1). [1][2][3] Labial tissues are anaesthetized by labial infiltration. Obtaining anesthesia for the relevant palatal soft tissue is however, not possible this way and necessitates direct injection of an anesthetic agent in the palatal area (incisive papilla). ...

... For procedures involving manipulation of palatal soft or hard tissues, routine use of palatal anaesthesia is emphasized [12]. Pain control during any operative or surgical procedure is one of the most important factors for reducing the fear and anxiety associated with that dental procedure [13]. ...

Pain control is one of the most important factors for successful treatment. Each new measure to control pain has been looked as miraculous act at the initial stages. The improvements in agents and techniques for local anaesthesia are probably the most important advances in dental science to have occurred in the past years. To evaluate 4% articaine hydrochloride against 2% lignocaine hydrochloride anaesthesia in providing adequate palatal anaesthesia in maxillary posterior regions, without the need for a palatal block. Healthy patients above 15 y of age and requiring bilateral extraction of their maxillary posterior teeth were included in this crossover study. The exclusion criteria included medical history of cardiovascular and kidney diseases, gastrointestinal bleeding or ulceration, allergic reactions to local anaesthetic, pregnancy or current lactation. Eighty patients, requiring bilateral extraction of their teeth due to various reasons were enrolled for this study. Each patient received both lignocaine and articaine anaesthetic in equivalent dose at two different appointments. Maxillary infiltration technique was used for extraction of maxillary posterior teeth at both the appointments. A 170-mm Heft Parker visual analogue scale was used to assess the pain on the palatal mucosa after buccal infiltration of either anaesthetic agent. Blood pressure, Pulse rate and electrocardiographic monitoring were done during the procedure. Adverse effects during the study period were also monitored. Data was analysed by Z-test and student's t-test. Pain scores on probing palatal mucosa after buccal infiltration of the anaesthetic were more for lignocaine as compare to articaine and it was statistically significant (p <.001). However, for hemodynamic parameters and electrocardiographic monitoring, there was no statistically significant difference in blood pressure, pulse rate and electrocardiograph before and after the completion of extraction (p > 0.05). Four percent articaine offers better clinical performance than 2% Lignocaine, particularly in terms of providing adequate palatal anaesthesia with only buccal infiltration.

... For example, pulpal and hard-tissue anesthesia with 2% lidocaine alone lasts approximately 10 minutes, because of its vasodilating effect, while the addition of 1:80,000, 1:100,000, or 1:200,000 epinephrine increases this to approximately 60 minutes (Malamed, 2004). The comparative studies of mentioned epinephrine concentrations used for oral surgery procedures showed that the clinical parameters of local anesthesia: success, onset, duration, intensity, did not show dependency on epinephrine-used concentrations (Meechan et al., 2000;Santos et al., 2007). On the other hand, a dose-dependent relationship was evident in the control of intraoperative bleeding, since 1:80,000 and 1:50,000 of epinephrine with respect to 1:200,000 and 1:100,000 epinephrine in healthy patients effectively prevent or minimize blood loss during surgical procedures (Malamed, 2004). ...

  • Dragica Stojić
  • Jelena Roganović Jelena Roganović
  • Bozidar Brkovic

Branches of the external carotid artery support the integrity and functionality of oral tissue beds with critical impact in both health and disease. Stenosis or occlusion of the common carotid artery or of the tributaries – facial, maxillary, lingual arteries and dental pulp arterioles – contribute to the etiology of disease, in particular in the setting of ischemic and metabolic syndrome disorders of orofacial tissues. Blood flow through salivary glands is largely controlled via autonomic innervation, and endothelium-derived vasodilating and vasoconstricting substances. Endothelial cells actively regulate basal vascular tone and vascular reactivity in physiological and pathological conditions. In the resting state, blood flow in rat submandibular gland is largely controlled by sympathetic nerves, but vascular resistance is rapidly lowered by parasympathetic activity. Increase in blood flow during parasympathetic stimulation, through co-release of the neurotransmitters Ach and VIP, has been attributed to the release of endothelium-derived NO, prostacyclin and EDHF. In the glandular branch of rabbit facial artery, Ach provokes endothelium-dependent vasorelaxation, mediated by NO and prostacyclin, while VIP induces an endothelium-independent vasorelaxant effect, mediated by cAMP from vascular smooth muscle and neuronal NO. In the human submandibular artery, both transmitters produce endothelium-dependent vasodilation with different mechanisms, release of NO and prostacyclin for Ach and release of NO and EDHF for VIP. Endothelial dysfunction is commonly attributed to impaired endothelium-dependent vasorelaxation and increased vascular tone. In diabetic rat salivary glands, parasympathetic stimulation causes increased blood flow with delayed initial response. Carotid artery occlusion decreases the responsiveness of the glandular branch of the The exclusive license for this PDF is limited to personal website use only. No part of this digital document may be reproduced, stored in a retrieval system or transmitted commercially in any form or by any means. The publisher has taken reasonable care in the preparation of this digital document, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained herein. This digital document is sold with the clear understanding that the publisher is not engaged in rendering legal, medical or any other professional services.

... However, the reasons why these points are used are not scientifically examined but depend only on the experiences of each practitioner. Although many of previous reports on infiltration local anesthesia have so far discussed local anesthetics [9][10][11][12][13][14][15][16][17][18][19], very few studies of the optimum injection sites for infiltration anesthesia have been carried out. In our previous paper [6], we morphologically examined the diffusion patterns of the injected anesthetic solution in the maxilla of rats after infiltration anesthesia. ...

  • Hiroyuki Yamada
  • Tetsuji Sato
  • Haruhisa Fukayama

PurposeThis study was conducted for the morphological and quantitative evaluation of the diffusible patterns of local anesthetic depending on the site of injection in infiltration anesthesia.ExperimentsThe mandibular first molars of rats were anesthetized by the local infiltration of 30 μl of 2% lidocaine containing trypan blue at a distance of 2 mm from the gingival margin on either the lingual or buccal side over the distal root apex of the first molar. Frozen sections were prepared to measure the volume of the infiltrated anesthetic using volume-calculating software.ResultsOn the lingual side, the local anesthetic infiltrated into the mouth floor and spread backward in a sagittal direction at an infiltration volume of 8.36 ± 7.34 mm3. On the buccal side, the anesthetic solution was restricted to the injected area and the infiltration volume was 2.22 ± 1.62 mm3.Conclusion The present results indicate that the infiltration volume of local anesthetics is very different between the lingual and buccal sides.

... Sensory innervations of the palate have led to the routine teaching of palatal anesthesia for procedures involving manipulation of palatal soft or hard tissues, including removal of maxillary third molars. 12 Research has shown that for many the fear of dentistry is closely associated with the intraoral administration of local anesthetics. 13 Therefore, giving a painful injection to block a small amount of potential pain may not be the most comfortable maneuver for any patient, particularly the anxious patient. ...

  • Sunil Yadav Sunil Yadav
  • Ajay Verma
  • Akash Sachdeva

Abstract The aim of the study was to demonstrate if 2% lidocaine hydrochloride with 1 : 200,000 epinephrine could provide palatal anesthesia in maxillary tooth removal with a single buccal injection. The subjects included in the clinical study were those requiring extraction of the maxillary third molar of either side. For the purpose of comparison, the sample was randomly divided into 2 main groups: group 1 (study group) included 100 subjects who were to receive a single injection before extraction, and group 2 (control group) included 100 subjects who were to receive a single buccal injection and a single palatal injection before extraction. After 5 minutes the extraction was performed. All patients were observed for Faces Pain Scale during extraction and asked for the same on a 100-mm visual analog scale after extraction. According to visual analog scale and Faces Pain Scale scores, when maxillary third molar removal without palatal injection (study group) and with palatal injection (control group) were compared the difference was not statistically significant (P > .05). Removal of maxillary third molars without palatal injection is possible by depositing 2 mL of 2% lidocaine hydrochloride with 1 : 200,000 epinephrine to the buccal vestibule of the tooth.

... The patient rinsed with 0.1% chlorhexidine mouthwash to reduce intraoral microorganisms. The patients were injected with 4% articaine [13][14][15]17,18 with adrenaline 1:100,000 in the amount of 0.3 ml. ...

  • Natthamet Wongsirichat Natthamet Wongsirichat
  • Verasak Pairuchvej
  • Satida Arunakul

This study investigated the extent of complete anaesthesia from buccal nerve block. 40 healthy Thai patients (20 males; 20 females) requiring buccal nerve block for surgery were studied. After the buccal nerve was blocked, the buccal mucosa was explored using a sharp probe to map out the extent of anaesthesia. The operation was carried out after inferior alveolar and lingual nerve block. The extent of the anaesthesia was mainly from the retromolar area to the second molar, followed by the first molar to the second premolar, whilst the first premolar to the central incisor was the area least affected. An important finding of this study was that the anaesthetized extent of some patients extended to the anterior region on the same quadrant. This study showed the affected areas of buccal nerve anaesthesia extended through the buccal mucosa from the first premolar to the central incisor in some patients. It can serve as another informative indication for lower anterior surgery.

  • Thomas von Arx Thomas von Arx
  • Scott Lozanoff

The roof of the oral cavity is formed by the hard and soft palate. While the main component of the hard palate is bone, the soft palate mainly consists of the muscles that play an important role in controlling the oropharyngeal isthmus. The largest blood vessel in the palate is the greater palatine artery that exits the greater palatine foramen and then courses anteriorly through the palatine sulcus. This artery must be taken into consideration when performing incisions, harvesting connective tissue grafts, or making osteotomies in the (posterior) palate.

  • W. H. Phillips

: THE IMPORTANCE of a thorough knowledge of the anatomical structures encountered in nerve blocking is quite obvious. The well trained anesthetist knows exactly the nerve supply to a given area and the position and relation of the various structures through which the needle must pass to reach its proper point of destination, The dental surgeon who wishes to master the technique of nerve blocking anesthesia, therefore, must possess a thorough knowledge of the anatomy of the oral cavity. This knowledge gives him confidence, which is essential in the successful administration of conduction anesthesia.

  • V J Oikarinen
  • Pekka Ylipaavalniemi
  • Hans Evers

Following the injection of local analgesic solutions at room temperature (21 degrees C) and at normal body temperature (37 degrees C), respectively, in the oral submucosal region, it was found that most of the subjects experienced the solutions as being of body temperature, regardless of whether the temperature of the solution was 37 degrees C or 21 degrees C. The duration of soft tissue anesthesia was not influenced by the temperature of the solutions. After the anesthetic effect had subsided, prilocaine 4% caused post-analgesic pain less frequently than did lidocaine 2% with adrenalin 12.5 mug/ml. Following injections with different mepivacaine solutions it was found that a low pH caused more frequent pain than a high pH, that the addition of a vasoconstrictor caused more frequent pain than a plain solution, and that there was a tendency for more frequent pain with increasing concentrations of the local anesthetic agent. In this study the addition of adrenalin was not found to prolong the period of soft tissue anesthesia.

  • John G Meechan John G Meechan

The introduction of specialized syringes in the late 1970s and early 1980s has led to an increase in the use of intraligamentary anaesthesia as a means of pain control in dentistry. This paper reviews the technique and its efficacy and considers the advocated advantages and disadvantages of the method in the light of the published scientific evidence. It is concluded that intraligamentary anaesthesia has a role to play in modern dental local anaesthesia but it does not fulfil all the requirements of a primary technique.

  • Andrew A. Fischer

Pressure threshold is the minimal pressure (force) which induces pain. The pressure threshold meter (PTM) is a force gauge with a rubber disc of 1 cm2 surface. The instrument has been proven to be useful in clinical practice for quantification of deep muscle tenderness. Trigger points, fibrositis, myalgic spots, activity of arthritis as well as assessment of sensitivity to pain can be diagnosed by PTM. This study therefore established standards for pressure threshold as well as the reproducibility and validity of measurement in 24 male and 26 female normal volunteers at 9 sites. Muscles frequently afflicted by trigger points were examined. The deltoid was chosen as a reference since it is rarely a site for trigger points. Comparison of corresponding muscles on opposite sides failed to demonstrate significant differences (except for 1 muscle in females). These identical results obtained over muscles of opposite sides proved the excellent reproducibility and validity of pressure threshold measurement. Results serve as a reference for clinical diagnosis of abnormal tenderness and for documentation of treatment results. The sensitivity of individual muscles varies. Therefore the results presented should be kept in mind when diagnosis of pathological tenderness by palpation is attempted.

  • Elliot V Hersh Elliot V Hersh
  • Dorit G. Hermann
  • C LAMP
  • Kenneth MacAfee

Dentists often employ solutions of 3 percent mepivacaine or 4 percent prilocaine without a vasoconstrictor in pediatric patients in an attempt to reduce the duration of mandibular soft tissue anesthesia. The authors compared the time course of soft tissue anesthesia produced by these solutions with that of 2 percent lidocaine plus 1:100,000 epinephrine in 60 adults. They found no reduction in the duration of soft tissue anesthesia when employing 3 percent mepivacaine or 4 percent prilocaine instead of 2 percent lido-epi. Combining these observations with local anesthetic dosage considerations, the authors recommend that 2 percent lido-epi be used when performing mandibular block injections in young children.

  • A S McMillan

The pain-pressure threshold in human tissues such as muscles may be affected by the anatomic location of the recording site and the rate of applied pressure. However, it is uncertain how these variables affect the pain-pressure threshold in healthy oral tissues. In 10 subjects, a custom-made algometer was used to apply pressure at a constant rate to 12 sites on the attached gingivae apical to teeth 11 to 16 and 41 to 46. The pain-pressure threshold was measured at three different rates of applied pressure at weekly intervals for 4 weeks. The pain-pressure threshold was consistently higher at maxillary recording sites. There were, however, no differences in the pain-pressure threshold at different recording sites along the tooth row in the maxilla or mandible. The pain-pressure threshold measurements were consistent between recording sessions. The pain-pressure threshold was affected by the rate of pressure application and appeared to increase linearly with increasing rate. This suggests that the pain-pressure threshold may be measured consistently in attached human gingivae. When measurement of deep sensation in the oral mucosa is planned, the location of the recording site and the rate of applied pressure should be verified.