Monika Daubländer

Comparison of 4% articaine with epinephrine (1:100,000) and without epinephrine in inferior alveolar block for tooth extraction: double-blind randomized clinical trial of anesthetic efficacy

OBJECTIVE The purpose of this clinical prospective, randomized, double-blind study was to compare the anesthetic efficacy of 4% articaine with epinephrine (1:100,000) and without epinephrine in inferior alveolar nerve block anesthesia for extractions of mandibular teeth. STUDY DESIGN Eighty-eight patients received intraoral inferior alveolar nerve blocks using 4% articaine with 1:100,000 epinephrine (n = 41; group 1) or without epinephrine (n = 47; group 2) for extractions of mandibular teeth. The primary objectives were differences in onset as well as in length of soft tissue anesthesia. The amount of anesthetic solution, need of a second injection, pain while injecting, pain during treatment, postoperative pain, and possible complications were surveyed. RESULTS In both groups, anesthesia was sufficient for dental extractions. In group 1, a significantly faster onset of the anesthetic effect (7.2 min vs. 9.2 min; P = .001) and a significantly longer duration of soft tissue anesthesia (3.8 h vs. 2.5 h; P < .0001) were seen. There was no significant difference in the amount of anesthetic solution needed, in the need for a second injection, in the injection pain, in pain during treatment, or in postoperative analgesia. In both groups, no complications were seen. CONCLUSIONS To minimize the epinephrine-induced side effects, 4% articaine without epinephrine is a suitable anesthetic agent for dental extractions in the mandible after inferior alveolar nerve block anesthesia. There could be less postoperative discomfort due to the shorter duration of anesthesia without increased postoperative pain.

Profiling intraoral neuropathic disturbances following lingual nerve injury and in burning mouth syndrome

BackgroundThe aim of the study was to analyse intraoral neurophysiological changes in patients with unilateral lingual nerve lesions as well as patients with Burning Mouth Syndrome (BMS) by applying a standardized Quantitative Sensory Testing (QST) protocol.MethodsThe study included patients suffering from a peripheral lesion of the lingual nerve (n = 4), from BMS (n = 5) and healthy controls (n = 8). Neurophysiological tests were performed in the innervation areas of the tongue bilaterally. For BMS patients the dorsal foot area was used as reference.ResultsFor patients with peripheral lesion of the lingual nerve the affected side of the tongue showed increased thresholds for thermal (p < 0.05–0.001) and mechanical (p < 0.01–0.001) QST parameters, indicating a hypoesthesia and thermal hypofunction. In BMS patients, a pinprick hypoalgesia (p < 0.001), a cold hyperalgesia (p < 0.01) and cold/warmth hypoesthesia (p < 0.01) could be detected.ConclusionsThe results of this study verified the lingual nerve lesion in our patients as a peripheral dysfunction. The profile showed a loss of sensory function for small and large fibre mediated stimuli. A more differentiated classification of the lingual nerve injury was possible with QST, regarding profile, type and severity of the neurologic lesion. BMS could be seen as neuropathy with variable central and peripheral contributions among individuals resulting in chronic pain.

Effectiveness of Self-Hypnosis on the Relief of Experimental Dental Pain: A Randomized Trial

Abstract This randomized, controlled clinical trial evaluates the effectiveness of self-hypnosis on pain perception. Pain thresholds were measured, and a targeted, standardized pain stimulus was created by electrical stimulation of the dental pulp of an upper anterior tooth. Pain stimulus was rated by a visual analogue scale (VAS). The pain threshold under self-hypnosis was higher (57.1 ± 17.1) than without hypnotic intervention (39.5 ± 11.8) (p < .001). Pain was rated lower on the VAS with self-hypnosis (4.0 ± 3.8) than in the basal condition without self-hypnosis (7.1 ± 2.7) (p < .001). Self-hypnosis can be used in clinical practice as an adjunct to the gold standard of local anesthesia for pain management, as well as an alternative in individual cases.

Qualität von Herz-Lungen-Wiederbelebungsmaßnahmen von Zahnärzten in der zahnärztlichen Notfallversorgung

Der limitierende Faktor für eine erfolgreiche Reanimation ist die adäquate Sauerstoffversorgung. Ca. 4 min nach Beginn des Herzstillstands tritt der Gehirntod aufgrund der Hypoxie auf. Somit sind zunächst unabhängig von der Genese des Herzstillstands sofort die Reanimationsmaßnahmen einzuleiten. Die Fragestellungen der Arbeit bestanden darin, zu zeigen, inwieweit die Richtlinien in Herz-Lungen-Wiederbelebungsmaßnahmen (HLW-Maßnahmen) von Teilnehmern eines zahnärztlichen Kongresses (n = 96) angewendet werden. Die beobachtende Studie beinhaltete die Überprüfung des Grundwissens und der praktischen Fähigkeiten vor und nach Instruktion anhand der Kriterien der American Heart Association. Eine Unterteilung in 4 Untergruppen mit/ohne Erfahrung am Patienten/an der Puppe wurde vorgenommen. Nach Durchführung einer kardiopulmonalen Reanimation ohne Anleitung an einer Puppe (Skillmeter-Resusci-Anne, Laerdal) erfolgte nach einer Fehleranalyse und Auffrischung der Kenntnisse eine erneute Durchführung der Reanimation mit erneuter Fehleranalyse. Die Ergebnisse zeigten gute Vorkenntnisse im ersten Durchgang v. a. bei der Überprüfung der Atmung und Überstrecken des Kopfs (67,7%), der Durchführung einer Primärinsufflation (93,8%), der extrathorakalen Herzmassage (99%) und der korrekten Durchführung der Kompressionsrate (68,4%). Die Testpersonen zeigten nach der Kurzschulung im 2. Durchgang bei allen Untergruppen außer der Gruppe ohne Training an der Puppe bei der Durchführung der Primärinsufflation (von 94,4 auf 88,9%) und der korrekten Durchführung der Reihenfolge der HLW-Maßnahmen (von 22,2 auf 5,6%) eine Verbesserung. Gute Ergebnisse mit deutlichen Verbesserungen im 2. Durchgang bestanden bei der Bewußtseinsüberprüfung, der Kontrolle des Karotispulses, der Handdruckmassage und der korrekten Durchführung der Kompressionen. Die Vorkenntnisse der Teilnehmer in bezug auf die Erkennung des Notfalls (42,7%), Kontrolle des Karotispulses (22,9%), einer korrekten Reihenfolge der Primärinsufflation und Herzdruckmassage (9,4%), der korrekten Durchführung der Kompression (21,8%) und Ventilation (36,4%) sowie die Einhaltung des korrekten Verhältnisses von Kompression und Ventilation (21,9%) sind jedoch verbesserungswürdig. Schlußfolgerungen sind die Einführung von Schulungen und Kursen speziell auf diesem Bereich, die regelmäßig wiederholt werden sollten. The crucial factor deciding the success of cardiopulmonary resuscitation is a sufficient oxygen supply. At about 4 min after cardiac arrest, cerebral death results because of hypoxia, and cardiopulmonary resuscitation has to be started regardless of the pathogenesis of the cardiac arrest. The purpose of the study was to assess the application of guidelines for cardiopulmonary resuscitation by participants at a dental surgery congress (n = 96) and to evaluate previous knowledge in cardiopulmonary resuscitation and knowledge after instruction. The present study was based on the standards and guidelines for cardiopulmonary resuscitation issued by the American Heart Association. The group was divided into four groups of doctors experienced or inexperienced in clinical emergencies or with dummies. For the study the Skillmeter-Resusci-Anne (Laerdal, Stavanger, Norway) was used, which has automatic data recording. After analysis of the individual errors, the success of new instruction was assessed. Good previous knowledge was registered, particularly with respect to checking respiration and hyperextension of the head (67.7%), primary insufflation (93.8%), closed-chest cardiac massage (99%) and correct compression rate (68.4%). The participants demonstrated post-instruction improvement in all subdivisions except in the group without practice on dummies (primary insufflation: from 94.4 to 88.9%; correct order of checking consciousness and respiration, primary insufflation, the carotid pulse and closed-chest cardiac massage: from 22.2 to 5.6%). Good results with marked improvements in the second passage were achieved in checking consciousness and the carotid pulse, closed-chest cardiac massage and correct implementation of compression. The participants were, however, found to be in need of further education and training in diagnostics and certain cardiopulmonary resuscitation measures. Knowledge should be improved concerning recognition of the emergency (42.7%), checking the carotid pulse (22.9%), the correct order of primary insufflation and closed-chest cardiac massage (9.4%), correct implementation of compression (21.8%) and ventilation (36.4%), and the correct ratio of compression and ventilation (21.9%). Regular courses should be targeted at these specific aspects.

Hypnosis and Local Anesthesia for Dental Pain Relief-Alternative or Adjunct Therapy?-A Randomized, Clinical-Experimental Crossover Study.

Abstract This prospective randomized clinical crossover trial was designed to compare hypnosis and local anesthesia for experimental dental pain relief. Pain thresholds of the dental pulp were determined. A targeted standardized pain stimulus was applied and rated on the Visual Analogue Scale (0–10). The pain threshold was lower under hypnosis (58.3 ± 17.3, p < .001), maximal (80.0) under local anesthesia. The pain stimulus was scored higher under hypnosis (3.9 ± 3.8) than with local anesthesia (0.0, p < .001). Local anesthesia was superior to hypnosis and is a safe and effective method for pain relief in dentistry. Hypnosis seems to produce similar effects observed under sedation. It can be used in addition to local anesthesia and in individual cases as an alternative for pain control in dentistry.

Methodical bias for comparison of periodontal ligament injection and local infiltration anesthesia for routine extractions in the maxilla

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