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Purpose of Review: This review addresses the dental sedation permit requirements for physician anesthesiologists in the United States and the European Union (EU). The regulatory landscape for office-based anesthesia, including dental settings, is often described as the 'Wild West' of patient safety, making it crucial to outline the similarities and differences in dental anesthesia regulations and offer practical guidelines for regulators., Recent Findings: There is virtually no literature that addresses the issue of dental sedation permits for physicians. By summarizing the variation in language and terminology from state to state, this review highlights the inconsistencies and gaps in dental regulations. The review also highlights the limited specific guidance on the permit process for physicians administering dental anesthesia., Summary: By comparing dental anesthesia regulations and guidelines across all U.S. states and the EU, the review aims to offer practical guidelines for regulators to institute an oversight process that is fair to physician anesthesiologists and does not impede their ability to practice in the dental office setting. This framework for credentialing and permitting physicians in dental office-based anesthesia settings is informed by existing safety recommendations and best practices., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The sensation of pain can elevate anxiety levels, establishing a cyclical pattern that may result in the avoidance or premature termination of dental procedures. Previous endeavors employing various methods and products have produced varied outcomes. Jet injection systems, employing high pressure and velocity to deliver anesthesia without needles, offer a non-invasive option for local anesthesia administration. To assess and measure pain perception levels in a pediatric population during the restoration of young permanent teeth, comparing a needle-free injection system with the traditional dental needle method. Sixty participants with young permanent first molars requiring indirect pulp capping were enrolled, all under the care of a single operator. A simple randomization method was employed, utilizing sequentially numbered, opaque, sealed envelopes to allocate participants into two intervention groups: Group 1 and Group 2. Group 1 received traditional needle syringe anesthesia, while Group 2 received the needle-less injection system, Injex (INJEX Pharma AG, Germany). Following topical anesthesia application, local anesthesia was administered, and indirect pulp capping was performed. The Face, Legs, Activity, Cry, Consolability Scale (FLACC), Wong-Baker Scale, Time of local anesthesia (LA) Administration, Frankl Behavior Rating Scale (FBRS), and Pulse rate were evaluated and recorded at various intervals. The needle-less injection system required approximately 26.2 seconds for anesthesia administration, significantly less time than the traditional syringe ( p < 0.001). FBRS score analysis revealed no significant differences between groups at all intervals. FLACC score analysis during anesthesia administration indicated lower scores in the needle-free injection group ( p < 0.001). Evaluation of Wong Baker Scale (WBS) scores showed higher values in the traditional syringe needle group ( p < 0.05). Using the Injex system presents a promising alternative for dental anesthesia administration, enhancing patient comfort and alleviating fear associated with traditional injections., Competing Interests: The authors declare no conflict of interest., (©2024 The Author(s). Published by MRE Press.)

Dental anxiety in children has been associated with poor oral health outcomes. Behaviour management and psychological interventions have been recognized as effective methods of reducing anxiety in children with positive long-term effects. So far, no information is available on how this issue is managed in the Fijian population. The aim is to investigate the practice and perception of dental practitioners in Suva-Nausori when managing paediatric patients with dental anxiety. A cross-sectional descriptive study was conducted using a questionnaire distributed to dental practitioners in Suva-Nausori area, Fiji. The questionnaire focused on assessment methods for identifying anxious paediatric patients, management approaches, and challenges faced by practitioners. The response rate was 80% (n = 40), with almost an equal distribution between private and public practitioners of 47% and 53% respectively. Observation-based assessment was reported as the most commonly used method for identifying dental anxiety by 79% of participants. Behaviour management techniques, particularly communication and Tell-Show-Do, were widely used by 83% of practitioners. Additionally, 17% utilised both behavioural and pharmacological techniques, with oral sedation being the most common pharmacological method (71%). Local anaesthesia was identified as the most challenging procedure for anxious children. These findings indicate that dental practitioners in the Suva-Nausori area primarily utilise behaviour management techniques and oral sedation to manage dentally anxious children, indicating a limited range of techniques. There is a need for further education and training to ensure that anxious patients receive optimal management, including options such as conscious sedation tailored to individual needs., Competing Interests: The authors declare no conflict of interest., (©2024 The Author(s). Published by MRE Press.)

Background: Sweet taste administration before dental injections helps to control associated pain in children., Aim: To evaluate the efficacy of using a sugar-free flavor on pain perception during dental injections., Design: Children (n = 84) aged 4-9 (mean 6.71 ± 1.55) years who required buccal infiltration bilaterally participated in this split-mouth randomized crossover study. On the test side (flavor visit), infiltration injections were applied after receiving a sugar-free flavor. On the control side (no flavor visit), sterile water was administered. Demographic characteristics, body mass index (BMI), and sweet taste preference (STP) were recorded. Pain perception during injection was measured using heart rate (HR), sound, eyes, and motor (SEM) scale, and Wong-Baker Faces pain scale (WBFPS)., Results: Most children had healthy weight (72.6%) and equal STP (32.1%). In the test side, mean HR during injection, HR differences before and during injection, and SEM scores were significantly lower (p < .001, for all). There was no significant difference in the WBFPS between both visits. Flavor had a significant effect on pain reduction (p = .001 for HR, p = .000 for SEM), whereas age, gender, BMI, STP, and treatment side did not. Treatment sequence had a significant effect on total SEM scores (p = .021); children who received the flavor during their first visit had lower SEM scores., Conclusion: Using a sugar-free flavor before dental injections helps in reducing associated pain in children., (© 2024 BSPD, IAPD and John Wiley & Sons Ltd.)

Background: Because of controversial results from clinical studies comparing different dental local anesthesia methods in children, the primary objective of this randomized, split-mouth, crossover, controlled trial was to compare pain intensity during local anaesthesia (LA) performed with a computer-controlled LA delivery system (C-CLADS) versus a conventional syringe (CONV). Secondary objectives included comparisons during dental treatment., Methods: Participants (4-8 years) with tooth pair requiring similar treatment were recruited from five French hospitals. The right primary molar, which was treated at the first visit, was randomly allocated to one of the anaesthesia groups (either intraosseous with C-CLADS or infiltration with CONV), whereas the contralateral molar (treated at the second visit) was assigned to the other group. Pain intensity and behaviour outcomes, assessed with the Faces Pain and Venham revised scales, respectively, were compared between groups using Proc mixed. Stratified analyses were performed on dentition and location., Results: Among 107 participants, the analysis revealed reduced pain perception during LA in the C-CLADS group compared with the CONV group (-0.72, 95% CI: -1.43, -0.006), but not during dental treatment. Stratified analyses showed that this effect was observed only in primary dentition (p = .006) and mandibular molars (p = .005). Behavioural issues were fewer in the C-CLADS group than in the CONV group (p = .05) only during injection., Conclusion: C-CLADS emerged as the preferable system in primary dentition., (© 2024 BSPD, IAPD and John Wiley & Sons Ltd.)

Aim: This case study delineates a minimally invasive and effective approach for the aesthetic and functional restoration of teeth in a patient with Rubinstein-Taybi syndrome (RTS), focusing on the challenges and strategies tailored to their specific dental care needs., Methods and Results: A 20-year-old patient diagnosed with RTS presented at the Pediatric Dentistry Department for a comprehensive dental assessment and care. The individual's genetic condition manifested in unique dental and craniofacial anomalies, complicating standard dental procedures. Following an initial consultation that underscored limited cooperation due to intellectual disabilities, a customized treatment plan was developed. This included behavior modification techniques to acclimate the patient to dental settings and procedures. Utilizing "simplified technologies" such as volumetric polymerization composites and self-etching primer and adhesive systems, tooth 36 was successfully treated. The approach showcased the potential for dental care in RTS patients with minimal sedation, prioritizing patient comfort and cooperation., Conclusion: The successful dental treatment of the RTS patient highlights the importance of patient-centered, minimally invasive approaches in managing individuals with special healthcare needs. Emphasizing continuity of care and prioritizing restorative treatments facilitated significant improvements in oral health and patient cooperation. This case contributes to the sparse literature on dental care for RTS patients, advocating for specialized strategies to address their comprehensive oral health needs. The findings underscore the necessity for interdisciplinary collaboration and innovative care protocols to ensure effective and empathetic dental treatment for individuals with RTS., (© 2024 Special Care Dentistry Association and Wiley Periodicals LLC.)

Purpose/objectives: A precordial stethoscope (PS) is essential for ensuring clear breath sounds during open airway sedations. However, a traditional PS limits the ability of new users to simultaneously listen to heart and lung sounds alongside experienced practitioners, hindering their learning and development. Bluetooth speaker systems allow for multiple providers but amplify all noise. An artificial intelligence (AI) PS has the potential to selectively reduce ambient noise, allowing multiple providers to monitor concurrently and provides a visual representation of the sound waves. The study looks at the benefits of AI PS in teaching in the dental setting., Methods: A questionnaire was created to compare the new AI PS to a conventional PS during intravenous moderate sedation in a dental clinic setting., Results: Sixteen individuals involved in sedations (four dental attendings, seven dental residents, and five dental assistants), were polled with a 100% response rate. 75% of participants agreed that clarity was improved using the AI PS and 81.25% of participants agreed that breath sounds and loudness were improved using the AI PS. 93.75% reported the AI PS was beneficial in allowing attendees to concurrently monitor a sedation case alongside dental residents. 100% of assistants reported that the AI PS benefited from their participation in sedation cases., Conclusion: As technology advances, it is important that we as providers continue to evolve and consider implementing AI to improve our ability to monitor patients and enhance educational experiences for dental resident trainees., (© 2024 Special Care Dentistry Association and Wiley Periodicals LLC.)

Introduction: Local anaesthesia (LA) is fundamental to successful dental treatment. Graduating hygienists, therapist and dentists should be confident and proficient in delivering LA. There is one previously published article reviewing LA teaching in United Kingdom (UK) dental schools in 2016, and at this time 10 out of 14 schools allowed peer-to-peer administration. The method of teaching LA administration has become an area of debate in terms of legality and morality given the potential complications and issues with valid consent. The aim of the study was to explore current teaching practices and assessment of LA in UK dental schools., Materials and Methods: Two national surveys (2020 and 2023) were sent out via the ABAOMS Education Committee to all 16 dental schools in the United Kingdom with dental and/or hygiene and therapy programmes., Results: There was a 100% response rate from all schools. There has been a significant shift from peer-to-peer administration of local anaesthesia, with only 4 schools now allowing peer-to-peer administration. The majority of schools use simulation methods to deliver the teaching, including LA models, cadavers and 'cap-on' simulation with a peer. When comparing the timing of teaching between 2020 and 2023, BDS students now administer their first LA injection to a patient later in the programme, and there has been a reduction in intra-professional teaching., Conclusion: Due to the large shift away from practicing LA on peers, there is a need for further development of simulation methods given the drawbacks with current models and the limited development of haptic technology in relation to LA., (© 2024 The Author(s). European Journal of Dental Education published by John Wiley & Sons Ltd.)

Background: Dental anxiety is a global problem in the realm of pediatric dentistry. The use of procedural sedation is recommended to avoid substandard or unsafe dental treatment in preschoolers. This study aimed to compare the effect sedation with Dexmedetomidine with or without Midazolam in terms of sedation level, analgesic effect and ease of treatment completion in preschool children., Methods: A triple blind randomized controlled clinical trial comprised 72 healthy uncooperative children, 4-6 years old, were randomly allocated into three groups of 24 patients each: Group I patients were sedated with nebulized 5 μg/kg Dexmedetomidine (DEX), Group II with nebulized 3 μg/kg DEX followed by nebulized 0.3 mg/kg Midazolam (MID), and Group III with nebulized 0.5 mg/kg MID. Along the session, the three regimens were assessed and compared during the sedation level (children responsiveness) using the Modified Observer's Assessment of Alertness/Sedation Scale, the analgesic effect using the Face, Leg, Activity, Cry, Consolability scale and ease of treatment completion using a separate 5-point scale. Vital signs were recorded before and during sedation, until full recovery., Results: A significant difference was detected regarding children responsiveness during operative procedure in favour of DEX in comparison to MID and DEX/MID groups (P = 0.045). Within the DEX group, a significant difference was recorded regarding children responsiveness at optimum sedation and during the operative procedure (P = 0.04). Although, the analgesic effects of sedative drugs showed no statistically significant difference among the study groups (P = 0.20), the ease of treatment completion was statistically higher in the DEX than MID and DEX/MID groups (P = 0.03)., Conclusion: Dexmedetomidine provides a moderate level of sedation, that allowed better patient cooperation, and easy completion of performed dental procedures., (© 2024. The Author(s).)

Background: Currently, the indications for pulpectomy of primary molars performed under dental general anesthesia vary across countries. Therefore, we retrospectively investigated the five-year survival rate of primary molars following pulpectomy performed under dental general anesthesia and the impact of this treatment on permanent successors, assessed the risk factors related to overall survival and clarified the indications for pulpectomy., Methods: The medical records of children receiving pulpectomy of primary molars under dental general anesthesia from August 1, 2013, to November 30, 2023, were reviewed. Potential risk factors, including gender, age, general health, tooth type, tooth location, endodontic diagnosis and quality of root filling, were assessed via univariate and multivariate Cox proportional hazards regression models, and the survival rate was examined via the Kaplan‒Meier technique. Moreover, the rate of resorption of the root canal filling materials, degree of resorption of the overfilled/over-extended root canal filling materials and development of permanent successors were assessed by clinical and radiographic examination., Results: The study included 320 teeth from 161 children (86 boys and 75 girls). The overall five-year survival rate was 38.2%, and the mean overall survival time was 54.2 months. Endodontic diagnosis was considered a significant risk factor (P < 0.05). In the first, second and third years, 57.4%, 81.8%, and 94.8%, respectively, of obturation materials in the root canals were resorbed at a faster rate than the roots. There was an altered eruption direction in 7 permanent teeth, and 4 permanent teeth were diagnosed with enamel hypoplasia., Conclusions: In this study, the 60-month survival rate of primary molars treated by pulpectomy under dental general anesthesia was 38.32%. Operators should have an accurate assessment of the status of the pulp, have a strict grasp of the preoperative indications and select the appropriate treatment method according to the guidelines. Individual cases suggest overfilling, overextension and periapical periodontitis in primary molars have an impact on enamel hypoplasia and altered eruption direction in permanent teeth., (© 2024. The Author(s).)

Purpose The posterior superior alveolar (PSA) block injection is one of many techniques used to provide profound anesthesia for invasive dental procedures. This technique has a high success rate but is not without complication risks. The purpose of this study was to determine if pulpal anesthesia of the maxillary second molar could be achieved using a reduced needle depth of 10mm or 5mm compared to the traditional needle depth of 16mm. Methods Sixty participants were asked to participate in three sessions. Each session started with a pre neural response test, followed by one randomized needle depth PSA injection, and ending with a post neural response test. The neural response test consisted of two parts, a cold refrigerant and a dental probe, on the buccal and interproximal surface of the maxillary second molar. After receiving a positive neural response, each participant received a posterior superior alveolar block injection using a short (21mm), 27-gauge dental needle with a randomized needle penetration depth of 16mm, 10mm, or 5mm. A post neural response test consisting of the same two parts as the pre-test was conducted on the maxillary second molar to evaluate for profound anesthesia. Results Positive neural responses were obtained from 100% of the participants (n=167) during the pre-tests. Study results demonstrated an 85% success rate at the traditional 16mm needle depth and a 93% and 92% success rates for the reduced needle depths of 10mm and 5mm, respectively. Pulpal anesthesia of the maxillary second molar had been achieved at all three needle depths with no statistically significant difference in the rate of success. Furthermore, there were no adverse events observed. Conclusion The reduced needle depth technique showed promise in achieving desired results of pulpal anesthesia with a reduced risk for complications associated with the PSA block injection. Additional studies are recommended to achieve evidence-based support for this reduced needle depth technique., (Copyright © 2024 The American Dental Hygienists’ Association.)

Background: Local anaesthesia in dental procedures is generally safe, although the occurrence of transient bradycardia (TB) has occasionally been reported. TB is often associated with two reflexes, the trigeminal cardiac reflex (TCR) and the vasovagal reflex (VVR) and is characterised by a rapid decrease in heart rate (HR) and blood pressure (BP). The prevalence of TCR is considered low, and its predictors have not been thoroughly investigated, although an association with the gag reflex has been suggested in recent years., Methods: This prospective study assessed TB occurrence during local anaesthesia and its potential associated factors. A comprehensive questionnaire was used to categorise discomforts during dental treatment, and various anxiety scales were used to measure patients' anxiety levels. We investigated HR variability during local anaesthesia administration under sedation and the association between the incidence of TB and gag reflex. Subsequently, logistic regression analysis was performed to assess factors associated with TB occurrence., Results: The prospective analysis included 188 patients of 234 initial patients. The analysis revealed a high TB incidence rate of 41% during local anaesthesia administration under sedation. No severe hypotensive events occurred, indicating a relatively benign nature of TB during local anaesthesia. TB occurrence was significantly higher in the group of patients with the gag reflex. Further analysis revealed that both gag reflex and trait anxiety were significantly associated with TB occurrence, whereas dental phobia did not directly correlate with TB., Conclusion: This study highlights the prominent occurrence of TB during local anaesthesia in dental treatment, which is primarily attributed to TCR activation. The identification of gag reflex and trait anxiety as independent factors associated with TB development may pave the way for TB prevention measures. Further research is required to clarify the mechanisms of TCR and perform safer dental procedures under sedation. Future studies should also aim to elucidate the precise mechanisms underlying TB during local anaesthesia through direct measurements of neural activity. A better understanding of TB in dentistry is crucial for improving patient safety and optimising dental practice protocols., (© 2024. The Author(s).)

Objectives: This study aimed to assess the effect of needle insertion angle on pain during labial infiltration anesthesia in the anterior maxillary region., Material and Methods: In this parallel-design randomized clinical trial, participants were randomly assigned to four groups for labial infiltration anesthesia of the anterior maxilla. Local anesthesia was performed with needle orientation parallel to the longitudinal axis of the tooth using a conventional syringe (Syringe-0), needle at α angle with a conventional syringe (Syringe-α), computer-controlled local anesthetic delivery (CCLAD) device parallel to the longitudinal axis of the tooth (CCLAD-0), and CCLAD at α angle (CCLAD-α). The heart rate (HR), blood pressure (BP), and respiratory rate (RR) of participants were measured before needle insertion, immediately after needle insertion, and immediately after the injection by a vital signs monitor. The level of pain experienced by participants was quantified using a numerical rating scale (NRS). Data were analyzed by repeated-measures ANOVA and regression models (α = 0.05)., Results: Thirty-six participants aged from 21 to 60 years, with a mean age of 35.36 years were recruited. The mean pain scores were 7.44, 4.67, 2.89, and 0.67 in groups Syringe-0, Syringe-α, CCLAD-0, and CCLAD-α, respectively (p < 0.001). Age and sex had no significant effect on pain scores (p = 0.914 and p = 0.702, respectively). The four groups had no significant difference in vital signs (p > 0.05)., Conclusions: Injection at an α angle and the application of CCLAD can be used in clinical practice to decrease the pain experienced by participants during labial infiltration anesthesia of the anterior maxilla., Trial Registration: Iranian Registry of Clinical Trials: IRCT20230719058849N1., (© 2024 The Author(s). Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Objective: Uncooperative behavior in pediatric dentistry is one of the most common manifestations of dental anxiety. Managing anxious patients can be attained by moderate sedation. This study aimed to compare the effect of sedation by dexmedetomidine-ketamine combination (DEX-KET) versus dexmedetomidine (DEX) on behavior of uncooperative pediatric dental patients., Methodology: In total, 56 uncooperative healthy children (3-5 years old) requiring dental treatment were divided randomly into two groups: Group I (study group), which received buccal dexmedetomidine (2 μg/kg) and ketamine (2 mg/kg), and Group II (control group), which received only buccal dexmedetomidine (4 μg/kg). Drugs effects were assessed in terms of hemodynamic parameters, patient's drug acceptance, child behavior, postoperative effect of sedation, amnesic effect, incidence of adverse events, as well as procedural induced stress measured by salivary secretory immunoglobulin A (s-IgA)., Results: Hemodynamic results did not reveal a statistically significant difference between the two study groups (P>0.05). There was a significant difference in patient's acceptance to sedative drug between both groups, favoring DEX (p=0.005). Children who received DEX-KET showed significantly better behavior than those who received DEX for local anesthesia (p=0.017) and during operative procedure (p=0.037). Adverse events, post-operative and amnesic effects of drugs were comparable in both groups (p>0.05). Moreover, the mean difference in the salivary s-IgA levels between initial and final value was not statistically significant between both groups (p=0.556)., Conclusion: Both DEX-KET combination and DEX alone are effective in providing hemodynamic stability. DEX-KET combination significantly improved the behavior of sedated children compared to DEX alone but the drug acceptance was decreased in the DEX-KET group. Both regimens did not have a negative effect on postoperative behavior of children and had comparable amnesic effect with no significant adverse events. Salivary s-IgA is not considered a potential stress biomarker in sedated children.

Objective: The use of midazolam (MZ) has increased in dentistry, but the effect in adults is sparsely studied. The aim of this study was to investigate doses, effects, and side effects of orally administered MZ as a sedative for adults in a dental care organization., Material and Methods: A retrospective record review was performed including all adult patients in the dental care organization ≥20 years receiving MZ, identified through a logbook for addictive drugs, during 2020. From patients' records, the following data were extracted: age, gender, medical history, reason for sedation, performed treatments, doses, effects, and side effects of MZ.  Results: In total, 265 patients on 418 occasions had been sedated, which constituted 2.3 sedations per 1,000 visits and 3.3 sedations per 1,000 treated patients. Mean age was 40.8 years and 67.7% were females. The most common reason for sedation was anxiety. Mean dose in primary dental clinics was 7.9 mg and in specialist clinics, 6.8 mg (p < 0.001). Older patients (>70 years) had lower doses than younger (p < 0.001), while no difference was found between ages 55-70 years and those who were younger. Dental treatment was completed in 91.9% of occasions, and side effects were registered in 2.2%. Successful dental treatment was related to type of treatment performed., Conclusions: Sedation is rarely used, particularly in primary dental care, and the use varies widely between clinics. MZ administered by dentists seems to be safe and effective. A sedation record should be used to make patient data such as weight and medical conditions available.

Purpose: To compare the efficacy of laser phototherapy, Buzzy®, and lignocaine gel in minimizing pain during intraoral injections. Methods: In this randomized controlled trial, the efficacy of standard lignocaine gel (Group A) was compared with Buzzy® (Group B) and laser phototherapy (Group C) as pre-anesthetic agents in 15 children aged eight to 12 years undergoing intraoral local anesthesia (LA). Pain perception during needle insertion was assessed objectively using the Face, Legs, Activity, Cry, Consolability (FLACC) scale and subjectively using the Visual Analogue Scale (VAS). Statistical analysis included chi-square and analysis of variance tests (P<0.05). Results: Objective assessment of pain perception using FLACC scores demonstrated that Buzzy® resulted in the highest comfort levels; 60 percent of the subjects treated with Buzzy®, 40 percent treated with laser phototherapy, and 6.7 percent treated with lignocaine topical anesthetic were judged to be relaxed and comfortable or exhibiting mild discomfort, respectively. Subjective pain assessment (self-reported using the VAS) was significantly lower in Buzzy® (0.67±0.82 standard deviation) followed by laser phototherapy (1.00±1.13) and Lignocaine gel group (2.13±1.51). Conclusions: The Buzzy® and laser phototherapy effectively reduced intraoral injection pain compared to the standard control, lignocaine gel. However, Buzzy® showed better efficacy.

Hepatic compromise poses significant impacts upon the care of patients undergoing routine dental treatment. When sedation or general anesthesia is planned for dental treatment or oral and maxillofacial surgery, an understanding of basic liver function and clinical evaluation can assist in adapting treatment modifications for patients with limited function due to previous disease and resultant organ transplantation efforts. Beginning with a basic overview of hepatic physiology, this review will outline the specific functions of digestion, metabolism, synthesis, and detoxification involving the liver. Specific clinical considerations will be reviewed regarding comorbidities that develop prior to and after liver transplantation that often impact a patient's suitability for ambulatory and office-based care. Lastly, choices in both local anesthetics, sedative medications, general anesthetics, and postoperative analgesics utilized in dental treatment will be discussed.

Pfeiffer syndrome (PS) is a rare inherited disorder that affects the craniofacial and extremity bones but can also include anomalies of the upper and lower airways. Among the 3 subtypes, PS types 2 and 3 are the most severe. We describe the anesthetic management of a 10-year-old boy with PS type 2 scheduled for dental treatment under general anesthesia. Because of his history of Chiari malformation, avoiding neck hyperextension was recommended to prevent worsening of his neurologic function. Preoperative computed tomography revealed significant nasal stenosis but no tracheal anomalies. Considering the difficulty of nasotracheal intubation, we planned for an oral intubation. General anesthesia was induced using sevoflurane, nitrous oxide, and oxygen along with an oropharyngeal airway. After lidocaine was topically applied to the oropharynx, fiber-optic orotracheal intubation was performed under spontaneous ventilation to minimize head and neck movement. Anesthesia was maintained using desflurane and remifentanil, and no postoperative complications were observed. General anesthesia for patients with PS requires careful planning, which should include preoperative assessment of the airway to determine the feasibility of nasotracheal intubation and identify airway irregularities.

Objective: To evaluate the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine via primary intraosseous (IO) injection with the QuickSleeper device vs inferior alveolar nerve block (IANB) for mandibular first molars diagnosed with symptomatic irreversible pulpitis (SIP)., Methods: Sixty-four patients with a first mandibular molar with SIP were randomly divided into 2 groups: IO (n = 32) and IANB (n = 32). Each received either an IO injection with the 5th generation QuickSleeper device or a conventional IANB with 1.7 mL 4% articaine with 1:100,000 epinephrine. Success was defined as no/mild pain upon the access cavity preparation and initial filing. Injection pain, anesthetic onset, heart rate (HR) change, HR recovery time, and duration of anesthesia were also recorded and analyzed., Results: The success rates were 40.6% for IANB and 81.2% for IO (P < .001). IO exhibited a significantly lower injection pain (P = .027), a shorter onset of action (P < .001), a greater heart rate increase (P < .001), a faster heart rate recovery time (P < .001), and a shorter duration of action (P < .001) vs IANB., Conclusion: Primary IO anesthesia using the fifth generation of the QuickSleeper device was more successful than IANB when using 4% articaine with 1:100,000 epinephrine to anesthetize mandibular first molars with SIP. The QuickSleeper device appeared to be a viable alternative to IANB for mandibular anesthesia.

Aim: This research aims to explore and evaluate various sedation strategies used in paediatric dentistry, focusing on effectively and safely addressing dental anxiety to improve cooperation during dental treatment in paediatric patients., Materials: To identify relevant studies for this systematic review, the Scopus, Web of Science and PubMed databases were used, combining the terms "sedation" with "pediatric dentistry" or "pedodontics" through the Boolean operators "AND" and "OR". Only literature published in English within the last ten years was included. The inclusion criteria were clinical studies, case reports and in vivo studies, while systematic reviews, meta-analyses and studies conducted on animals or in vitro were excluded. After eliminating duplicates, 544 articles were identified, of which 501 were excluded for not meeting the inclusion criteria. A further 27 articles were excluded for various reasons, including lack of retrieval, in vitro nature or being reviews. Finally, 16 articles were selected for inclusion in the review., Conclusion: These findings underscore the importance of pharmacological management in paediatric dental care, offering valuable insights into the selection and application of sedation techniques to mitigate dental anxiety and enhance patient outcomes.

This study aims to retrospectively evaluate the differences in dental treatments rendered in general anesthesia (GA) for patients who did or did not receive application of silver diamine fluoride (SDF) prior to GA. 1559 patients (≤6 years) who completed treatment with GA for caries at University of California San Francisco (UCSF) between 2015 and 2019 were included in the study. At baseline patients' electronic health record was reviewed to collect planned treatment, complete dental treatment and demographics. Patients were identified as SDF group (N = 335, 21.49%) or comparison (N = 1224, 78.51%). Dental treatments rendered were compared between the SDF and comparison group with multi-variable regression, including variables for demographics and clinical findings at baseline. The initial analysis identified variations in gender, age, dental pain, pulp involvement, and initial treatment plans between the SDF and comparison groups at baseline. In an unadjusted analysis, the SDF group displayed a statistically significant increase in the number of crown procedures but a notable decrease in the number of pulp therapy and extraction treatments completed ( p < 0.05). An adjusted multivariable model affirmed the inverse relationship between SDF application and completion of pulp therapy and extractions at the time of GA ( p < 0.05). No significant association was identified with the total number of crowns needed and SDF. The model further indicated a positive correlation between the total count of pulp therapy and extractions completed with patient age and the wait-time for GA. In conclusion, pre-GA application of SDF to carious primary teeth is negatively correlated with completed pulp therapy and extraction. SDF application prior to dental treatment with GA may be a valuable tool to reduce invasive dental procedures in GA., Competing Interests: The authors declare no conflict of interest., (©2024 The Author(s). Published by MRE Press.)

Background: To compare acceptance and preference of topical lidocaine gel anesthesia with articaine injection anesthesia in patients with moderate periodontitis undergoing scaling and root debridement., Methods: Ninety-one patients completed this randomized multicenter split-mouth controlled study and underwent two separate periodontal treatment sessions on different days, one with a topical intrapocket lidocaine gel application and the other with an articaine injection anesthesia in a different order depending on randomization. Parameters measured were the patients' preference for topical lidocaine gel anesthesia or injection anesthesia with articaine (primary efficacy criterion), their maximum and average pain, and their intensity of numbness as well as experience of side effects; the probing depth; and the dentists' preference and their evaluations of handling/application, onset and duration of anesthetic effect, and patient compliance., Results: After having experienced both alternatives, 58.3% of the patients preferred the topical lidocaine gel instillation into the periodontal pockets. The safety profile of the lidocaine gel differed positively from the safety profile of articaine injection in type and frequency of adverse drug reactions. The dentists' acceptance and preference regarding either anesthetic method studied were balanced., Conclusions: Instillation of lidocaine gel into the periodontal pocket is a preferred alternative to injection anesthesia for most of the patients and an equivalent alternative for dentists in nonsurgical periodontal therapy., (© 2024 The Authors. Journal of Periodontology published by Wiley Periodicals LLC on behalf of American Academy of Periodontology.)

Introduction: Effective pain control is crucial in dental practice; thus, local anesthetic techniques have been extensively taught. The Halstead technique is the most commonly used inferior alveolar nerve block despite its relatively high failure rate. On the other hand, the Vazirani‒Akinosi technique (VAT) is less commonly taught. This study evaluated changes in final-year students' perceptions of VAT after a period of active learning., Methods: This prospective randomized study was performed in 2022 and included fifth-year dental students (n = 91). The study group (n = 49) received practical VAT training during oral surgery internships, whereas the control group (n = 42) did not. A Likert-scale questionnaire assessed students' perceptions, theoretical knowledge, and difficulty levels. An independent sample t-test was used for comparison and the statistical significance level was set at p < 0.05., Results: The survey response rate was 100%. Statistical analysis revealed significant differences between the groups for seven of the 12 questionnaire statements (p < 0.05). Overall, perception scores favored the study group, indicating a more positive response. The statements related to theoretical knowledge, except for one statement, showed no significant differences (p > 0.05)., Conclusion: Practical training significantly improved students' perceptions of VAT, demonstrating the importance of active learning in dental education. Faculties should integrate active learning methods to enhance students' clinical skills and prepare them for professional practice., (© 2024 American Dental Education Association.)

Introduction: Little is known regarding the impact of dental treatment under sedation on distressed young children's oral health-related quality of life (OHRQoL)., Aim: To evaluate the impact of dental treatment under sedation on the OHRQoL of children and their families., Methods: Caregivers of two-to-six-year-old children answered the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS): (1) before treatment under sedation (T0), (2) two weeks (T1) and (3) 3 months after the completion of treatment (T2). A global transition judgment was included in the posttreatment evaluations to determine the perception of changes in OHRQoL after dental treatment. Bivariate analysis was performed. Changes in scores and effect sizes (ES) were calculated., Results: Reductions were found at both posttreatment evaluations in the total B-ECOHIS scores (median [25th-75th percentile] at T0: 14 [9.8-21.7]; T1: 2.0 [0.0-5.1]; T2: 2.0 [0.0-6.7]); "child impact" section (T0: 8.8 [4.0-13.1]; T1: 0.0 [0.0-2.2]; T2: 0.0 [0.0-4.3]) and "family impact" section (T0: 6.0 [4.0-8.5]; T1: 0.0 [0.0-2.0]; T2: 0.0 [0.0-2.0]) (≤0.001; large ES). In 92.3% of cases at T1 and 88.3% at T2, caregivers reported that their child's oral health improved considerably., Conclusion: Dental treatment under sedation significantly improved the OHRQoL of the children and their families., (© 2024 Special Care Dentistry Association and Wiley Periodicals LLC.)

Aims: Potocki-Lupski syndrome (PTLS), which is caused by the partial duplication of the short arm of autosome 17, is characterized by feeding difficulties associated with muscle hypotonia and dysphagia in infancy, followed by growth retardation and low body weight in later stages. Speech and motor developmental disorders are observed in childhood, accompanied by autism spectrum disorders in several cases. Other disorders include dental and skeletal abnormalities, and associated sleep apnea. Herein, we describe the first case of dental evaluation and treatment under intravenous sedation in a patient with PTLS., Methods: A 13-year-old boy with PTLS and intellectual disability was referred for the treatment of dental caries. Routine intraoral examination and dental treatment were not feasible. As the patient had no muscle hypotonia, dysphagia, or severe growth delay, intraoral examination and dental treatment were successfully performed under intravenous sedation. No incidence of intraoral airway obstruction or aspiration was reported. The patient was followed-up post-operatively., Conclusion: PTLS, a newly identified syndrome, is associated with cardiovascular abnormalities, dysphagia, failure to thrive, and sleep apnea, which are potential risk factors for sedation. This case report highlights the importance of facial and oral findings in determining the risks of difficulties in airway management., (© 2024 Special Care Dentistry Association and Wiley Periodicals LLC.)

Background: Local anesthesia (LA) during routine dental treatment in children fails in 5%-35% of first attempts. No data, however, are available on the success rates of subsequent attempts., Aim: To evaluate the effectiveness of primary, secondary, and tertiary LA attempts (P-LA, S-LA, and T-LA, respectively) for anesthetizing molars during routine dental treatments in children., Design: We retrospectively analyzed dental records of all children (2-18 years) who had been administered LA for the treatment of primary or permanent molars by a single paediatric dentist, between 2011 and 2022. All LAs were delivered using a computer-controlled local anesthetic delivery (CCLAD) system., Results: The failure rate of P-LA in 1312 molars was 13% and correlated with age (p < .001), type of tooth (p < .001), type of treatment (p < .001), and treated arch (p < .001). The effectiveness of S-LA for buccal infiltration, intrasulcular, inferior alveolar nerve block, greater palatine nerve block (GPNB), posterior superior alveolar nerve block (PSANB), or a combination of the last two was 50%, 87.2%, 66.7%, 63.6%, 33.3%, and 100%, respectively, and was not significantly associated with age or the type of tooth, treatment, or P-LA., Conclusion: The optimal choice of S-LA for anesthetizing maxillary molars was a combination of PSANB and GPNB, whereas for mandibular molars, it was IS-CCLAD system., (© 2024 BSPD, IAPD and John Wiley & Sons Ltd.)

This double-blind, randomised clinical trial aimed to find out whether there is a difference in the prevalence of neurosensory disturbance (NSD) between patients who received 2% lidocaine and those who received 4% articaine during inferior alveolar nerve blocks (IANBs). Patients who underwent third molar extraction were randomised into two groups. IANB was performed using 2% lidocaine in Group 1 and 4% articaine in Group 2. The occurrence of NSD was documented. Patients were visited within 48 hours and one week after the tooth was removed. The type of anaesthetic drug (4% articaine versus 2% lidocaine) was the study's predictive factor. A total of 2400 patients were studied in two groups (1200 in each group). The mean (range) age of the patients was 28.40 (18-44) years. Five patients (0.41%) in the lidocaine group and seven (0.58%) in the articaine group had NSD after injection (p = 0.77). The prevalence of NSD after IANB was no higher in the articaine group than in the lidocaine group., (Copyright © 2024 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: The aim of this study was to assess factors associated with higher odds of undergoing repeat general anesthesia (GA2) for dental treatments., Methods: The authors studied children up to age 48 months of age enrolled in Medicaid who underwent dental treatment under first general anesthesia (GA1). The authors used a case-control design to compare children who had a GA2 within 48 months of GA1 (case patients) with those who did not (control patients)., Results: In total, 60 case patients were age and sex matched to 120 control patients. Mean (SD) age at GA1 was 38 (5.2) months for case participants and 40 (4.7) months for control participants (P = .08). Higher caries involvement of maxillary incisors (P = .04), and lower caries involvment of canines (P = .003), first molars (P = .012), and second molars (P < .001) at GA1 was associated with higher odds of occurrence of GA2. There was a significant inverse association between full-coverage restoration on canines (P = .003), first molars (P = .001), and second molars (P = .002) at GA1 and occurrence of GA2. There was a significant direct association between the use of composites or sealants on second molars in GA1 and occurrence of GA2 (P = .02). The number of extractions at GA1 was not associated significantly with the occurrence of GA2., Conclusions: The use of full-coverage restorations on primary molars and canines under general anesthesia (GA) was associated with lower odds of occurrence of GA2. Resin restorations and sealants on primary second molars were associated with higher odds of occurrence repeat GA. The findings support preferential use of full-coverage restorations for young children undergoing dental GA., Practical Implications: Full-coverage restorations should be considered strongly for young children undergoing GA for dental treatments to reduce the risk of requiring GA2., Competing Interests: Disclosures None of the authors reported any disclosures., (Copyright © 2024 American Dental Association. Published by Elsevier Inc. All rights reserved.)

The aim of this study was to assess the effect of ibuprofen sustained release (SR) oral premedication on the efficacy of buccal infiltration (BI) with intraoperative and postoperative pain after single-visit root canal treatment. Sixty patients diagnosed with symptomatic irreversible pulpitis and apical periodontitis in mandibular molar were divided into two groups. Group SR received ibuprofen SR 800 mg and group PL received placebo capsule 1 h before 3.6 mL articaine BI injection. Pain was recorded using a modified visual analogue scale and postoperatively at intervals 6, 24 and 48 h. Group SR showed a significantly higher anaesthetic success rate (73.3%) compared to group PL (46.7%) (p < 0.05). Intraoperative and postoperative pain was significantly higher in group PL compared to group SR (p < 0.05). Premedication of ibuprofen SR improved the efficacy of primary BI in mandibular molars with symptomatic irreversible pulpitis and decreased postoperative pain at 6 and 48 h., (© 2024 Australian Society of Endodontology Inc.)

Dental anxiety and phobia are widespread in the population, with various non-pharmacological and pharmacological techniques available to manage it, including conscious sedation. Medically complex, anxious patients may be at a higher risk of a stress-induced medical emergency during dental treatment. This article lays out the forms of sedation that may be used to help mitigate this risk, the detailed risk assessment required and how conscious sedation may be used as a prophylactic tool to prevent medical emergencies in these patients. Referring clinicians must know what options are available to enable this cohort of patients to access care., (© 2024. The Author(s), under exclusive licence to the British Dental Association.)

Introduction: The present study evaluated the effect of 2 different back pressure-based supplemental anesthesia on postoperative pain in patients receiving endodontic treatment for a mandibular molar with symptomatic irreversible pulpitis., Methods: One-hundred-thirty-five adult patients with symptomatic irreversible pulpits in a mandibular first or second molar, received an initial inferior alveolar nerve block (IANB) injection with 2% lidocaine with 1:80,000 epinephrine. Ten minutes following the injection, access to cavity preparation began. Lip numbness was a must for all patients. The Heft-Parker visual analogue scale (HP-VAS) was used to measure pain during endodontic therapy. Success of primary injections was defined as no or mild pain (less than 55 mm on HP-VAS) during access preparation. The patients with initial successful anesthesia served as control and received endodontic treatment. Ninety-five patients with unsuccessful primary anesthesia randomly received either intraligamentary injections of 2% lidocaine with 1:80,000 epinephrine or intrapulpal injections with similar anesthetic solution. Endodontic treatment was re-initiated and canals were instrumented till working length under copious irrigation. Intracanal medicament of calcium hydroxide was placed and teeth received a temporary restoration. Postoperative pain was measured at 2 hours, 4 hours, 6 hours, 24 hours, and 3 days. Data were analyzed using the Pearson chi-square test, one-way analysis of variance, and one-way repeated measures analysis of variance., Results: The initial initial inferior alveolar nerve block was successful in 40 cases (out of 135). The intraligamentary injections were successful in 33 out of 47 cases (70%), and intrapulpal injections were successful in all cases (45/45). The patients receiving intraligamentary injections reported significantly higher pain scores at all intervals till 24 hours. After 3 days, the pain significantly reduced in all the groups with no significant difference between them., Conclusions: Patients receiving supplementary intraligamentary injections can experience increased postoperative pain till 24 hours after the endodontic treatment. The pain scores reduced to the level of the control group after 3 days., (Copyright © 2024 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Most invasive dental procedures elicit some degree of bleeding which ultimately leads to clotting and eventual hemostasis. However, patients with inherited coagulation disorders may exhibit prolonged or, in some cases, excessive bleeding requiring multiple perioperative interventions. Von Willebrand disease is the most common inherited coagulopathy and often manifests via easy bruising, epistaxis, or prolonged bleeding. Hemophilia A (factor VII) and B (factor IX) are factor deficiencies that are clinically indistinguishable and managed according to severity and the required dental treatment. Other coagulopathies are rare (ie, inheritance is autosomal recessive) and may only become evident in homozygotes or compound heterozygotes. Current lab values and medical consultation with the patient's hematologist are imperative prior to rendering invasive dental treatment. There are a myriad of sedation and general anesthesia considerations, including risks for epistaxis with nasal instrumentation and bruising with improper patient positioning. Preoperative treatment with desmopressin or factor replacement may be required and generally should facilitate normal hemostasis. Additional therapies should be considered to help ensure adequate postoperative hemostasis, including pressure dressings, resorbable clotting materials, laser therapy, and oral rinses.

Emerging evidence suggests that many conventional anticonvulsants, such as carbamazepine, phenytoin, and valproic acid, could cause cross-resistance to nondepolarizing muscle relaxants. However, there are few reports describing the interactions between levetiracetam and rocuronium. This case report describes the delayed onset of rocuronium in an adult patient with intractable epilepsy on long-term levetiracetam therapy. A 33-year-old man was scheduled for extraction of third molars and restorative dental treatment. His daily levetiracetam was continued preoperatively, and after a slow mask induction, rocuronium (20 mg; 0.66 mg/kg) was administered. Muscle relaxation was monitored by train-of-four (TOF) stimulation using the adductor muscle of the thumb. However, it took more than 9 minutes to finally obtain a TOF count of 0. This case report highlights that patients with intractable epilepsy taking levetiracetam may have resistance to rocuronium and should be carefully monitored to avoid harm triggered by prematurely initiated intubation maneuvers.

This study aimed to compare parental satisfaction between two pediatric dental anesthesia techniques, computerized intraosseous anesthesia (CIA) and inferior alveolar nerve block (IANB). This study was designed as a split-mouth randomized controlled clinical trial. A total of 52 parents of children undergoing dental treatment were enrolled in the study. Each participant received both CIA and IANB anesthesia, with the order of administration randomized. Parental satisfaction was evaluated using the parental satisfaction of dental local anesthetic techniques scale (PSLAS). Statistical analysis revealed that parental satisfaction regarding CIA was higher than that for IANB with a significant difference (P ˂ 0.05). However, there was no difference regarding the age, gender or the education level of the parents. (P > 0.05). This study provides insights into parental satisfaction with pediatric dental anesthesia techniques and highlights the influence of socioeconomic factors on anesthesia decision-making. Within the limitations of this trial, it was concluded that CIA was significantly superior to IANB in overall parental satisfaction. However, parental satisfaction values were lower in CIA group regarding costs and concern from complications. In addition, it was concluded that there was no difference in satisfaction levels regarding the gender, age and education level of the parents., (© 2024. The Author(s).)

Palatal injections are considered to be one of the most painful dental procedures. As a result, it was important to find alternatives to this painful injection to improve children's cooperation. The dental literature mentioned using EMLA cream as a possible alternative to conventional injections, but its anesthetic effect was debated. Therefore, it was valuable to research the impact of microneedle patches to enhance the effectiveness of this cream. The purpose of this randomized controlled clinical trial was to compare the effectiveness of different methods of anesthesia and pain levels in children aged 7-11 years. The study compared the use of EMLA cream, EMLA with microneedles, and conventional palatal injections. A total of 90 children were randomly assigned to three groups: Group 1 received conventional palatal anesthesia (control), Group 2 received EMLA cream only, and Group 3 received EMLA with microneedles. Pain levels were assessed using the FLACC and Wong-Baker scales at three different time points: T1(during anesthesia), T2(on palatal probing), and T3(during extraction). The FLACC scale revealed a significant difference in pain between groups only at T1 (P value = 0.000). It was found that the conventional palatal injection group had a higher pain level than the EMLA cream-only group and the group using microneedle patches with EMLA cream (P value = 0.000). However, the other groups did not show significant differences in pain levels during the anesthesia (P value  = 1.00). Similarly, the Wong-Baker scale also demonstrated a statistically significant difference in pain between groups only at T1 (P value  = 0.000). It was found that the conventional palatal injection group had a higher pain level than the EMLA cream-only group and the group using microneedle patches with EMLA cream (P value  = 0.000). However, the other groups did not show significant differences in pain levels during the anesthesia (P value  = 0.091). The study concludes that both EMLA cream alone and EMLA with microneedles can be used as an alternative to conventional palatal anesthesia for children., (© 2024. The Author(s).)

Aim: To evaluate tramadol hydrochloride, an atypical opioid with potential analgesic properties, as a viable alternative to lignocaine hydrochloride in supraperiosteal anesthesia for dental implants., Materials and Methods: A split-mouth, double-blind, randomized controlled trial was conducted in patients requiring maxillary dental implants. Patients meeting inclusion criteria received either 5% tramadol hydrochloride with adrenaline or 2% lignocaine hydrochloride with adrenaline via supraperiosteal infiltration. Onset, duration of anesthesia, visual analog scale (VAS) pain scores, and adverse effects were recorded., Results: Forty patients were included, with a mean age of 39.35 years, 62.5% male. No significant differences were observed in VAS pain scores between tramadol (2.08 ± 1.328) and lignocaine (2.05 ± 1.260) groups ( p = 0.931). Onset of anesthesia showed no significant difference between the tramadol (128.00 ± 18.207 seconds) and lignocaine (128.30 ± 18.287 seconds) groups ( p = 0.736). The duration of anesthesia was comparable between tramadol (59 ± 12.092 minutes) and lignocaine (59.90 ± 11.705 minutes) groups ( p = 0.0736). Adverse effects included nausea in two tramadol and one lignocaine patient., Conclusion: Tramadol hydrochloride demonstrated comparable local anesthetic efficacy to lignocaine hydrochloride in dental implant surgery Clinical significance: Both drugs provided effective pain control with similar onset and duration of anesthesia. Tramadol may offer an alternative for patients with lignocaine contraindications, although further studies are warranted to validate its safety and efficacy in dental procedures. How to cite this article: Parlawar AN, Mundada BP. Assessing Tramadol Hydrochloride as an Alternative to Lignocaine Hydrochloride in Dental Implant Procedures: A Randomized Trial. J Contemp Dent Pract 2024;25(7):639-644.

Background: The main goal of the pediatric dentist is to address and reduce children's fear and anxiety during the dental treatment, especially when conventional behavior-guiding strategies fail. In such cases, the use of pharmacological agents becomes an essential factor to consider., Objective: The objective of the study was to compare the efficacy, safety, and acceptability of intranasal ketamine (INK) with the combination of intranasal midazolam and dexmedetomidine (INMzD) in pediatric dental patients for the procedural sedation., Patients and Methods: Forty-seven children aged 3-9 years who required dental procedures such as extractions, pulpectomy, and restorations were randomly distributed into two groups using the envelope drawing method. Group INK received 7 mg/kg INK, whereas Group INMzD received a combination of midazolam spray (0.3 mg/kg) and atomized dexmedetomidine (3 μg/kg)., Results: INK showed faster onset, faster recovery, and shorter discharge time than INMzD. Both groups had acceptable physiological parameters and no postoperative complications. INK was more accepted by the patients than INMzD., Conclusions: In terms of efficacy, safety, and acceptability, INK outperformed the combination of INMzD for the procedural sedation., (Copyright © 2024 Copyright: © 2024 Journal of Indian Society of Pedodontics and Preventive Dentistry.)

This study identified the dental treatment modalities administered to patients undergoing dental procedures under deep sedation and examined potential relations among treatment types, age, gender and tooth types. This study protocol included data from 502 patients, including a total of 5141 teeth, who underwent dental procedures under deep sedation between October 2022 and October 2023. The dental treatments were categorized based on primary types and subtypes. Subsequently, this study examined the associations between treatment types and age, gender and tooth type. Data were analyzed using the Chi-Square test, with the significance level set at 5%. Most patients (76.9%) were aged 0-6 years, and 93.4% of the treated teeth were primary teeth. The predominant treatment was restorative therapy (61.6%), followed by extraction (27.2%), endodontic treatment (6.1%), and preventive treatment (5.1%). Among restorative materials, compomer was the most frequently applied (49.8%). Significant differences between the treatment types were observed in terms of age group and tooth type ( p < 0.001 for both) but not gender ( p = 0.920). Based on our findings, restorative treatments and tooth extraction are the most frequently performed procedures, whereas endodontic treatments are performed less frequently under deep sedation., Competing Interests: The authors declare no conflict of interest., (©2024 The Author(s). Published by MRE Press.)

Objectives: To assess the knowledge and awareness of dental house officers regarding calculation of local anaesthesia dosage, and to evaluate differences in practices at various tertiary care facilities., Methods: The cross-sectional study was conducted at three dental hospitals affiliated with Dow University of Health Sciences, Karachi from July to December 2022, and comprised house officers of either gender currently enrolled at the participating centres. Data was collected using a self-administered questionnaire to assess knowledge and awareness of local anaesthesia dosage calculation, administration methods, and common complications. Data was analysed using SPSS 26., Results: Of the 200 subjects approached, 136(68%) responded, and 89(65.4%) of them were females. Knowledge regarding the meaning of 2% lidocaine solution was low 45(33%), and 68(50%) subjects were knowledgeable about the maximum dosage of lidocaine with epinephrine. In terms of practice, lidocaine was the most commonly administered local anaesthetic 115(85%), followed by bupivacaine 15(11%). The majority of subjects administered local anaesthesia with vasoconstrictor 127(94%), but only 36(27%) performed aspiration during administration. Syncope 71(52%) was the most commonly reported complication, followed by lip/cheek/tongue biting by 35(26%)., Conclusions: House officers' knowledge level of local anaesthesia administration indicated the need for adequate training.

Dental general anaesthesia provides a comfortable treatment modality for children with early childhood caries and children's dental anxiety, but US Food and Drug Administration safety warnings have raised concerns about the neurotoxicity of general anaesthetic drugs. Currently, anaesthetic drugs have been found to impair neurocognitive function in animals, with possible mechanisms including cell damage, cell loss and impaired neuronal network function. The outcomes of clinical studies on the neurocognitive effects of surgical general anaesthesia in children have been inconsistent. However, studies focusing on dental general anaesthesia in children suggest that it does not affect neurocognitive function. In general, a growing number of studies suggest that dental general anaesthesia does not affect neurocognitive development in children. Moreover, dental general anesthesia should be used as normal when other behavioural management is unavailable., Competing Interests: The authors declare no conflict of interest., (©2024 The Author(s). Published by MRE Press.)

Objective: To compare the effectiveness of administering inferior alveolar nerve blocks (IANB) for the first time with or without a previous practical lesson using a simple manufactured simulator., Methods: This was a study designed to compare students' first administration of IANB anesthesia during 2022, with or without a previous practical lesson. Students were randomized into two groups. The experimental group attended both theoretical lessons and a practical lesson with a simulator device, while the control group attended only theoretical lessons. The theoretical lesson included usual contents such as anatomy, physiology, technical maneuvers for administering anesthesia, tips, and complications, and the practical lesson consisted of the administration of anesthesia using a simple manufactured simulator. After students applied their first IANB, its efficacy, and their answers to a questionnaire on a 5-point Likert scale were recorded. Statistical analysis consisted of the Chi-square test (p < 0.05)., Results: The study recorded 60 anonymous surveys. The main difference observed was in instrument handing (p < 0.05), and there was a tendency in the ease of recognition of the anatomical marks used for the technique-pterygomandibular raphe and coronoid notch of the mandible (p = 0.08 and 0.11, respectively). No difference in success was observed (p > 0.05). Self-confidence and personal feelings did not differ statistically. All students agreed strongly or partially that training with the simulator model was helpful., Conclusion: Students who used simple manufactured simulators achieved better outcomes for instrument handling, and possibly for identification of anatomical landmarks, than those who received only theoretical lessons., (© 2024 American Dental Education Association.)

Introduction: Chronic inflammation in irreversible pulpitis leads to heightened sensitivity of nociceptive receptors, resulting in persistent hyperalgesia. This poses significant challenges in achieving effective anesthesia for patients with irreversible pulpitis. Various anesthetic techniques and pharmacological approaches have been employed to enhance the success of local anesthesia. Recently, the preemptive use of anti-inflammatory agents, specifically corticosteroids, has gained attention and shown promising results in randomized controlled trials. This systemic review and meta-analysis aimed to evaluate the impact of systemically administered corticosteroids on enhancing anesthetic success in patients undergoing endodontic treatment., Methods: A comprehensive search was conducted across multiple databases including PubMed, Cochrane Library, Embase, Scopus, Dentistry & Oral Science, and ProQuest. Additionally, the references of primary studies and related systematic reviews were manually searched for additional relevant publications. The primary outcome assessed was the success of anesthesia, and the effect measure was risk ratio using the random-effects inverse variance method. Statistical significance was set at P < .05. The certainty of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach., Results: Twelve studies involving 917 participants were analyzed to determine the frequency of successful anesthesia. The corticosteroid group demonstrated a significantly higher number of patients achieving successful anesthesia (risk ratio = 1.66; 95% confidence interval, 1.34-2.06;P < .00001). However, heterogeneity within the pooled data analysis was observed (I 2  = 57%, P = .007)., Conclusions: Moderate certainty evidence indicates that preemptive use of systemic corticosteroids enhances the success of local anesthesia, specifically inferior alveolar nerve block, in cases of irreversible pulpitis., (Copyright © 2024 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background/objective: Advancements in augmented reality (AR) technology enable developers to create augmented reality books (AR Books). AR Books can show interactive 3D objects and multimedia content to the user. The purpose of this study was to investigate the effect of a developed AR Book on the theoretical and practical abilities in the administration of local anesthesia of the inferior alveolar nerve block., Methods: An exclusive AR Book was developed based on Chapter 14, Handbook of Local Anesthesia, seventh edition, Stanley F. Malamed, which enabled students to use their book (printed or electronic) as an AR Book. Forty dental students were randomly divided into control and study groups. In the control group, students were asked to use regular books, while in the study group, students were instructed to use interactive AR Books. All students took the written exam, scoring 0 to 10. Also, the administration of mandibular local anesthesia was evaluated in students. The level of concentration during the study, the written exam score, the practical score, the success rate of local anesthesia, and the needed time for injection were compared between the two groups., Results: There was a significant difference in the level of concentration during the study (p < 0.001), practical skill score (p = 0.037), and needed time for injection (p = 0.040) between the two groups. Conversely, the success rate of local anesthesia was almost similar (p = 0.705). Although the written exam score was higher in the study group than in the control group, the difference was not significant (p = 0.414)., Conclusion: Using AR Books can engage students and help them to remain focused during the study. AR Books may be beneficial in enhancing the practical abilities of dental students., (© 2024 American Dental Education Association.)

Background: Prior literature highlights the importance of local anesthesia (LA) for stainless steel crown (SSC) preparation and placement. Nevertheless, the effectiveness of a eutectic mixture of local anesthesia (EMLA), a topical anesthesia, for this purpose remains unexplored., Aim: The study evaluated the effectiveness of two EMLA application methods during SSC preparation and placement., Design: Eighty-four children between 4 and 8 years of age were randomly allocated to three intervention groups. Group A received EMLA applied supragingivally, Group B received a gingival retraction cord impregnated with EMLA (GRC&#95;EMLA), and Group C (control) received LA. Pain was recorded using Wong-Baker Faces Pain Scale (WBFPS) and Children Hospital Eastern Ontario Pain Scale (CHEOPS) at three time intervals., Results: Control had highest mean pain scores at the first time interval in both maxillary and mandibular arches, followed by Group B and Group A, with statistically significant p-values (p = .00, p < .05). After preparation and placement, all three groups had low mean pain scores, with no statistically significant differences. Group A had minimal pain scores at all three time intervals, although not statistically significant., Conclusion: EMLA is a potent topical anesthetic and can be used as an alternative to LA for conventional SSC preparation and placement in primary molars., (© 2023 BSPD, IAPD and John Wiley & Sons Ltd.)

Climate change represents an urgent global threat. Without action, rising temperatures resulting from human activity will increasingly affect our health and wellbeing through changing patterns of disease, extreme weather events and availability of resources. Expedient decarbonisation of the UK economy is an ambitious goal to which we must all contribute.The NHS aims to be the world's first net-zero health service and reach carbon-neutral status by 2040. Dental services are particularly resource-intensive. Some dental anxiety management techniques have a disproportionately high impact on the environment relative to their usage. Inhalation sedation with nitrous oxide is one such example.Nitrous oxide is a greenhouse gas almost 300 times more potent than carbon dioxide, but its utility to facilitate dental treatment for anxious and vulnerable patients is well-documented. This paper balances the health utility with environmental and social harm of continuing to use nitrous oxide and suggests evidence-based methods we can apply to limit the environmental impact of sedation services., (© 2024. The Author(s), under exclusive licence to the British Dental Association.)

Purpose: Awake extubation and deep extubation are commonly used anesthesia techniques. In this study, the safety of propofol-assisted deep extubation in the dental treatment of children was assessed., Materials and Methods: Children with severe caries who received dental treatment under general anesthesia and deep extubation between January 2017 and June 2023 were included in this study. Data were collected on the following variables: details and time of anesthesia, perioperative vital signs, and incidence of postoperative complications. The incidence of laryngeal spasm (LS) was considered to be the primary observation indicator., Results: The perioperative data obtained from 195 children undergoing dental treatment was reviewed. The median age was 4.2 years (range: 2.3 to 9.6 years), and the average duration of anesthesia was 2.56 h (range 1 to 4.5 h). During intubation with a videoscope, purulent mucus was found in the pharyngeal cavity of seven children (3.6%); LS occurred in five of them (2.6%), and one child developed a fever (T = 37.8 °C) after discharge. Five children (2.6%) experienced emergence agitation (EA) in the recovery room. Also, 13 children (6.7%) experienced epistaxis; 10 had a mild experience and three had a moderate experience. No cases of airway obstruction (AO) and hypoxemia were recorded. The time to open eyes (TOE) was 16.3 ± 7.2 min. The incidence rate of complications was 23/195 (11.8%). Emergency tracheal reintubation was not required. Patients with mild upper respiratory tract infections showed a significantly higher incidence of complications (P < 0.001)., Conclusions: Propofol-assisted deep extubation is a suitable technique that can be used for pediatric patients who exhibited non-cooperation in the outpatient setting. Epistaxis represents the most frequently encountered complication. Preoperative upper respiratory tract infection significantly increases the risk of complications. The occurrence of EA was notably lower than reported in other studies., (© 2024. The Author(s).)

Background: One of the main goals for pediatric dentists is to offer a painless anesthesia experience. Laser photobiomodulation is among the suggested strategies to decrease injection pain. So, this study aimed to assess the impact of laser photobiomodulation on local anesthesia (LA) injection pain in children and its effect on the efficacy of LA during pulpotomy and SSC procedures., Methods: The research was carried out as a randomized controlled clinical trial with two parallel group design. It involved 64 cooperative healthy children, age range from 5 to 7 years, each having at least one maxillary molar indicated for pulpotomy. Children were randomly allocated to one of the two groups based on the pre-anesthetic tissue management technique used: test group received laser photobiomodulation, while control group received topical anesthetic gel. Pain during injection, pulpotomy, and SSC procedures was assessed using physiological measures (Heart Rate (HR)), subjective evaluation (modified Face-Pain-Scale (FPS), and objective analysis (Sound-Eye-Motor scale (SEM))., Results: A total of 64 children with mean age 6.23 ± 0.78 participated in this research. The mean HR scores were significantly lower in the laser PBM group during buccal and palatal infiltration injections. The SEM mean scores were significantly lower in the laser PBM group during both injections. For the FPS scale, the number of children who recorded satisfaction during injection was significantly higher in laser PBM group. There was no statistically significant difference in mean HR as well as in SEM and FPS scores between the two groups during pulpotomy and SSC procedures. Comparisons between the two study groups were performed using independent samples t- and Mann-Whitney U tests. Significance was set at p value < 0.05., Conclusion: Laser photobiomodulation is a promising non-pharmacological pre-anesthetic tissue management technique in children that offered less painful injection compared to topical anesthetic gel without compromising the effectiveness of LA., Trial Registration: ClinicalTrials.gov Identifier: NCT05861154. Registered on 16/5/2023., (© 2024. The Author(s).)

Background: Surgical extraction of impacted third molars (ITM) often leads to postoperative discomfort including pain, swelling, and limited function. Steroids like dexamethasone (DXN) are commonly used in oral surgery to manage pain and inflammation. Various administration routes for DXN exist, including intravenous (IV), perineural (PN), and oral applications, each with its advantages. Previous studies have shown that adding DXN to local anesthetics can prolong anesthesia duration and reduce postoperative sequelae. However, comparative studies on IV and PN applications with inferior alveolar nerve block (IANB) of DXN in ITM surgeries are limited., Methods: This controlled, randomized observational study involved patients undergoing Class II position B ITM extraction. Patients were divided into three groups. IANB (1.8 ml of articaine hydrochloride + 1 ml of saline) was performed 1 h after IV-DXN (4 mg/ml DXN) was administered to the IV group. DXN along with IANB (1.8 ml of articaine hydrochloride + 1 ml of 4 mg/ml DXN) was applied to the PN group. Only IANB (1.8 ml of articaine hydrochloride + 1 ml of saline) was applied to the control group. Anesthesia duration was assessed as primary outcomes. Anesthesia duration was evaluated using a vitalometer from the molars. Secondary outcomes included postoperative pain and edema measured on the 1st, 3rd, and 7th days after surgery. Pain was evaluated postoperatively by using a visual analog scale. A p-value < 0.05 was considered statistically significant., Results: The study included 45 patients with similar demographic characteristics across groups. IV application significantly prolonged anesthesia duration compared to the control group. (p = 0.049) Both IV and PN administration of DXN reduced postoperative edema at 3rd (p = 0.048) and 7th day (p = 0.01). Post-procedure pain reduction was significant in the IV group (p = 0.011). On the other hand, it was observed that the pain did not decrease in the PN group at 3rd and 7th days compared to the control and IV groups., Conclusions: PN and IV DXN administration prolonged anesthesia duration and reduced postoperative edema in ITM surgeries. However, PN DXN administration was associated with increased postoperative pain compared to IV DXN and control groups. Further studies comparing different doses and administration routes of DXN are needed to determine optimal strategies for managing postoperative discomfort in ITM surgeries., Trial Registration: This study was conducted at Ahmet Keleşoğlu Faculty of Dentistry with the permission of Karamanoğlu Mehmetbey University Faculty of Medicine Ethics Committee (#04-2022/101). Trial registration is also available at clinicaltrail.gov. (NCT06318013, 26/05/2024)., (© 2024. The Author(s).)

Objectives: This study examined the impact of premedication with ibuprofen and ibuprofen-arginine and the influence of preoperative pain and anxiety on inferior alveolar nerve block (IANB) efficacy in cases of symptomatic irreversible pulpitis., Materials and Methods: The study involved 150 SIP patients who were randomly assigned to receive ibuprofen (600 mg), ibuprofen-arginine (1,155 mg), or a placebo 30 min before IANB. Preoperative anxiety and pain levels were assessed using the Modified Dental Anxiety Scale and the Heft-Parker visual scale. IANB efficacy was determined by the absence of or mild pain during the procedure. Statistical analysis included chi-square, z-tests, Analysis of Variance, and Student's t tests., Results: The ibuprofen and ibuprofen-arginine groups exhibited significantly higher IANB success rates (62% and 78%, respectively) compared to the placebo group (34%). However, no significant difference was observed between the ibuprofen and ibuprofen-arginine groups. Patients with successful IANB in the ibuprofen and ibuprofen-arginine groups displayed lower median anxiety scores (8) than those with failed blocks (15) and lower mean preoperative pain scores (118.3)., Conclusion: In cases of symptomatic irreversible pulpitis the preemptive medication with ibuprofen-arginine effectively increased the efficacy of the inferior alveolar nerve block The inferior alveolar nerve block efficacy was influenced by preoperative anxiety levels and the intensity of pain., Clinical Relevance: This research underscores the potential benefits of oral premedication with ibuprofen and ibuprofen-arginine in improving anesthesia outcomes in cases of symptomatic irreversible pulpitis., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)