June 2014
Volume 35, Issue 6


Compendium has compiled Abstracts from key recently published articles in the dental literature on pain management. These PubMed-indexed articles offer clinical relevance to the dental practitioner and can be applied to a range of situations.

Effects of a vibratory device on pain from anesthetic injections

DiFelice MG, Vandewalle KS, Maller SC, Hancock RH. Compend Contin Educ Dent. 2014;35(4);246-253.

ABSTRACT: A randomized block, split-mouth design was used to determine the effectiveness of a vibratory device with topical anesthetic compared to topical anesthetic only in reducing the pain experienced during an inferior alveolar nerve block. Twenty participants each received two inferior alveolar injections with a 5-minute interval between injections, one with topical anesthetic and one with topical anesthetic and a vibratory device. Each injection included a 2-minute application of topical anesthetic gel at the injection site. Local anesthetic was administered bilaterally using a 27-gauge needle with or without the vibratory device. Participants rated the pain they experienced after each injection by using a visual analog scale (VAS). A mean VAS score and standard deviation was determined per group. Data was analyzed with a paired t test (α = 0.05). RESULTS: The group receiving the vibratory device with topical anesthetic had a mean VAS score of 21.2 mm ± 18.6 mm, and the group receiving the topical anesthetic alone had a VAS score of 38.7 mm ± 23.3 mm. CONCLUSION: The use of the vibratory device and topical anesthetic significantly reduced the pain experienced during the administration of a local anesthetic injection compared with the use of topical anesthetic alone (P = 0.006).

Influence of intra-pocket anesthesia gel on treatment outcome in periodontal patients: a randomized controlled trial

Derman SH, Lowden CE, Hellmich M, Noack MJ. J Clin Periodontol. 2014 Feb 7. doi:10.1111/jcpe.12239. [Epub ahead of print]

ABSTRACT: This study compared the treatment outcome after scaling and root-planing using local anesthesia gel or injected local anesthesia. Thirty-eight patients with periodontitis were included in a randomized, single-blind, split-mouth clinical trial. Probing depths and clinical attachment levels were recorded at baseline and 6 weeks after treatment. Scaling and root planing was done using two types of local anesthesia for separate treatment appointments. Anesthetics used were intra-pocket lidocaine and prilocaine gel (2.5% each) and injected articaine (1:100,000 adrenaline). Type of anesthesia for first appointment was randomized and switched for second appointment. RESULTS: No influence of applied type of anesthesia could be detected for change of probing pocket depths and clinical attachment level (P > 0.05). These findings are valid even for deeper pockets. Gel group had significant higher intra-operative pain perception. In retrospect, 69% of patients favored gel. CONCLUSION: Treatment outcome is not compromised by use of anesthesia gel in comparison to injected anesthesia. The same beneficial results for probing pocket depths and clinical attachment gain could be detected. The majority of patients prefer local anesthesia gel despite a slightly greater procedural discomfort.

Effects of conscious sedation on patient recall of anxiety and pain after oral surgery

Wilson TD, McNeil DW, Kyle BN, et al. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;117(3):277-282.

ABSTRACT: The objective of this study was to examine the effect of conscious (“moderate”) sedation with amnestic effects and local anesthetic, versus local anesthetic alone, on recall of pain and anxiety related to surgical tooth extraction. Greater anxiety and pain were hypothesized in the local anesthesia-alone group. STUDY DESIGN: Patients undergoing tooth extraction, receiving moderate sedation plus local anesthetic (n = 27) or local anesthetic alone (n = 27), were assessed on trait dental anxiety, preextraction state pain and anxiety, anticipated pain and anxiety, and 1-month recall of pain and anxiety. RESULTS: Patients with moderate sedation, compared with those administered only local anesthetic, recalled less procedural pain and anxiety after 1 month. The local anesthetic-alone group reported more preextraction pain and anticipated more procedural anxiety. CONCLUSION: Moderate sedation had the desired effect of lower recalled pain and anxiety associated with extraction, even 1 month later. Anticipating moderate sedation also prompts expectation of less anxiety during the procedure.

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