Efficacy Of Articaine And Lidocaine Health Essay
Efficacy Of Articaine And Lidocaine Health Essay
As discussed in the paper, the survey of comparings of safety and efficaciousness of articaine and Lidocaine have been carried out many times, demoing no differences in effectivity. However, there have non been any surveies, up boulder clay this paper, which compare the reaction of kids when given 2 % Lidocaine with 1:100000 and 4 % articaine with 1:200000 epinephrine and compared the variables listed supra. This makes this peculiar survey original as new comparings are made between the two local anesthetic agents. Efficacy Of Articaine And Lidocaine Health Essay.
Patient enlisting
The paper does non give a elaborate history as to how the topics were recruited, but, all the topics, who were kids, were all recruited from two pediatric dental clinics. This fact may hold introduced prejudice into the survey as all the patients have been having intervention from a specialized paediatric clinic – where, as an illustration, particular anxiousness control techniques may be routinely used to handle kids. Hypothetically, this means that the kids included in the survey may be able to easy accept local anesthetic for dental intervention. This may intend that the sample in the survey may non be representative.
Sample size, gender, age
The survey included 62 kids ( 34 females and 28 males ) aged between 5-13 old ages. The sample size is peculiarly little, which consequences in a big sum of mistake in the consequences. The smaller the sample, the harder it is to observe a important difference between the anesthetic agents, even if it exists. The sample is about 50 % male and 50 % female, which eliminates sex as a confounding factor. In footings of age, the patients in this age scope will hold deciduous dentitions and a combination of deciduous and freshly erupted lasting dentitions traveling towards the upper terminal of the age scope. The survey does non take this into history tooth type into historyEfficacy Of Articaine And Lidocaine Health Essay.. Having mentioned this, tooth type is likely non a confusing factor in footings of patient reaction and the remainder of the measured results since the survey merely looks the consequence of anesthetic on soft tissue, instead than mush.
Patient choice
The patients who were included for the survey were 1s who required two or more visits for two similar alveolar consonant processs necessitating local anesthetic. All other patients were excluded from the survey. This eliminates a big beginning of prejudice, since if on the two visits, two really different processs were carried out on the patient, one really simple and one really traumatic, it may bring forth a false difference between the two anesthetic agents which may non be at that place if the two processs were both simple or both complicated.
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Study design
The survey was carried out as a randomized controlled cross-over survey. Each kid received one anesthetic agent on their first dental visit and the other agent on their 2nd visit. The advantage of utilizing this type of survey is that each topic is a control to themselves, which helps cut down the influence of confusing factors.
To extinguish the inquiry whether giving the anesthetic agents in a peculiar order influences the consequences, the patients were indiscriminately assigned to have either Lidocaine foremost and so articaine during the 2nd visit, or vice-versa. However, the survey does non depict the procedure of this randomization.
Two experient pediatric tooth doctors carried out the intervention on patients. The tooth doctor from which you received intervention depended on which clinic you attended as the tooth doctors were based at one of the two clinics. The fact that there were two tooth doctors involved in the proviso of intervention is a beginning of prejudice since techniques between the two clinicians may be somewhat different. To graduate the possible differences between the clinicians, a upper limit of one cartridge of anesthetic was used, injected at a slow rate, at an mean continuance of about 2 proceedingss and topical anesthetic was applied for 1 minute before each injection. Taking the premise, for ethical intents ( consent ) the clinician was non blinded to the intervention which was provided can add a beginning of prejudice into the survey. Efficacy Of Articaine And Lidocaine Health Essay.Since hurting direction involves a batch of psychological science, if one of the clinicians believed or wanted there to be a certain difference between the two anesthetic agents, so this may go implemented into the proviso of local anesthetic e.g. offering more care/sympathy when utilizing one peculiar anesthetic than the other. Assorted results were measured in the patient during disposal of the local anesthetic, during intervention and after intervention.
Data aggregation methods and Data presentation
To mensurate the kid ‘s reaction when given the anesthetic, the modified behavioral hurting graduated table was used, A dental helper who was blinded to the anesthetic agent used, recorded each of these parametric quantities
Onset clip was measured by inquiring the patient when the numbness began
The efficaciousness of each anesthetic agent was evaluated while the patient was undergoing intervention – if the patient showed any marks of hurting, the local was topped up
To mensurate the continuance of soft tissue anaesthesia – the parent of the patient recorded the clip when the feeling of numbness went
To rate esthesis after injection, the facial hurting graduated table ( FPS ) was used immediately after intervention, and 1 and 2 hours after ( by phone ) for each patient
To mensurate the happening of any inauspicious effects, the parent was asked if any had occurred 1 and 2 hours after intervention ( by phone ) .
In footings of blinding, for all the results measured, the kid was likely blinded to which anesthetic agent was used, since at ages 5-13, which is below the age of consent, there would hold been no demand to explicate to the kid, which anesthetic was used. However, the parent of the kid, who was responsible for taking certain measurings, may non hold been blinded to which anesthetic was used. Having said this, the paper does non province this, so we can non take an premise that this was true. However, whether the patient/parent was blinded to the agent used, likely did non affair. The lone individual who was blinded was the dental helper, when entering for the modified behavioral hurting graduated table – where it mattered, since the perceiver may hold some clinical cognition. Efficacy Of Articaine And Lidocaine Health Essay.
All patients were followed up precisely the same manner, all possible measuring were recorded during the visit, and if that was non possible, so specific measurings were recorded 1 and 2 hours after the dental visit. All topics who entered the survey were accounted for 100 % at the terminal, since no topics decided to go forth the survey.
Data presentation
The undermentioned information is divided into whether the kid was given an ID block or an infiltration – to infer whether there is a difference between the types:
Child ‘s reaction
The information for this is represented as a frequence tabular array ( besides demoing per centums ) demoing if the kid cried on both visits, on the 1st and non the 2nd, on the 2nd and non the 1st, and on neither visits.
Onset clip
The information for this is besides represented as a frequence tabular array ( besides demoing per centums ) demoing if onset clip was immediate on both visits, immediate on 1st after 2 mins on 2nd, after 2 mins on 1st immediate on 2nd, and after 2 mins of both
Efficacy
In footings of efficaciousness of anesthetic agents, the paper merely states that 9 patients required at top up of anesthetic, out of which 8 required it for both agents.
For both soft tissue anesthesia continuance and hurting esthesiss after injection, the information has non been shown. Alternatively the information has been evaluated utilizing McNemar trial and paired t-test ( significance P & A ; lt ; 0.05 ) A mated t-test is suited since the informations being compared comes from the same sample. A McNemar trial would besides be suited since the information is transverse tabulated and sums for all combinations of results are put together. However, this is non shown. The paper does non province if both trial were used for each result and the consequences demoing significance used, if one trial was used for one result and one trial for another.
Duration of soft tissue anesthesia
The information for this measuring is non described. The tabular array merely shows an mean continuance clip + criterion mistake for each anesthetic agent and the P value to demo the significance if the difference is important.
Pain esthesiss after injection
The information for this measuring is non described. The tabular array merely shows an mean FPS class + criterion mistake for each anesthetic agent and the P value to demo the significance if the difference is important. Efficacy Of Articaine And Lidocaine Health Essay.
Adverse effects
The tabular array for this shows the figure of different inauspicious effects which occurred for each type of anesthetic agent.
Despite the advent of modern injection techniques, palatal injection continues to be a painful experience for children.
Aims:
To compare the pain experienced during extraction of maxillary primary molars with conventional lignocaine anesthesia versus lignocaine and articaine buccal infiltration in children aged 6–14 years.
Materials and Methods:
A prospective randomized triple blinded study was conducted with ninety children (n = 90), randomly allocated to receive lignocaine conventional anesthesia (Group I [control group]), and buccal infiltration using articaine (Group II [articaine group]) or lignocaine (Group III [lignocaine group]). A composite score of self-report (faces pain scale-revised), behavioral measure (face legs activity cry consolability scale), and a physiological response (pulse rate) was measured following maxillary primary molar extraction.
Statistical Analysis Used:
To test the mean difference between two groups, Students’ t-test was used and among the three groups, one-way ANOVA with post hoc test was used.
Results:
Articaine group had significantly lower pain scores for self-report (P < 000.1) and behavioral measures (P < 000.1) while there was no significant difference (P > 0.05) between articaine and control groups during primary maxillary molar extraction.
Conclusion:
Maxillary primary molar extraction procedure can be successfully accomplished by bypassing the palatal injection.Efficacy Of Articaine And Lidocaine Health Essay. Articaine buccal infiltration can be considered as an alternative to conventional local anesthesia for the extraction of maxillary primary molars.
Local anesthetics (LA) are essential in dentistry for appropriate pain control as they inhibit nociception generated during surgical and dental procedures.[1] Palatal injections are ranked among the most painful intraoral injections[2] and direct experience of administering the palatal anesthesia is considered to be the frequent source of fear during pediatric dental invasive procedures. Palatal injections are painful due to tight adherence of palatal mucosa to its underlying periosteum and its rich neural innervations,[3] displacement of mucoperiosteum results in increased pain rather than the needle piercing the mucosa.[4]
A number of methods and techniques have been suggested to reduce the discomfort due to infiltration of LA agents, including transcutaneous electronic nerve stimulation,[5] topical anesthetic application,[6] precooling of the palate,[7] computerized injection systems,[8] pressure administration,[9] and eutectic mixture of LA,[10] though none of them gained universal acceptance.
Maxillary molars removal without palatal injection is possible due to relatively thin porous bone of posterior buccal maxilla that facilitates the diffusion of any local anesthetic.[11] LA should be able to diffuse through soft and hard tissues by a property of diffusability, and anesthetic requirement is not as high as that required for routine conservative dental treatment.[12]
Articaine can diffuse through soft and hard tissues more reliably than other LA so that maxillary buccal infiltration of articaine provides palatal soft tissue anesthesia.[1] The basis for the prevalent use of articaine is due to the belief that it has better diffusion through soft tissue and bone, rapid onset, excellent quality of anesthesia, and lower degree of toxicity than lidocaine. Articaine provides complete anesthesia even by infiltration technique due to its superior tissue penetration capability.[13] Lidocaine is the most widely used local anesthetic in medicine as well as dentistry. Efficacy Of Articaine And Lidocaine Health Essay. It is evident that extraction of the permanent maxillary tooth is possible with single buccal infiltration of 2% lidocaine without the need for palatal injection.[14]
This study was conducted to determine the efficacy of 4% of articaine hydrochloride and 2% of lignocaine hydrochloride for maxillary primary molar tooth extraction without the need of palatal injection in children aged 6–14 years. The study hypothesized that; there would be no significant difference among the three groups in all the outcome measures.
Materials and Methods
This study was registered with Clinical Trial Registration of India (CTRI registration number: CTRI/2016/02/006605).
Ethics
This study was approved by the Institutional Ethical Committee and the University of Health Sciences under protocol number D138407005/2014. Informed statement of consent was obtained from parents/caregivers before their child’s participation in the research.
Study design and participants
A prospective, randomized, equivalence, quantitative, closed label study with a balanced allocation ratio of 1:1:1 was carried out. The study population consisted of individuals and their parents/caregivers, who attended the department of pediatric dentistry and those referred from orthodontics of local dental college and hospital.Efficacy Of Articaine And Lidocaine Health Essay. Children aged 6–14 years were selected based on the following eligibility criteria:
Inclusion criteria
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Cooperative children
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Children with definite indications for extraction of primary first or second maxillary molar
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No history of intra-oral injections
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Maxillary molars with 2/3 of root should be present
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Children who can fully understand the given instructions.
Exclusion criteria
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Whose parents or caregivers did not give consent for the study
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Children allergic to lidocaine/articaine
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Children with underlying vascular or immunological disease.
Pilot study was carried out with ten participants with the same characteristics of the main population to confirm the applicability of the proposed methodology. After the pilot study, the required adjustments were made to the methodology before the development of the main study. The sample size was calculated based on the detected difference of 0.3 value obtained from the pilot study with a power of 80% with minimum possible error of 0.05. The sample size arrived at 28, and 5% was added. Hence, a total of thirty children have been allocated to each treatment.
Research team
An experienced pediatric dentist performed all the injections who was blinded to the anesthetic solutions while another experienced pediatric dentist performed the extraction procedure. An experienced investigator not related to the study has ascertained outcomes from the child. The statistical analyst was blinded regarding the three groups and decoded only after the analysis of the results. Efficacy Of Articaine And Lidocaine Health Essay.
Recruitment and randomization
The treatment allocation was predetermined by generating randomization list using GraphPad StatMate version 1.01i (GraphPad Software, Inc., Armonk, NY: IBM Corp). Children were allocated sequentially into one of the three groups.
Treatment procedure
In the control group, the mucobuccal fold near the concerned teeth was dried with gauge, followed by application of topical anesthetic gel (benzocaine 2%) with the help of cotton applicator for about 30 s. Later, 1.7 ml of anesthetic solution (2% lidocaine with adrenaline 1:80,000 buccally [1.5 ml] and palatally [0.2 ml]), was injected under aseptic conditions using a 27-gauge needle at a rate of approximately 1 ml/min. To achieve effective buccal and palatal anesthesia, the procedure was delayed for at least 5 min. Objective signs were checked with the help of number 9. Molt periosteal elevator, first on the contralateral side followed by the anesthetized side. The tooth was extracted using a standard protocol, with minimal elevation of the palatal gingiva. Similar procedure was followed in other two groups, except that 1.7 ml of 4% articaine was injected buccally in articaine group, and 1.7 ml of 2% lignocaine was injected buccally in lignocaine group.
Outcome measures
For all the groups, the pulse oximeter device was attached to the left index finger, and three readings of pulse rate were recorded before, during, and after the extraction, and the mean was calculated, respectively. Faces pain scale-revised (FPS-R) score was recorded after the extraction and face legs activity cry consolability (FLACC) score was recorded perioperatively.
Statistical analysis
The data were entered in the Microsoft excel spreadsheet 2013. The statistical analysis was performed using IBM SPSS Version 20.0 (Armonk, NY: IBM Corp.). To test the mean difference among two groups’ Student’s t-test was used and to test the mean difference between three or more groups ANOVA one-way with post hoc (Tukey honest significant difference) test was used. All the efficacy parameters were presented as absolute change from baseline. All P values having < 0.05 were considered as statistical significant (P < 0.05).
Results
A total number of children assessed for eligibility, recruitment, randomization allocation, and numbers analyzed were illustrated [Figure 1].
CONSORT flow diagram.
A total of ninety children (45 boys and 45 girls), who required extraction of one or more maxillary primary molars were included in the study. The mean age of the children was 9.74 ± 1.9 years. There was no significant difference among the groups regarding age or gender (independent t-test, P < 0.01) [Table 1].
Table 1
Gender-wise distribution of sample among the groups
Intergroup comparison of the mean values of physiological parameters (heart rate) at baseline (P = 0.26), during extraction (P = 0.08), and after extraction (P = 0.56) revealed that they were not statistically significant among the three groups [Table 2].
Table 2
Comparison of mean value of the physiological responses before, during, and after extraction in the control and test groups
Intergroup comparison of the mean values of self-report scale (FPS-R) after extraction and FLACC during extraction revealed that there was a highly statistical significant difference among the three groups (P < 0.0001) [Table 3]. Efficacy Of Articaine And Lidocaine Health Essay.
Table 3
Comparison of mean value of the self-report faces pain scale (revised) score and face legs activity cry consolability score in the control and test groups
There was no statistical significant difference in the mean reduction of pain scores between the conventional and articaine groups with FPS-R and FLACC (P > 0.05) [Table 3].
The mean FLACC and FPS-R scores were found to be higher in the lignocaine group, compared to the conventional group, indicating that the pain experienced among the children in the lignocaine group was higher compared to the conventional group. This difference in the pain was found to be statistically significant (P < 0.0001) [Table 3].
The mean FLACC and FPS-R scores were found to be higher in the lignocaine group, compared to the articaine group, indicating a statistically significant difference in the pain, between the lignocaine and articaine groups [Table 3].
No adverse events were observed during the course of the study.
Discussion
Anxiety and fear may develop due to poorly managed injection pain during childhood, and these reactions may not develop if appropriate measures are taken to reduce the pain associated with injections.[15] Customarily, adequate surface anesthesia could not be achieved for palatal muvosa through topical anesthetics, due to poor drug penetration through the highly keratinized tissue, firmly attached tissue inhibiting tissue distention created by the pressure of the injected solution (volume dependent), and the decreased tissue buffering capacity.[16]
Three approaches to measure pain in children include self-report, observational or behavioral, and physiological. A composite measure including self-report and one or more of these other approaches would be ideal for measurement of pain.[17] Hence, the FPS-R, the FLACC scale, and pulse rate were used for measuring self-report, behavioral, and physiological measures, respectively. FLACC and FPS-R were considered to be valid and reliable instruments for pain measurement, improving management of pain in children, and adolescents.[18]
In this study, there was no significant difference in the pain perception between control and articaine groups during extraction of maxillary primary molars. Efficacy Of Articaine And Lidocaine Health Essay. The results of this study are in concordance with the many studies[19,20,21,22,23,24] while another study had contradictory outcomes, in which they could not establish the presence of 4% articaine HCl at the palatal tissues after buccal injection.[25]
This study showed that pain perception was high in the lignocaine group compared to articaine group during the extraction of primary molars. The study results states that 4% articaine offers better clinical performance than 2% lignocaine particularly regarding providing adequate palatal anesthesia with only buccal infiltration as inferred by other others.[26,27,28]
Pain perception in lignocaine group was higher compared to that in control group during the extraction of maxillary primary molars, which are in concordance with one study[29] while contradictory to the results of few other studies.[14,30,31]
A study reported by Mittal M et al., in which articaine failed to provide adequate palatal anesthesia during the extraction of primary maxillary molars, contradictory to the results of this study.[32]
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In this study, articaine buccal infiltration showed better success than lignocaine buccal infiltration, which can be explained by the fact that articaine is unique among amide LA due to the presence of thiophene ring, which makes it better lipid soluble. Due to its higher lipid solubility, articaine diffuses better through soft tissues than do other anesthetics, thereby achieving higher intraneural concentration, more extensive longitudinal spreading, and better conduction blockade. Articaine (2% and 4%) is better than lidocaine (2% and 4%) in depressing the compound action potential of the A fibers in the isolated rat sural nerve.[33] In addition, ionic channels are blocked even in lower concentrations with the thiophene derivative (articaine), compared to the benzene derivative (lidocaine).[34] A study noted that none of the younger subjects (below 20 years) in the articaine group had pain during extraction.[21] This can be ascribed to the fact that the maxillary bone becomes more sclerotic with age, thereby diminishing the bone penetrating effect of articaine. Efficacy Of Articaine And Lidocaine Health Essay. This study was conducted in children below 14 years, which might be the reason for enhanced vestibulo-palatal diffusion of articaine, thus providing effective palatal anesthesia with buccal infiltration only.
Delivering comfortable palatal anesthesia is a practice builder that will increase both patient’s trust and treatment acceptance at the same time reduces personal stress levels.[2] Avoidance of the palatal injection completely when it is not necessary is desirable Using 1.7 ml of 4% articaine, we can avoid palatal injection during extraction of primary molars.
Limitation of the study was not utilizing similar concentration of drug in the injection solutions for buccal infiltration anesthesia. However, more randomized clinical trials with higher sample size should be conducted to synthesize higher levels of evidence to use this child-friendly approach in pediatric dentistry. Efficacy Of Articaine And Lidocaine Health Essay.
