ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Application of Oraqix (Lidocaine/Prilocaine Local Anesthetic Gel) Reduces Pain During Scaling and Root Planing
Clinical Question For an adult patient with periodontitis, does applying Oraqix (lidocaine/prilocaine local anesthetic gel) effectively reduce the patient’s pain during scaling and root planing compared to scaling and root planing with placebo?
Clinical Bottom Line Scaling and root planing in conjunction with the application of Oraqix (lidocaine/prilocaine local anesthetic gel) is less painful for adult periodontitis patients than scaling and root planing with placebo.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 15646610Magnusson/2005337 subjects with moderate to severe periodontitisRandomized Controlled Trial
Key resultsThe article reported on three multicenter double-blinded, randomized controlled studies with a large population of 337 subjects. The studies were conducted with similar materials and methods. Anesthetic gel was applied to the subject’s periodontal pockets before scaling and root planing. Subjects reported their overall pain perceptions on a 100-mm Visual Analog Scale (VAS) and a Verbal Rating Scale (VRS). A visual analog scale (VAS) is a 100 mm in length measurement instrument with “No Pain” marked on the one end and “Worst Pain Imaginable” marked on the other end. A verbal rating scale (VRS) is a five-point measurement instrument including no pain, mild pain, moderate pain, severe pain, and very severe pain. Jeffcoat et al. 2001: 122 subjects. The treatment group reported a lower median VAS pain score (7 mm) than the placebo group (17 mm) with a mean difference of 8 mm (P < 0.0005). There was statistically significant difference in the overall VRS pain score between the active group and control group (90% and 64%, respectively), P = 0.001. The overall VAS and VRS pain scores were statistically significantly correlated with a correlation coefficient of 0.83; P < 0.0005. Donaldson et al. 2003: 130 subjects. The active group reported a lower median VAS pain score (5 mm) than the control group (13 mm). The mean difference was 4 mm, P = 0.015. There was no statistically significant difference in the overall VRS pain score between the active group and control group (78% and 76%, respectively; P = 0.23). The overall VAS and VRS pain scores were statistically significantly correlated with a correlation coefficient of 0.79; P < 0.0005. Magnusson et al. 2003: 85 subjects. The treatment group reported a lower median VAS pain score (11 mm) than the placebo group (27 mm) with the mean difference of 10 mm (P = 0.004). There was statistically significant difference in the overall VRS pain score between the active group and control group (70% and 48%, respectively), P = 0.003. The overall VAS and VRS pain scores were statistically significantly correlated with a coefficient of 0.74; P = 0.0001. The studies showed consistent significantly lower pain scores for the active/treatment vs placebo groups.
Evidence Search ("EMLA"[Supplementary Concept] AND "Periodontitis"[Mesh]) AND "Root Planing"[Mesh]
Comments on
The Evidence
Validity: There was a large sample size with subjects who were randomly divided into groups. The studies achieved more than 80% of completion rate. The groups were treated the same with adequate compliance and follow up. The studies were double blinded. It was unlikely that differences amongst the study centers led to bias. Last but not least, there was a potential conflict of interest, as two of the authors were employees of AstraZeneca. Perspective: According to these randomized controlled trials, adult periodontitis patients could benefit from the application of Oraqix (lidocaine/prilocaine local anesthesia gel) to reduce pain associated with periodontal debridement. It is easy to apply and perform with minimal significant clinical adverse effects.
Applicability Subjects in these studies were adults presenting with moderate to severe periodontitis. Oraqix (lidocaine/prilocaine local anesthesia gel) is effective in reducing pain associated with scaling and root planing with a small number of significant clinical adverse effects such as discomfort, numbness, and/or soreness in the oral cavity. In addition, it is suggested that lidocaine/prilocaine local anesthesia gel could present as an alternative to injection anesthesia. However, more studies are needed to support this claim.
Specialty/Discipline (General Dentistry) (Periodontics)
Keywords Oraqix, Periodontitis, Root planing
ID# 2833
Date of submission: 04/10/2015spacer
E-mail phamnk@livemail.uthscsa
Author Ngan (Nancy) Pham
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Guy Huynh-Ba, DDS
Faculty mentor/Co-author e-mail HuynhBa@uthscsa.edu
Basic Science Rationale
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