ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Simple Maxillary Teeth Extractions Can Be Successfully Performed Without Including a Palatal Injection
Clinical Question In healthy patients undergoing maxillary teeth extractions, can local anesthesia without palatal injections result in successful extractions with equivalent or reduced discomfort felt by the patient compared to when palatal injections are included?
Clinical Bottom Line In healthy patients undergoing simple non-surgical maxillary teeth extractions, local anesthesia without palatal injections can be a successful method in performing these extractions. Adequate anesthesia, including anesthesia to the palatal tissues, can be achieved without the use of a direct palatal injection.
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) 22414352Janjua/2012200 patients requiring simple maxillary extractionsRandomized Controlled Trial
Key resultsBoth the Faces Pain Scale (FPS) and Visual Analogue Scale (VAS) showed that during the injections, patients experienced less pain during transpapillary injections (FPS: 0.77 +/- 0.07; VAS: 1.07+/- 0.09) compared to palatal injections (FPS: 2.52 +/- 0.08; VAS: 4.14 +/- 0.14). These results were shown to be statistically significant (p<.001). Also, The FPS and VAS scales showed that during extractions, there was little to no difference in pain experienced when only transpapillary injections were used as anesthesia (FPS: 0.26 +/- 0.06; VAS: 0.38 +/- 0.09) compared to when palatal injections were included (FPS: 0.29 +/- 0.07; VAS: 0.34 +/- 0.09). These results were shown to be statistically insignificant (p = 0.76)
#2) 24010986Yadav/2013200 patients with no systemic diseases affecting extractions or impacted 3rd molarsRandomized Controlled Trial
Key resultsThere was found to be no statistically significant difference (FPS: p = 0.44; VAS: p = 0.75) between the Faces Pain Scale (FPS) and Visual Analogue Scale (VAS) scores of patients during extractions when only a single mucobuccal injection was given (FPS: Mean = 0.98, STD = 1.79; VAS: Mean = 5.3, STD = 11.71) compared to when a mucobuccal and palatal injection were given (FPS: Mean = 0.8, STD = 1.5; VAS: Mean= 4.82, STD = 9.72).
Evidence Search ("Anesthesia, Local"[Mesh] AND "Pain"[Mesh]) AND "Mouth"[Mesh] AND (Clinical Trial, Phase IV[ptyp] OR Randomized Controlled Trial[ptyp])
Comments on
The Evidence
Validity: Both studies were Randomized controlled trials with a similar patient pool in regards to health, had over 80% completion rates, and no bias was detected. It was undetectable whether Janjua (2012) included an independent observer for FPS and VAS measurements. The main difference was that Janjua (2012) excluded 2nd and 3rd molar extractions, while Yaday (2013) focused on 3rd molar extractions. Perspective: The evidence disagrees with current teaching standards of administering palatal injections during maxillary teeth extractions in addition to the respective nerve blocks.
Applicability The patient pool is representative of an average healthy patient pool with no bias between males and females, and ages ranging from 10-70 years. Evidence shows that the clinician can successfully perform simple non-surgical maxillary teeth extractions excluding the notorious palatal injection and achieve no difference in discomfort for the patient during the extractions, while also achieving adequate anesthesia to all tissues surrounding teeth to be extracted. As pain is arbitrarily experienced differently from patient-to-patient, clinical judgment is critical in applying these findings.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics) (Restorative Dentistry)
Keywords Local Anesthesia, Teeth Extractions, Maxilla
ID# 3007
Date of submission: 03/11/2016spacer
E-mail lopezc12@livemail.uthscsa.edu
Author Christian Lopez
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Gregory Spackman, DDS, MBA
Faculty mentor/Co-author e-mail Spackman@uthscsa.edu
Basic Science Rationale
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Comments on the CAT
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