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Title Evidence Unclear on Effectiveness of Palatal Anesthesia in Controlling Pain and Improving Behavior of Pediatric Patients
Clinical Question For children that need a dental extraction or stainless-steel crown (SSC) for primary maxillary molars due to dental caries, will buccal and palatal lidocaine anesthesia, as compared to buccal lidocaine anesthesia only, improve their behavior and increase compliance in the dental chair during procedure?
Clinical Bottom Line In pediatric patients, the effectiveness of buccal and palatal anesthesia, as compared to buccal anesthesia only, in controlling pain, improving behavior, and increasing compliance in the dental chair is not clearly supported by literature.
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) 28298777Kolli/201790 children aged 6-14 yearsRandomized Controlled Trial
Key resultsThe sample was divided in three groups of 30 children to compare the efficacy on pain control for three anesthetic techniques and agents: Group 1 (control) utilized 2% lidocaine 1/80,000 adrenaline for buccal and palatal infiltration; with two experimental groups of buccal infiltration with 4% articaine and buccal infiltration with 2% lignocaine during the extraction of maxillary molars. The physiological parameters (heart rate) showed no significant difference between groups. Self-reported scores showed no difference in pain perception between palatal and buccal anesthesia together (conventional technique) and buccal anesthesia with articaine (p>0.05); however, there was a significant difference when compared with buccal infiltration with lignocaine (p>0.0001). Therefore, the authors concluded that the buccal infiltration of articaine can eliminate the need for palatal anesthesia during the extraction of primary molars.
#2) 26883609Mittal/2015102 children aged 5-12 yearsRandomized Controlled Trial
Key resultsThis study evaluated the effectiveness of two different anesthetic agents, 2% lidocaine 1/80,000 epinephrine and 4% articaine with 1/100,000 epinephrine, in children receiving extractions of maxillary primary molars by infiltration on the buccal mucosa without the need to give palatal anesthesia. The results show no statistically significant difference between any of the objective and subjective factors evaluated in each group. The authors concluded that neither of the two types of anesthetics were able to achieve adequate palatal anesthesia.
Evidence Search PubMed Clinical Queries: Palatal anesthesia, Children
Comments on
The Evidence
Validity: In both studies, the authors used measuring tools for pain and behavior that have already been tested and validated. In both studies, the patients' age ranged from 5 to 14 years with a mean age around 9 years old. Completion rate was excellent in all the studies. Study design was different for each study, but they both have a comparison group. In both trials, both investigator and patient were blinded. Overall, the measurement and criteria used in these studies to arrive at the results were valid. Perspective: Palatal anesthesia is considered to be an effective and safe method of anesthetizing the other side of the tissue around the tooth, which will eventually improve patient behavior and increase compliance during treatment. Thus, including this injection with the buccal anesthesia when doing a dental procedure on maxillary teeth could be beneficial even though it is painful. However, the result of the literature review was inconclusive on the effectiveness of different anesthetic agents when only infiltrated in the buccal mucosa. None of the studies evaluated children's compliance during treatment after using both buccal and palatal anesthesia as compared to buccal anesthesia only, so further investigation is needed to confirm this.
Applicability Palatal anesthesia in children is not commonly used because it is associated with pain during administration. Although anesthetizing the palatal tissues is important in reducing the amount of pain that is encountered in a dental procedure, many dentists try to avoid it because of the pain that is associated with its administration. It has been shown that there is no statistically significant difference in pain when giving buccal and palatal anesthesia. Administering both buccal and palatal anesthesia will achieved the desired level of anesthesia, which will eventually reduce the amount of pain, improve behavior, and increase compliance of children in the dental chair.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Pediatric Dentistry) (Restorative Dentistry)
Keywords Palatal anesthesia, buccal anesthesia, children
ID# 3298
Date of submission: 11/20/2017spacer
E-mail Alrashdi@livemail.uthscsa.edu
Author Murad Alrashdi
Co-author(s) e-mail
Faculty mentor/Co-author Maria Jose Cervantes, DDS
Faculty mentor/Co-author e-mail cervantesmen@uthscsa.edu
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