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Title Dentists Treating Cleft Lip and/or Palate Patients Will Need to Consider Anatomical Variations when Delivering Local Anesthetic
Clinical Question In cleft lip and palate patients, will altered anesthetic techniques be more effective than standard techniques in achieving adequate pain control?
Clinical Bottom Line Low evidence to support minor alterations needed that include first anesthetize away from cleft and then at cleft margins. But similarities include the use of topical anesthetic and the guidance for slow 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) 22437689Trindade-Suedam/20122 patients with cleft palate and lipCase Report
Key resultsThis article discussed the innervation of the cleft area and reported on the management of two patients. The authors made the following recommendations: 1. Topical anesthetic. 2. Puncture away from cleft area first (i.e. PM area). 3. Slow administration of local anesthetic. 4. Infiltrate local anesthetic at cleft margins.
#2) 11318002da Silva Dalben/2000Cleft lip and palate patientsNarrative Review
Key resultsThis article discussed the anatomical features of cleft lip and palate patients and frequently used dental anesthetic techniques. Recommendations: 1. Dry mucosa. 2. Topical anesthetic. 3. Initial infiltration along long axis of dental tooth. 4. Local anesthesia of the adjacent segment may be needed; therefore change needle direction at initial puncture site towards pre-maxilla, crossing cleft towards other side.
Evidence Search Search (((cleft lip and palate)) AND local anesthetic) AND dental treatment
Comments on
The Evidence
Validity: Limited articles with low level of evidence have been published to support modifications to anesthetic techniques on cleft lip and palate. For example, da Silva Dalben/2000 only cited three other articles on this topic. Therefore, more studies are needed in order to provide quality evidence that can support best clinical practices for the cleft lip and palate population. Perspective: Personally, I did not think of any technique changes needed for cleft lip and palate patient that would need operative/extraction/etc. It is important to be confidant when treating patients and having gained this knowledge, I will be better prepared to treat a cleft lip and palate patient in the future.
Applicability Effective local anesthetic technique is imperative to the success of any procedure, especially in the pediatric population - pain can alter how a patient will tolerate the rest of the procedure. Patients and parents expect to be anesthetized properly.
Specialty/Discipline (General Dentistry) (Pediatric Dentistry)
Keywords cleft lip, cleft palate, local anesthesia
ID# 3331
Date of submission: 09/13/2018spacer
E-mail wheelers1@livemail.uthscsa.edu
Author Sarah Wheeler, DDS
Co-author(s) e-mail
Faculty mentor/Co-author Maria-Jose Cervantes Mendez, DDS MS
Faculty mentor/Co-author e-mail CervantesMen@uthscsa.edu
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