Pain during orthodontic treatment –pharmacological treatments

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This Cochrane review of drug interventions for pain during orthodontic treatment including 32 RCTs find that analgesics were effective in reducing pain. However, low quality evidence did not show a difference in effectiveness between systemic NSAIDs compared with paracetamol, or topical NSAIDs compared with local anaesthetic.

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Tooth extraction: factors affecting anxiety and fear

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This review of factors affecting fear and anxiety in adult patients undergoing tooth extraction included 16 studies and identified a number of factors associated with anxiety although there are concerns over the quality of the available studies.

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Periodontal treatment: effectiveness of intra-pocket anaesthesia

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This review of intra-pocket anaesthesia for patients having scaling and root planing included 11 trials and demonstrated a benefit over placebo.

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Do analgesics before dental treatment reduce post treatment pain in children?

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This Cochrane review found 5 RCTs of pre-op analgesics prior to dental treatment for children under local anaesthetic. The evidence as insufficient to determine a benefit but there may be a benefit prior to orthodontic band placement. Further high quality studies are needed.

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Palatal injections for maxillary extractions: are they needed?

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This review of the use of palatal injections for maxillary extractions included 15 studies. While the findings suggest that they may not be needed further high quality studies are needed to confirm the findings.

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Dental local anaesthesia and ophthalmic side effects

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65 case reports and 1 case series were included in this reviews of the ophthalmic side effects from dental local anaesthesia. 92 % were transitory the remainder permanent. 25% of the transitory side effects took up to 6 hours to resolve.

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Articaine better than lidocaine for supplementary infiltration after mandibular block anaesthesia

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10 studies involving 746 adult patients were included in this review comparing articaine and lidocaine in patients with symptomatic irreversible pulpitis. Articaine was as effective as lidocaine and provided better supplementary infiltration after mandibular block but no other advantages.

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Inferior alveolar nerve block: mepivacaine-lidocaine no better than lidocaine alone suggests trial

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This well conducted and reported trial found that there was no difference between 3% mepivacaine & 2% lidocaine with 1:100,000 epinephrine and 2 cartridges of 2% lidocaine with 1:100,000 epinephrine in terms of injection pain, onset time, and pulpal anesthetic success for the IAN block.

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Local anaesthetic to reduce pain of dental care under general anaesthesia – evidence unclear

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This Cochrane review included 14 trials of variable quality that could not be combined due to variation in local anaesthetic delivery and outcome measures. So the results from individual studies for pain, bleeding and other adverse effects are uncertain.

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New Cochrane Protocol – April 2014

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  The aim of this new Cochrane protocol is to evaluate the effects of methods for acceptance of local anaesthetic in children during dental treatment. As the protocol notes three factors have been considered to influence discomfort during delivery of local anaesthetic: factors related to the patient, equipment factors and aspects that are under control [read the full story…]