psd-502 and Periodontal-Pocket

Periodontal therapy usually requires local anesthesia. If effective, a non-invasive, liposomal anesthetic gel could increase the levels of acceptance of patients in relation to periodontal therapy.. This study investigated the efficacy of liposomal anesthetic gel for pain control during periodontal therapy.. Forty volunteers with moderate to severe chronic periodontitis were recruited, of which at least three sextants required periodontal therapy. At least one of the selected teeth had one site with a probing depth of ≥4 mm. The volunteers received the following three gels: a placebo, lidocaine/prilocaine (Oraqix®), or a liposomal lidocaine/prilocaine, which were applied to different sextants. Pain frequency was registered during treatment and the volunteers received a digital counter to register any painful or uncomfortable experiences. At the end of each session, the volunteers indicated their pain intensity using rating scales (NRS-101 and VRS-4). The volunteers had their hemodynamic parameters measured by a non-invasive digital monitor.. Pain frequency/intensity did not show statistical difference between intervention groups. The tested gels did not interfere with the hemodynamic indices. Dental anxiety, suppuration and probing depth could influence pain during periodontal therapy.. Our results suggest limited indications for the use of non-invasive anesthesia when used for scaling and root planing. Intra-pocket anesthetic gel could be a good option for anxious patients, or those who have a fear of needles.

Topics: Adult; Aged; Anesthesia, Dental; Anesthetics, Local; Chronic Periodontitis; Dental Scaling; Double-Blind Method; Female; Gels; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Pain Measurement; Periodontal Pocket; Placebos; Prilocaine; Root Planing; Young Adult

Scaling and root planing (SRP) in periodontitis is considered to be painful and thus requires anesthesia. The present study evaluates the effectiveness of a eutectic mixture of 25 mg/g lignocaine plus 25 mg/g prilocaine and thermosetting agents (EMLA), 20% lignocaine patch, and electronic dental anesthesia (EDA) during SRP.. In a single-center, randomized, controlled study, 25 subjects with probing depth of 5 mm or more and visual analog scale (VAS) score of >or=30 mm on probing were selected and asked to assess the pain by VAS and verbal rating scale (VRS) during SRP after application of the three agents.. The difference between VAS values of patch and EDA (P = 0.012) and EMLA and EDA (P = 0.018) is significant, whereas that between patch and EMLA is non-significant (P = 1.000). The difference between VRS values of patch and EDA (P = 0.046) is significant, whereas that between patch and EMLA (P = 0.655) and EMLA and EDA (P = 0.180) is non-significant. According to the VRS scores, 12% of the subjects in the patch group reported no pain, 84% mild pain, and 4% moderate pain. In the EMLA group, 16% reported no pain, 76% mild pain, and 8% moderate pain. In the EDA group, 88% reported mild pain and 12% moderate pain. None reported severe pain. One subject in the patch group had an adverse event of slight redness.. The data suggest the topical agents used, 5% EMLA and 20% lignocaine patch, are more effective and comparable. Both are superior in performance to EDA.

Topics: Adolescent; Adult; Anesthesia, Dental; Anesthesia, Local; Anesthetics, Combined; Anesthetics, Local; Chronic Periodontitis; Dental Scaling; Electric Stimulation Therapy; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain Measurement; Periodontal Pocket; Prilocaine; Root Planing; Treatment Outcome; Young Adult

Three efficacy studies, comprising a database of 337 subjects, were conducted as part of the clinical evaluation of the noninjectable anesthetic gel Oraqix (AstraZeneca, Södertälje, Sweden). The authors discuss some of the challenges encountered when they interpreted the results of the clinical studies and present the results from an alternative analysis of the anesthetic efficacy.. The three multicenter studies were double-blind, randomized and placebo-controlled. Clinicians applied gel in the subjects' periodontal pockets before scaling and/or root planing, or SRP. Subjects recorded overall pain on a 100-millimeter visual analog scale, or VAS. In the studies, the evaluation of the anesthetic efficacy was based on absolute treatment difference (active-placebo). Investigators used an alternative post hoc approach to evaluate the effect expressed as a ratio (active:placebo).. The studies demonstrated consistent and significant lower pain scores for the anesthetic gel versus the placebo gel, with point estimates of absolute treatment difference being 8, 4 and 10 mm. The alternative analysis verified that the estimated treatment effect in terms of a ratio was close to 50 percent in all three studies.. Treatment effects of the anesthetic gel relative to the placebo gel were described more appropriately by means of ratios instead of absolute differences. In this sample of 337 subjects, it was shown that pain was reduced by 50 percent when the anesthetic gel was used compared with when the placebo gel was used.. The authors found that the anesthetic periodontal gel is effective in reducing pain resulting from SRP.

Topics: Adult; Aged; Aged, 80 and over; Anesthetics, Combined; Anesthetics, Local; Dental Scaling; Double-Blind Method; Female; Gels; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain; Pain Measurement; Periodontal Pocket; Periodontitis; Placebos; Prilocaine; Root Planing; Treatment Outcome

Six Canadian dental schools investigated the ability of a thermosetting gel containing 25 mg/g prilocaine and 25 mg/g lidocaine as active agents to produce analgesia in periodontal pockets utilizing a randomized, double-blind, placebo-controlled study.. The study consisted of 130 patients, each of whom received the active or placebo gel in periodontal pockets in one quadrant of the mouth for 30 s prior to periodontal debridement (scaling and root planing). Pain was measured using both a 100-mm Visual Analogue Scale (VAS) and a Verbal Rating Scale (VRS).. The median VAS pain score for the patients treated with the anaesthetic gel was 5 mm (range 0-85 mm) as opposed to 13 mm (range 0-79 mm) in the placebo-treated patients (P=0.015). There was no significant difference in the percentage of patients reporting no or mild pain (78% and 76% for the anaesthetic gel and placebo, respectively). No significant differences were seen in patient demographics, or mandible versus maxilla.. The VAS pain scores showed that the anaesthetic gel 5% was statistically more effective than the placebo in reducing pain during periodontal debridement.

Topics: Adult; Aged; Aged, 80 and over; Anesthetics, Combined; Anesthetics, Local; Confidence Intervals; Dental Scaling; Double-Blind Method; Gels; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Mandible; Maxilla; Middle Aged; Pain Measurement; Periodontal Pocket; Placebos; Prilocaine; Root Planing; Statistics, Nonparametric; Time Factors

Oraqix, a novel non-injectable anesthetic gel containing lidocaine and prilocaine and a thermosetting agent has been developed to provide localized anesthesia in periodontal pockets during scaling/root planing (SRP). The aim of this open study was to determine the plasma levels of lidocaine and prilocaine following application of 8.5 g Oraqix (5 cartridges) to 11 patients with generalized periodontitis (> or = 49% of tooth pockets > or = 5 mm and > or = 23% of pockets > or = 6 mm). Oraqix was applied to the pockets during periodontal probing and SRP over a 2.6 3.4 h period. Blood samples were collected up to 10 h after the start of application of Oraqix. Peak plasma levels of lidocaine (0.16-0.55 mg/L) and prilocaine (0.05-0.18 mg/L) occurred 2.0-3.7 h and 2.0-3.3 h, respectively, after the start of application of Oraqix. These levels are well below threshold levels for initial signs of central nervous system (CNS) toxicity. In conclusion, application of 8.5 g Oraqix (212.5 mg of lidocaine base and 212.5 mg of prilocaine base) in periodontal pockets was well tolerated and displayed a wide safety margin with respect to plasma levels normally associated with systemic toxicity.

Topics: Adult; Aged; Anesthesia, Dental; Anesthetics, Combined; Anesthetics, Local; Dental Scaling; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Methemoglobin; Middle Aged; Periodontal Pocket; Prilocaine; Toluidines

A new non-injection anesthetic, lidocaine/prilocaine gel (Oraqix, AstraZeneca) in a reversible thermosetting system, has been developed to provide local anesthesia for scaling/root planing (SRP). The aim of this study was to determine the anesthetic onset and duration of the gel for SRP in patients with periodontitis.. 30 patients were randomized to either 30 s, 2 min, or 5 min of treatment with the gel prior to SRP of a tooth. The gel was applied to periodontal pockets with a blunt applicator. On completion of the SRP of each tooth (2-3 teeth treated/patient), the patients rated their pain on a 100-mm visual analogue scale (VAS).. The median VAS pain score was 7.5 mm in the 30-s group, 28.5 mm in the 2-min group, and 15.5 mm in the 5-min group, with a significant difference between the 30-s and 2-min groups (p=0.03). In 2 patients in the 5-min group, but none in the other groups, the SRP was interrupted due to pain. The mean duration of anesthesia measured as pain on probing were 18.1, 17.3, and 19.9 min in the 30-s, 2-min, and 5-min groups, respectively. There were no reports of numbness of the tongue, lip, or cheek, neither were there any adverse local reactions in the oral mucosa. The gel was easy to apply and did not interfere with the SRP procedure.. Oraqix provides anesthesia after an application time of 30 s, with a mean duration of action of about 17 to 20 min.

Topics: Administration, Topical; Adolescent; Adult; Anesthetics, Combined; Anesthetics, Local; Dental Scaling; Female; Gels; Humans; Hypesthesia; Lidocaine; Lidocaine, Prilocaine Drug Combination; Lip; Male; Middle Aged; Mouth Mucosa; Pain; Pain Measurement; Periodontal Pocket; Periodontitis; Prilocaine; Root Planing; Statistics as Topic; Taste; Time Factors; Tongue

The aim of this study was to determine the impact of the pocket depth on the effectiveness of an intrapocket anaesthesia gel during SRP in periodontal maintenance patients. Effectiveness was measured by pain levels during SRP via visual analogue scale (VAS) and verbal rating scale (VRS). Secondary endpoint was the evaluation of patients' preferred choice of anaesthesia for SRP.. A total of 638 patients undergoing the periodontal maintenance programme and with the need for SRP participated in this observational study. After SRP, patients filled in questionnaires to record pain levels experienced and anaesthesia preference for future use. Mann-Whitney U-test was used to analyse intergroup difference in pain perception and anaesthesia choice.. Overall, increasing pocket depths were accompanied by higher pain levels, irrespective of maximum or commonest pocket depths (P < 0.05). For SRP procedures, patients definitely prefer the anaesthesia gel (72.4%).. In this study, an effectiveness of local anaesthesia gel (lidocaine/prilocaine) related to pocket depths was found in periodontal maintenance patients during SRP. Increasing pocket depths were accompanied by increasing procedural pain levels. Nevertheless, the anaesthesia gel is well accepted and in the majority of cases was found to be the preferred option for future SRP treatments.

Topics: Adult; Aged; Aged, 80 and over; Anesthesia, Dental; Anesthesia, Local; Anesthetics, Combined; Anesthetics, Local; Dental Prophylaxis; Dental Scaling; Female; Gels; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain Measurement; Pain Perception; Patient Preference; Periodontal Pocket; Periodontitis; Prilocaine; Root Planing; Visual Analog Scale; Young Adult

In recent years, three multicenter studies have been conducted to evaluate the clinical efficacy of an active 5% dental gel to reduce pain when placed into periodontal pockets before initiating scaling and root planing procedures. In each of the clinical studies, the researchers found statistically significant differences between the pain scores of the active dental gel group and the placebo gel group that favored the active gel for the control of pain during periodontal scaling and root planing procedures. This article reviews each of the three studies and highlights some of the differences among them.

Topics: Administration, Topical; Anesthetics, Combined; Anesthetics, Local; Clinical Trials as Topic; Dental Scaling; Double-Blind Method; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Multicenter Studies as Topic; Ointments; Pain; Pain Measurement; Periodontal Pocket; Periodontitis; Placebos; Prilocaine; Randomized Controlled Trials as Topic; Root Planing; Treatment Outcome

Oraqix, a new non-injection local anesthetic, lidocaine/prilocaine gel 5%, has been developed to provide pain relief in association with periodontal probing and scaling/root planing (SRP). The aim of this open study was to describe the plasma profiles of lidocaine and prilocaine following a single dose of Oraqix to patients with advanced periodontitis.. 10 patients with 18 to 28 teeth with pocket depths of at least 4 mm were included. Oraqix was applied in the pockets around all the teeth in the mouth by means of a blunt applicator. The total dose applied per patient was 0.9 to 3.5 g. Directly thereafter all the pockets were probed and 3 teeth subjected to SRP. The mouth was rinsed out with a glass of water 20-27 min after the application of the gel. Blood samples were collected before and up to 90 min after the start of application of Oraqix.. Peak plasma concentrations of lidocaine (99-266 ng/ml) and prilocaine (46-118 ng/ml) occurred 20-40 min after the start of application. These levels were low compared to those reported to cause initial signs of CNS toxicity (5000-6000 ng/ml). Side-effects were few and mild local effects of short duration.. In conclusion, there is a large safety margin with respect to systemic effects following the application of up to 3.5 g Oraqix in periodontal pockets.

Topics: Administration, Topical; Adult; Anesthetics, Combined; Anesthetics, Local; Aniline Compounds; Chromatography, Liquid; Dental Scaling; Female; Follow-Up Studies; Gels; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Linear Models; Male; Mass Spectrometry; Middle Aged; Mouthwashes; Periodontal Pocket; Periodontitis; Prilocaine; Regression Analysis; Root Planing; Safety; Toluidines; Water