psd-502 and Periodontitis

The aims of this study are to evaluate the efficacy of a eutectic mixture of local anesthetic (EMLA) cream on pain perception during scaling and to compare the intensities of pain provoked by hand and ultrasonic instruments.. Forty subjects with chronic gingivitis or periodontitis were enrolled in the study. In this randomized, split-mouth, controlled, masked clinical trial, each of the four quadrants in subjects was randomly assigned to receive one of the following protocols: scaling with an ultrasonic scaler with or without the application of the EMLA cream or scaling with a Gracey curet with or without the application of the EMLA cream. Pain levels after each quadrant of scaling were assessed with a visual analog scale (VAS; 0 to 100 mm) and verbal rating score (VRS; 0 to 4). All subjects were recalled to detect any complications after 24 hours.. The mean VAS and VRS when EMLA cream was applied (18.39 ± 14.47 mm and 0.95 ± 0.69) were significantly lower (P <0.001 for VAS and VRS) compared to when EMLA cream was not used (26.54 ± 16.46 mm and 1.30 ± 0.75). The mean VAS and VRS of the ultrasonic scaler group (20.43 ± 16.40 mm and 0.98 ± 0.76) were significantly lower (P = 0.024 for VAS; P = 0.003 for VRS) than those of the Gracey curet group (24.50 ± 15.17 mm and 1.28 ± 0.69). None of the subjects showed adverse effects after EMLA-cream application.. Although most patients experienced limited pain during scaling, a significant reduction of pain is achieved by using EMLA cream and ultrasonic scaler.

Topics: Adult; Analysis of Variance; Anesthetics, Combined; Anesthetics, Local; Dental Instruments; Drug Combinations; Female; Follow-Up Studies; Gingivitis; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Matched-Pair Analysis; Middle Aged; Pain; Pain Perception; Periodontitis; Prilocaine; Root Planing; Single-Blind Method; Treatment Outcome; Ultrasonic Therapy; 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

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 efficacy of a topical anesthetic on pain and unpleasantness provoked by scaling of gingival pockets was investigated in 20 patients with mild chronic periodontitis. A eutectic mixture of local anesthetics (EMLA) and a placebo cream, both occluded by Orahesive Oral Bandages, were applied in a balanced, randomized, double-blind, split-mouth design, which enabled within-subject comparison of the anesthetic and the placebo in the upper and the lower jaw. Pretreatment interviews showed that approximately two-thirds of the patients considered gingival scaling to be associated with some degree of pain and unpleasantness. Pain intensity and unpleasantness were evaluated on 100-mm visual analog scales (VAS). Application of EMLA reduced both pain intensity and unpleasantness significantly compared to placebo cream. Median reductions in VAS pain intensity in the upper and lower jaw were 58.9% and 61.9%, and corresponding reductions in VAS unpleasantness were 31.9% and 25.6%, respectively. Generally, the patients accepted the anesthetic procedure well. The residual perception of pain and unpleasantness following topical anesthesia may be dependent on activation of nonanesthetized nociceptive fibers in the tooth pulp. However, the present study clearly demonstrates the efficacy of a topical anesthetic in a clinical situation, which may be recommended as a simple pharmacologic strategy to reduce pain and unpleasantness during scaling procedures.

Topics: Administration, Topical; Adult; Anesthesia, Dental; Anesthesia, Local; Anesthetics, Local; Dental Scaling; Double-Blind Method; Drug Combinations; Facial Pain; Female; Gingival Pocket; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain Measurement; Periodontal Dressings; Periodontitis; Prilocaine; Statistics, Nonparametric

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