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Mike Beck - One of the best experts on this subject based on the ideXlab platform.
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pain reduction in untreated symptomatic irreversible Pulpitis using liposomal bupivacaine exparel a prospective randomized double blind trial
Journal of Endodontics, 2016Co-Authors: Kristy Bultema, Al Reader, John Nusstein, Melissa Drum, Sara Fowler, Mike BeckAbstract:Introduction In the treatment of patients with symptomatic irreversible Pulpitis, endodontic debridement is a predictable method to relieve pain. However, there are clinical situations in which emergency care cannot be provided immediately. An unexplored treatment option in these cases may be the use of a long-acting anesthetic to reduce pain in untreated irreversible Pulpitis. Some medical studies have shown potential for infiltrations of liposomal bupivacaine (Exparel; Pacira Pharmaceuticals, San Diego, CA) to prolong pain relief and reduce opioid use postoperatively. The Food and Drug Administration has approved Exparel only for infiltrations; therefore, the purpose of this study was to compare an infiltration of liposomal bupivacaine versus bupivacaine for pain control in untreated, symptomatic irreversible Pulpitis.
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incidence of missed inferior alveolar nerve blocks in vital asymptomatic subjects and in patients with symptomatic irreversible Pulpitis
Journal of Endodontics, 2015Co-Authors: Sara Fowler, Al Reader, Mike BeckAbstract:Abstract Introduction The purpose of this retrospective study was to determine the incidence of missed inferior alveolar nerve (IAN) blocks by using a 1- or 2-cartridge volume of 2% lidocaine with 1:100,000 epinephrine in vital asymptomatic teeth and in emergency patients with symptomatic irreversible Pulpitis. Methods As part of 37 studies, 3169 subjects/patients were evaluated for missed IAN blocks. The study included 2450 asymptomatic subjects and 719 emergency patients presenting with symptomatic irreversible Pulpitis. Each subject or patient received either a 1- or 2-cartridge volume of 2% lidocaine with 1:100,000 epinephrine. A missed block was defined as no lip numbness at 15–20 minutes after the IAN block. The effect of anesthetic volume on the incidence of missed blocks was assessed by using mixed models logistic regression with individual studies as a random effect. Results The incidence of missed blocks for asymptomatic subjects was 6.3% for the 1-cartridge volume and 3.8% for the 2-cartridge volume. For patients presenting with irreversible Pulpitis, the incidence of missed blocks was 7.7% for the 1-cartridge volume and 2.3% for the 2-cartridge volume. In both asymptomatic subjects and patients with irreversible Pulpitis, the 2-cartridge volume was significantly ( P = .0395) better than the 1-cartridge volume. There were no significant effects for pulpal diagnosis ( P = .7523) or the pulpal diagnosis and anesthetic volume interaction ( P = .3973). Conclusions Concerning missed IAN blocks, we concluded that administration of a 2-cartridge volume was significantly better ( P = .0395) than a 1-cartridge volume in both asymptomatic subjects and emergency patients presenting with irreversible Pulpitis.
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Long buccal nerve block injection pain in patients with irreversible Pulpitis
Oral surgery oral medicine oral pathology oral radiology and endodontics, 2011Co-Authors: Melissa Drum, Al Reader, Mike BeckAbstract:Objectives The purpose of this study was to determine the pain associated with needle insertion (with or without topical anesthetic) and solution deposition for the long buccal nerve block injection in patients with irreversible Pulpitis. Initial pain and any differences by age and gender were also studied. Study design One hundred twelve emergency patients with irreversible Pulpitis received long buccal nerve block injections using 2% lidocaine with 1:100,000 epinephrine. The patients recorded pain of needle insertion and solution deposition on a Heft-Parker visual analog scale (VAS). Results Moderate-to-severe pain occurred from 41% to 46% of the time with the long buccal nerve block. The use of topical anesthetic did not statistically decrease the pain of needle insertion. Conclusions In conclusion, 41% to 46% of patients presenting with irreversible Pulpitis have the potential for moderate-to-severe pain with the long buccal nerve block.
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effect of sublingual triazolam on the success of inferior alveolar nerve block in patients with irreversible Pulpitis
Journal of Endodontics, 2008Co-Authors: Matthew Lindemann, Al Reader, John Nusstein, Melissa Drum, Mike BeckAbstract:Abstract The purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine the effect of the administration of sublingual triazolam on the success of the inferior alveolar nerve (IAN) block in patients experiencing irreversible Pulpitis. Fifty-eight emergency patients diagnosed with irreversible Pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, an identical sublingual tablet of either 0.25 mg of triazolam or a placebo 30 minutes before administration of a conventional IAN block. Access was begun 15 minutes after completion of the IAN block, and all patients had profound lip numbness. Success was defined as no or mild pain (visual analog scale recordings) on access or initial instrumentation. The success rate for the IAN block was 43% with triazolam and 57% with the placebo, with no significant difference (P = .43) between the 2 groups. For mandibular posterior teeth, triazolam in a sublingual dose of 0.25 mg did not result in an increase in success of the IAN block in patients with irreversible Pulpitis. Therefore, when using conscious sedation, profound local anesthesia is still required to eliminate the sensation of pain during endodontic treatment for patients with irreversible Pulpitis.
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comparison of preoperative pain and medication use in emergency patients presenting with irreversible Pulpitis or teeth with necrotic pulps
Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, 2003Co-Authors: John Nusstein, Mike BeckAbstract:Abstract Objective This retrospective study compared differences in preoperative pain and medication use in patients with moderate to severe pain who sought emergency endodontic care for teeth with irreversible Pulpitis and for symptomatic teeth with necrotic pulps. Study design A total of 323 patients seeking emergency endodontic treatment completed questionnaires regarding their biographical information, pain, pain history, and medications. Teeth were tested for vitality, mobility, percussion, and palpation pain. Lymphadenopathy was also evaluated. Results Patients with irreversible Pulpitis waited significantly (P .05) were found between the groups in terms of analgesic or antibiotic use and pain relief from preoperative narcotic medications. Nonnarcotic analgesics were reported to significantly reduce pain more often in patients with symptomatic teeth with necrotic pulps. There were sex differences in the group of patients with irreversible Pulpitis: More women than men were taking analgesic medications and, in the group having symptomatic teeth with necrotic pulps, more men than women reported pain relief from their analgesic medications. Conclusion Patients with irreversible Pulpitis wait longer to seek emergency treatment. A majority (81%-83%) of emergency patients with moderate to severe pain will have taken some type of medication(s) to help control their pain, and more women than men with irreversible Pulpitis will take an analgesic. By taking their preoperative medication(s), this group of patients will get relief 62% to 65% of the time; furthermore, more men than women with symptomatic teeth with necrotic pulps will experience pain relief.
Al Reader - One of the best experts on this subject based on the ideXlab platform.
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Successful pulpal anesthesia for symptomatic irreversible Pulpitis
Journal of the American Dental Association (1939), 2017Co-Authors: Melissa Drum, Al Reader, John Nusstein, Sara FowlerAbstract:Abstract Background and Overview Profound pulpal anesthesia after a successful inferior alveolar nerve block can be difficult to achieve when the clinical condition is a pulpal diagnosis of symptomatic irreversible Pulpitis. The authors reviewed the literature as it relates to the anesthesia necessary for endodontic therapy of patients with painful, vital, mandibular teeth diagnosed with symptomatic irreversible Pulpitis. Conclusions Supplemental anesthetic techniques and medications are available that can be used to improve pulpal anesthesia for patients with the clinical condition of symptomatic irreversible Pulpitis. Practical Implications The authors identified treatment recommendations for anesthesia in the case of symptomatic irreversible Pulpitis based on a review of the available evidence.
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pain reduction in untreated symptomatic irreversible Pulpitis using liposomal bupivacaine exparel a prospective randomized double blind trial
Journal of Endodontics, 2016Co-Authors: Kristy Bultema, Al Reader, John Nusstein, Melissa Drum, Sara Fowler, Mike BeckAbstract:Introduction In the treatment of patients with symptomatic irreversible Pulpitis, endodontic debridement is a predictable method to relieve pain. However, there are clinical situations in which emergency care cannot be provided immediately. An unexplored treatment option in these cases may be the use of a long-acting anesthetic to reduce pain in untreated irreversible Pulpitis. Some medical studies have shown potential for infiltrations of liposomal bupivacaine (Exparel; Pacira Pharmaceuticals, San Diego, CA) to prolong pain relief and reduce opioid use postoperatively. The Food and Drug Administration has approved Exparel only for infiltrations; therefore, the purpose of this study was to compare an infiltration of liposomal bupivacaine versus bupivacaine for pain control in untreated, symptomatic irreversible Pulpitis.
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incidence of missed inferior alveolar nerve blocks in vital asymptomatic subjects and in patients with symptomatic irreversible Pulpitis
Journal of Endodontics, 2015Co-Authors: Sara Fowler, Al Reader, Mike BeckAbstract:Abstract Introduction The purpose of this retrospective study was to determine the incidence of missed inferior alveolar nerve (IAN) blocks by using a 1- or 2-cartridge volume of 2% lidocaine with 1:100,000 epinephrine in vital asymptomatic teeth and in emergency patients with symptomatic irreversible Pulpitis. Methods As part of 37 studies, 3169 subjects/patients were evaluated for missed IAN blocks. The study included 2450 asymptomatic subjects and 719 emergency patients presenting with symptomatic irreversible Pulpitis. Each subject or patient received either a 1- or 2-cartridge volume of 2% lidocaine with 1:100,000 epinephrine. A missed block was defined as no lip numbness at 15–20 minutes after the IAN block. The effect of anesthetic volume on the incidence of missed blocks was assessed by using mixed models logistic regression with individual studies as a random effect. Results The incidence of missed blocks for asymptomatic subjects was 6.3% for the 1-cartridge volume and 3.8% for the 2-cartridge volume. For patients presenting with irreversible Pulpitis, the incidence of missed blocks was 7.7% for the 1-cartridge volume and 2.3% for the 2-cartridge volume. In both asymptomatic subjects and patients with irreversible Pulpitis, the 2-cartridge volume was significantly ( P = .0395) better than the 1-cartridge volume. There were no significant effects for pulpal diagnosis ( P = .7523) or the pulpal diagnosis and anesthetic volume interaction ( P = .3973). Conclusions Concerning missed IAN blocks, we concluded that administration of a 2-cartridge volume was significantly better ( P = .0395) than a 1-cartridge volume in both asymptomatic subjects and emergency patients presenting with irreversible Pulpitis.
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Long buccal nerve block injection pain in patients with irreversible Pulpitis
Oral surgery oral medicine oral pathology oral radiology and endodontics, 2011Co-Authors: Melissa Drum, Al Reader, Mike BeckAbstract:Objectives The purpose of this study was to determine the pain associated with needle insertion (with or without topical anesthetic) and solution deposition for the long buccal nerve block injection in patients with irreversible Pulpitis. Initial pain and any differences by age and gender were also studied. Study design One hundred twelve emergency patients with irreversible Pulpitis received long buccal nerve block injections using 2% lidocaine with 1:100,000 epinephrine. The patients recorded pain of needle insertion and solution deposition on a Heft-Parker visual analog scale (VAS). Results Moderate-to-severe pain occurred from 41% to 46% of the time with the long buccal nerve block. The use of topical anesthetic did not statistically decrease the pain of needle insertion. Conclusions In conclusion, 41% to 46% of patients presenting with irreversible Pulpitis have the potential for moderate-to-severe pain with the long buccal nerve block.
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effect of sublingual triazolam on the success of inferior alveolar nerve block in patients with irreversible Pulpitis
Journal of Endodontics, 2008Co-Authors: Matthew Lindemann, Al Reader, John Nusstein, Melissa Drum, Mike BeckAbstract:Abstract The purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine the effect of the administration of sublingual triazolam on the success of the inferior alveolar nerve (IAN) block in patients experiencing irreversible Pulpitis. Fifty-eight emergency patients diagnosed with irreversible Pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, an identical sublingual tablet of either 0.25 mg of triazolam or a placebo 30 minutes before administration of a conventional IAN block. Access was begun 15 minutes after completion of the IAN block, and all patients had profound lip numbness. Success was defined as no or mild pain (visual analog scale recordings) on access or initial instrumentation. The success rate for the IAN block was 43% with triazolam and 57% with the placebo, with no significant difference (P = .43) between the 2 groups. For mandibular posterior teeth, triazolam in a sublingual dose of 0.25 mg did not result in an increase in success of the IAN block in patients with irreversible Pulpitis. Therefore, when using conscious sedation, profound local anesthesia is still required to eliminate the sensation of pain during endodontic treatment for patients with irreversible Pulpitis.
Sara Fowler - One of the best experts on this subject based on the ideXlab platform.
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Successful pulpal anesthesia for symptomatic irreversible Pulpitis
Journal of the American Dental Association (1939), 2017Co-Authors: Melissa Drum, Al Reader, John Nusstein, Sara FowlerAbstract:Abstract Background and Overview Profound pulpal anesthesia after a successful inferior alveolar nerve block can be difficult to achieve when the clinical condition is a pulpal diagnosis of symptomatic irreversible Pulpitis. The authors reviewed the literature as it relates to the anesthesia necessary for endodontic therapy of patients with painful, vital, mandibular teeth diagnosed with symptomatic irreversible Pulpitis. Conclusions Supplemental anesthetic techniques and medications are available that can be used to improve pulpal anesthesia for patients with the clinical condition of symptomatic irreversible Pulpitis. Practical Implications The authors identified treatment recommendations for anesthesia in the case of symptomatic irreversible Pulpitis based on a review of the available evidence.
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pain reduction in untreated symptomatic irreversible Pulpitis using liposomal bupivacaine exparel a prospective randomized double blind trial
Journal of Endodontics, 2016Co-Authors: Kristy Bultema, Al Reader, John Nusstein, Melissa Drum, Sara Fowler, Mike BeckAbstract:Introduction In the treatment of patients with symptomatic irreversible Pulpitis, endodontic debridement is a predictable method to relieve pain. However, there are clinical situations in which emergency care cannot be provided immediately. An unexplored treatment option in these cases may be the use of a long-acting anesthetic to reduce pain in untreated irreversible Pulpitis. Some medical studies have shown potential for infiltrations of liposomal bupivacaine (Exparel; Pacira Pharmaceuticals, San Diego, CA) to prolong pain relief and reduce opioid use postoperatively. The Food and Drug Administration has approved Exparel only for infiltrations; therefore, the purpose of this study was to compare an infiltration of liposomal bupivacaine versus bupivacaine for pain control in untreated, symptomatic irreversible Pulpitis.
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incidence of missed inferior alveolar nerve blocks in vital asymptomatic subjects and in patients with symptomatic irreversible Pulpitis
Journal of Endodontics, 2015Co-Authors: Sara Fowler, Al Reader, Mike BeckAbstract:Abstract Introduction The purpose of this retrospective study was to determine the incidence of missed inferior alveolar nerve (IAN) blocks by using a 1- or 2-cartridge volume of 2% lidocaine with 1:100,000 epinephrine in vital asymptomatic teeth and in emergency patients with symptomatic irreversible Pulpitis. Methods As part of 37 studies, 3169 subjects/patients were evaluated for missed IAN blocks. The study included 2450 asymptomatic subjects and 719 emergency patients presenting with symptomatic irreversible Pulpitis. Each subject or patient received either a 1- or 2-cartridge volume of 2% lidocaine with 1:100,000 epinephrine. A missed block was defined as no lip numbness at 15–20 minutes after the IAN block. The effect of anesthetic volume on the incidence of missed blocks was assessed by using mixed models logistic regression with individual studies as a random effect. Results The incidence of missed blocks for asymptomatic subjects was 6.3% for the 1-cartridge volume and 3.8% for the 2-cartridge volume. For patients presenting with irreversible Pulpitis, the incidence of missed blocks was 7.7% for the 1-cartridge volume and 2.3% for the 2-cartridge volume. In both asymptomatic subjects and patients with irreversible Pulpitis, the 2-cartridge volume was significantly ( P = .0395) better than the 1-cartridge volume. There were no significant effects for pulpal diagnosis ( P = .7523) or the pulpal diagnosis and anesthetic volume interaction ( P = .3973). Conclusions Concerning missed IAN blocks, we concluded that administration of a 2-cartridge volume was significantly better ( P = .0395) than a 1-cartridge volume in both asymptomatic subjects and emergency patients presenting with irreversible Pulpitis.
Paul V. Abbott - One of the best experts on this subject based on the ideXlab platform.
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Postoperative Pain Following Treatment of Teeth with Irreversible Pulpitis: A Review.
The New York state dental journal, 2017Co-Authors: Zahed Mohammadi, Paul V. Abbott, Sousan Shalavi, Mohammad YazdizadehAbstract:Patients typically associate dental care with pain. Pain has both physiological and psychological components. Endodontic post-treatment pain continues to be a significant problem facing the dental profession. For patients presenting with preoperative pain, most will continue to experience pain after root canal treatment, with pain levels ranging from mild to severe. The purpose of this paper was to review the symptoms and classification of irreversible Pulpitis, including acute and chronic Pulpitis, incidence of postoperative pain following treating teeth with irreversible Pulpitis, factors influencing postoperative pain, persistent pain after root canal treatment, preventing postoperative pain and pharmacological management of postoperative pain.
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a comparison of different volumes of articaine for inferior alveolar nerve block for molar teeth with symptomatic irreversible Pulpitis
Journal of Endodontics, 2015Co-Authors: Ramin Abazarpoor, Masoud Parirokh, Nouzar Nakhaee, Paul V. AbbottAbstract:Abstract Introduction Achieving anesthesia in mandibular molar teeth with irreversible Pulpitis is very difficult. The aim of this study was to compare the efficacy of 1.8 mL and 3.6 mL articaine for an inferior alveolar nerve block (IANB) when treating molars with symptomatic irreversible Pulpitis. Methods In a randomized, double-blind clinical trial, 82 first mandibular molar teeth with symptomatic irreversible Pulpitis randomly received conventional IANB injection either with 1 (1.8 mL) or 2 cartridges (3.6 mL) of 4% articaine with 1:100,000 epinephrine. The patients recorded their pain before and during access cavity preparation as well as during root canal instrumentation using a Heft-Parker visual analog scale. No or mild pain was considered as successful anesthesia. Data were analyzed by t and chi-square tests. Results Eighty patients were eligible to participate in this study, which showed that 3.6 mL articaine provided a significantly higher success rate (77.5%) of IANBs compared with 1.8 mL of the same anesthetic solution (27.5%) although neither group had 100% successful anesthesia ( P Conclusions Increasing the volume of articaine provided a significantly higher success rate of IANBs in mandibular first molar teeth with symptomatic irreversible Pulpitis, but it did not result in 100% anesthetic success.
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efficacy of supplementary buccal infiltrations and intraligamentary injections to inferior alveolar nerve blocks in mandibular first molars with asymptomatic irreversible Pulpitis a randomized controlled trial
International Endodontic Journal, 2014Co-Authors: Masoud Parirokh, Paul V. Abbott, Nouzar Nakhaee, Saeedeh Sadr, Sara AskarifardAbstract:Aim This randomized double-blinded controlled trial was performed to compare the efficacy of inferior alveolar nerve block (IANB) injection for mandibular first molar teeth with irreversible Pulpitis with or without supplementary buccal infiltration and intraligamentary injection. Methodology Eighty-two patients with asymptomatic irreversible Pulpitis received either a combination of intraligamentary injection + buccal infiltration+ IANB or with traditional IANB injection in mandibular first molar teeth with irreversible Pulpitis. Each patient recorded their pain score on a Heft–Parker visual analogue scale before commencing treatment, in response to a cold test 15 min after the designated anaesthetic injection, during access cavity preparation and during root canal instrumentation. No or mild pain at any stage was considered a success. Data were analysed by chi-square test. Results At the final stage of treatment, 69 of the 82 patients were eligible to be included in the study. No significant difference was found between age (P = 0.569) and gender (P = 0.570) amongst the patients in the two groups. The success rate of anaesthesia in the IANB and the combination groups were 22% and 58%, respectively. The success rate of anaesthesia in the combination group was significantly higher than the traditional IANB injection (P = 0.003). Conclusion A combination of anaesthetic techniques can improve the success rate of anaesthesia for mandibular first molar teeth with irreversible Pulpitis.
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the effect of premedication with ibuprofen and indomethacin on the success of inferior alveolar nerve block for teeth with irreversible Pulpitis
Journal of Endodontics, 2010Co-Authors: Masoud Parirokh, Nouzar Nakhaee, Rezvan Ashouri, Ali Reza Rekabi, Abbas Pardakhti, Sara Askarifard, Paul V. AbbottAbstract:Abstract Introduction Achieving pulp anesthesia with irreversible Pulpitis is difficult. This study evaluated whether nonsteroidal anti-inflammatory drugs assist local anesthesia. Methods In a randomized double-blinded clinical trial, 150 patients (50 per group) with irreversible Pulpitis were given placebo, 600 mg ibuprofen, or 75mg indomethacin 1 hour before local anesthesia. Each patient recorded their pain score on a visual analog scale before taking the medication, 15 minutes after anesthesia in response to a cold test, during access cavity preparation and during root canal instrumentation. No or mild pain at any stage was considered a success. Data were analyzed by the chi-square and analysis of variance tests. Results Overall success rates for placebo, ibuprofen, and indomethacin were 32%, 78%, and 62%, respectively (p Conclusions Premedication with ibuprofen and indomethacin significantly increased the success rates of inferior alveolar nerve block anesthesia for teeth with irreversible Pulpitis.
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Predictable management of cracked teeth with reversible Pulpitis
Australian dental journal, 2009Co-Authors: Paul V. Abbott, N. LeowAbstract:Background: The aims of this study were to assess symptoms and signs caused by cracks in teeth and to assess a conservative management protocol. Methods: The symptoms and signs of 100 consecutive teeth that had reversible Pulpitis associated with cracks were compared to findings from other reports. Teeth were managed with a conservative protocol which involved removal of cracks, caries and restorations, followed by placement of a sedative lining and interim restoration unless there were pulp exposures or insufficient tooth structure remaining. Teeth were monitored for pulp healing after three months and for up to five years. Results: Eighty teeth did not require endodontic treatment. One tooth had an uncertain pulp status at review appointments. Fifteen teeth required endodontic treatment at the initial appointment because of carious pulp exposures (4 teeth), cracks extending into the pulp (2), and posts required (9). Four other teeth required endodontic treatment later following conservative pulp treatment due to continued Pulpitis under the temporary restoration (1), Pulpitis after core restoration (2), and pulp necrosis diagnosed at the review (1). Conclusions: Provided there is an accurate diagnosis of the pulp status and its cause, teeth with reversible Pulpitis due to cracks can be treated conservatively without endodontic treatment in about 80 per cent of cases.
Melissa Drum - One of the best experts on this subject based on the ideXlab platform.
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Successful pulpal anesthesia for symptomatic irreversible Pulpitis
Journal of the American Dental Association (1939), 2017Co-Authors: Melissa Drum, Al Reader, John Nusstein, Sara FowlerAbstract:Abstract Background and Overview Profound pulpal anesthesia after a successful inferior alveolar nerve block can be difficult to achieve when the clinical condition is a pulpal diagnosis of symptomatic irreversible Pulpitis. The authors reviewed the literature as it relates to the anesthesia necessary for endodontic therapy of patients with painful, vital, mandibular teeth diagnosed with symptomatic irreversible Pulpitis. Conclusions Supplemental anesthetic techniques and medications are available that can be used to improve pulpal anesthesia for patients with the clinical condition of symptomatic irreversible Pulpitis. Practical Implications The authors identified treatment recommendations for anesthesia in the case of symptomatic irreversible Pulpitis based on a review of the available evidence.
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pain reduction in untreated symptomatic irreversible Pulpitis using liposomal bupivacaine exparel a prospective randomized double blind trial
Journal of Endodontics, 2016Co-Authors: Kristy Bultema, Al Reader, John Nusstein, Melissa Drum, Sara Fowler, Mike BeckAbstract:Introduction In the treatment of patients with symptomatic irreversible Pulpitis, endodontic debridement is a predictable method to relieve pain. However, there are clinical situations in which emergency care cannot be provided immediately. An unexplored treatment option in these cases may be the use of a long-acting anesthetic to reduce pain in untreated irreversible Pulpitis. Some medical studies have shown potential for infiltrations of liposomal bupivacaine (Exparel; Pacira Pharmaceuticals, San Diego, CA) to prolong pain relief and reduce opioid use postoperatively. The Food and Drug Administration has approved Exparel only for infiltrations; therefore, the purpose of this study was to compare an infiltration of liposomal bupivacaine versus bupivacaine for pain control in untreated, symptomatic irreversible Pulpitis.
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Long buccal nerve block injection pain in patients with irreversible Pulpitis
Oral surgery oral medicine oral pathology oral radiology and endodontics, 2011Co-Authors: Melissa Drum, Al Reader, Mike BeckAbstract:Objectives The purpose of this study was to determine the pain associated with needle insertion (with or without topical anesthetic) and solution deposition for the long buccal nerve block injection in patients with irreversible Pulpitis. Initial pain and any differences by age and gender were also studied. Study design One hundred twelve emergency patients with irreversible Pulpitis received long buccal nerve block injections using 2% lidocaine with 1:100,000 epinephrine. The patients recorded pain of needle insertion and solution deposition on a Heft-Parker visual analog scale (VAS). Results Moderate-to-severe pain occurred from 41% to 46% of the time with the long buccal nerve block. The use of topical anesthetic did not statistically decrease the pain of needle insertion. Conclusions In conclusion, 41% to 46% of patients presenting with irreversible Pulpitis have the potential for moderate-to-severe pain with the long buccal nerve block.
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effect of sublingual triazolam on the success of inferior alveolar nerve block in patients with irreversible Pulpitis
Journal of Endodontics, 2008Co-Authors: Matthew Lindemann, Al Reader, John Nusstein, Melissa Drum, Mike BeckAbstract:Abstract The purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine the effect of the administration of sublingual triazolam on the success of the inferior alveolar nerve (IAN) block in patients experiencing irreversible Pulpitis. Fifty-eight emergency patients diagnosed with irreversible Pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, an identical sublingual tablet of either 0.25 mg of triazolam or a placebo 30 minutes before administration of a conventional IAN block. Access was begun 15 minutes after completion of the IAN block, and all patients had profound lip numbness. Success was defined as no or mild pain (visual analog scale recordings) on access or initial instrumentation. The success rate for the IAN block was 43% with triazolam and 57% with the placebo, with no significant difference (P = .43) between the 2 groups. For mandibular posterior teeth, triazolam in a sublingual dose of 0.25 mg did not result in an increase in success of the IAN block in patients with irreversible Pulpitis. Therefore, when using conscious sedation, profound local anesthesia is still required to eliminate the sensation of pain during endodontic treatment for patients with irreversible Pulpitis.
