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Editorial

Earning Continuing Education Credits From Anesthesia Progress

DDS, PhD

DOI: 10.2344/0003-3006(2005)52[121:ECE]2.0.CO;2

Obtaining continuing education on a regular basis is mandatory for maintaining and updating the practices of all healthcare professionals. Because the delivery of all types of anxiety and pain control involves the potential for causing catastrophic consequences, continuing education in anesthesia is even more important than perhaps any other area of dentistry. Dental practitioners receive their anesthesia continuing education from a wide variety of sources, such as scientific journals and attendance at study clubs, courses, and professional meetings. Although the American Dental Society of Anesthesiology (ADSA) was originally founded to advance the art and science of anesthesia in dentistry and

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Scientific Reports

A Survey of Pain, Pressure, and Discomfort Induced by Commonly Used Oral Local Anesthesia Injections

DMD,

DMD, MSD, FRCD(C),

DSc,

DMD,

DMD, and

DMD

DOI: 10.2344/0003-3006(2005)52[122:ASP]2.0.CO;2

Abstract

Intraoral local anesthesia is essential for delivering dental care. However, it is often perceived by some patients as the most painful and in some instances as the only painful part of the treatment, leading in extreme cases to avoidance of dental care. The present study measured the variables of pain, pressure, and discomfort caused by 4 commonly used local anesthesia injections: local infiltration, mental nerve block, inferior alveolar nerve block, and periodontal ligament injections. Patients were asked to grade pain, discomfort, and pressure on a visual analog scale as associated with needle insertion, operator finger position in the mouth, and pressure at injection. The inferior alveolar injection was graded to be the most painful followed by periodontal ligament and then mental nerve block injections. The periodontal ligament injections yielded the highest pressure scores. The inferior alveolar block injection yielded significantly more discomfort than local infiltration and mental nerve block injections when comparing finger and needle position. Local infiltration in the anterior maxillary region yielded the highest needle insertion and finger position discomfort scores. The present study suggests that the dental operator should be aware of local anesthesia injection pain, pressure, and discomfort together with efficacy of technique.

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Zaleplon (Sonata) Oral Sedation for Outpatient Third Molar Extraction Surgery

DMD, MS,

DDS,

DDS, and

DDS, MA

DOI: 10.2344/0003-3006(2005)52[128:ZOS]2.0.CO;2

Abstract

Zalpelon was compared with triazolam for oral sedation in a third molar surgery model using a double-blind crossover design. Factors such as anxiolysis, amnesia, and quality of sedation were assessed. Of the 14 participants who completed the study, zaleplon sedation was found to be similar to triazolam sedation in all regards except that recovery from zaleplon was more rapid.

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Anesthetic Efficacy of Bupivacaine Solutions in Inferior Alveolar Nerve Block

DDS, PhD,

DDS, MS,

PhD, and

DDS, PhD

DOI: 10.2344/0003-3006(2005)52[132:AEB]2.0.CO;2

Abstract

The purpose of this study was to compare the anesthetic efficacy of 2 bupivacaine solutions. Twenty-two volunteers randomly received in a crossover, double-blinded manner 2 inferior alveolar nerve blocks with 1.8 mL of racemic bupivacaine and a mixture of 75% levobupivacaine and 25% dextrobupivacaine, both 0.5% and with 1 : 200,000 epinephrine. Before and after the injection, the first mandibular pre-molar was evaluated every 2 minutes until no response to the maximal output (80 reading) of the pulp tester and then again every 20 minutes. Data were analyzed using the Wilcoxon paired test and the paired t test. No differences were found between the solutions for onset and duration of pulpal anesthesia and duration of soft tissue anesthesia (P > .05). It was concluded that the solutions have similar anesthetic efficacy.

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Case Report

Benzocaine-induced Methemoglobinemia

DDS and

DMD, MD

DOI: 10.2344/0003-3006(2005)52[136:BM]2.0.CO;2

Abstract

A case is reported in which a patient developed methemoglobinemia-induced cyanosis while under general anesthesia during surgery for multiple fascial space infections. The cause of methemoglobinemia was 20% benzocaine spray used for local anesthesia before intubation. Acutely developing methemoglobinemia is infrequently encountered in clinical practice. When confronted with cyanosis in the absence of cardiac or pulmonary disease, one must seriously consider the diagnosis of methe-moglobinemia. The etiology of methemoglobinemia, the causative agents, the diagnosis, and the emergency treatment required are discussed.

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Continuing Education

Drug Therapy in Dental Practice: Nonopioid and Opioid Analgesics

DDS and

DMD

DOI: 10.2344/0003-3006(2005)52[140:DTD]2.0.CO;2

Abstract

To prevent patient pain, the clinician may chose from opioid and nonopioid analgesics. It is rational for the practitioner to combine drugs from these classes when managing moderate to severe pain. To select combination regimens wisely, it is necessary to understand the significant pharmacological features of each category alone. Careful selection of an effective analgesic regimen based on the type and amount of pain the patient is expected to have can prevent the stress and anxiety associated with breakthrough pain. The clinician can and should develop a variety of effective, safe analgesic regimens, based on estimates of anticipated pain intensity that use sound pharmacological principles.

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Book Review

A Textbook of Anaesthesia, 4th Edition

BSc, DDS, BScD, MSc, FADSA

DOI: 10.2344/0003-3006(2005)52[151:ATA]2.0.CO;2

A. Aitkenhead, D. Rowbotham, and G. Smith

London, England, 2002 Churchill Livingstone

When I picked up this book, it was clearly an introductory textbook, which would normally necessitate cover-to-cover reading. What an onerous task. This is a large, soft-cover book of more than 800 pages, and the print is small. However, what a surprise I had. This book is an absolute gem, providing a readable, extremely comprehensive text that is heavily founded on basic scientific concepts, especially anatomy, physiology, and pharmacology. It is well written, clear, and concise. The text is especially strong in basic pharmacology—as up-to-date and accurate as

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Departments

JDSA Journal Abstracts

DOI: 10.2344/0003-3006(2005)52[152:JJA]2.0.CO;2

K. Ogata,

Address correspondence to Akiko Shiki, Ogata Dental Clinic, 1-13-17, Hakata-eki, Higashi, Kakata-ku, Fukuoka 812-0013, Japan.

A. Shiki,

Address correspondence to Akiko Shiki, Ogata Dental Clinic, 1-13-17, Hakata-eki, Higashi, Kakata-ku, Fukuoka 812-0013, Japan.

K. Ogata,

Address correspondence to Akiko Shiki, Ogata Dental Clinic, 1-13-17, Hakata-eki, Higashi, Kakata-ku, Fukuoka 812-0013, Japan.

Evaluation of Day-care Propofol Anesthesia with Low-dose Sevoflurane for Dental Treatment of the Mentally Handicapped

Abstract

Propofol is considered a suitable anesthetic to dental treatments of the mentally handicapped for the reason that it has an antiemetic effect and seldom leads to postoperative agitation. However, limiting the anesthetics to

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