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Double versus single cartridge of 4% articaine infiltration into the retro-molar area for lower third molar surgery.

Kamonpun SAWANG ; Teeranut CHAIYASAMUT ; Sirichai KIATTAVORNCHAREON ; Verasak PAIRUCHVEJ ; Bishwa Prakash BHATTARAI ; Natthamet WONGSIRICHAT

Journal of Dental Anesthesia and Pain Medicine.2017;17(2):121-127. doi:10.17245/jdapm.2017.17.2.121

BACKGROUND: There are no studies regarding 4% articaine infiltration injection into the retro-molar area for an impacted lower third molar (LITM) surgery. This study aimed to evaluate the efficacy of infiltration using 1.7 ml (single cartridge: SC) of 4% articaine versus 3.4 ml (double cartridges: DC) of 4% articaine with 1:100,000 epinephrine in LITM surgery. METHOD: This study involved 30 healthy patients with symmetrical LITM. The patients were assigned to receive either a DC or SC of 4% articaine with 1:100,000 epinephrine as a local anesthetic for each operation. Onset, duration, profoundness, need for additional anesthetic administration, total volume of anesthetic used, vitality of the tooth, and pain score during operation were recorded. RESULTS: The DC of 4 % articaine had a significantly higher success rate (83.3%) than did the SC (53.3%; P < 0.05). The duration of soft tissue anesthesia was longer in the DC group. The intra-operative pain was higher in the SC group with a significant (P < 0.05) requirement for a supplementary local anesthetic. CONCLUSION: We concluded that using DC for the infiltration injection had a higher success rate, longer duration of anesthesia, less intra-operative pain, and a lower amount of additional anesthesia than SC in the surgical removal of LITM. We recommend that a DC of 4% articaine and a 1:100,000 epinephrine infiltration in the retro-molar region can be an alternative anesthetic for LITM surgery.
Anesthesia ; Anesthetics, Local ; Carticaine* ; Epinephrine ; Humans ; Methods ; Molar, Third* ; Tooth ; Tooth, Impacted

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Distribution of medical status and medications in elderly patients treated with dental implant surgery covered by national healthcare insurance in Korea.

Kyungjin LEE ; Chugeum DAM ; Jisun HUH ; Kyeong Mee PARK ; Seo Yul KIM ; Wonse PARK

Journal of Dental Anesthesia and Pain Medicine.2017;17(2):113-119. doi:10.17245/jdapm.2017.17.2.113

BACKGROUND: The purpose of this study was to investigate the distribution of systemic diseases and medications in patients older than 65 years of age who visited the hospital for implant treatment, as well as to investigate basic information about surgical complications that may occur after insured implant treatment. METHODS: A total of 126 patients over 65 years of age were treated for implant surgery from October 1, 2013 to October 30, 2016. Electronic chart review was conducted to obtain medical records, which included sex, age, systemic diseases, medication(s) being taken, and control of the medications. Five patients were excluded due to lack of medical records giving information about systemic disease. RESULTS: Of the 126 patients, 112 (88.9%) were taking medication due to systemic disease and 9 patients (7.1%) were not. The sex distribution was 71 women and 55 men and the highest proportion of patients were between 65 and 69 years old. The most common diseases were, from most to least frequent, hypertension, cardiovascular disease, diabetes, and osteoporosis. The drug groups that can cause major complications after dental treatment were classified as hemorrhagic, osteoporotic, and immunosuppressive agents, and were taken by 45 (35.7%), 22 (17.5%) and 4 (3.2%) patients, respectively. CONCLUSION: Given that 88.9% of the elderly patients who were eligible for insurance implant treatment had systemic disease, it is necessary to carefully evaluate patients' medical histories and their general conditions in order to prevent emergencies during implant surgery.
Aged* ; Cardiovascular Diseases ; Delivery of Health Care* ; Dental Implants* ; Emergencies ; Female ; Humans ; Hypertension ; Immunosuppressive Agents ; Insurance* ; Korea* ; Male ; Medical History Taking ; Medical Records ; National Health Programs ; Osteoporosis ; Postoperative Complications ; Sex Distribution

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Hemodynamic changes and pain perception-related anxiety after experiencing an impacted-tooth removal: clinical practice outcome.

Somchart RAOCHARERNPORN ; Kiatanant BOONSIRISETH ; Manop KHANIJOU ; Natthamet WONGSIRICHAT

Journal of Dental Anesthesia and Pain Medicine.2017;17(2):105-111. doi:10.17245/jdapm.2017.17.2.105

BACKGROUND: Dental fear is usually associated with hemodynamic changes. Fear of pain during the surgical removal of a lower impacted third molar might cause patients anxiety, thereby leading to avoidance of any future dental therapy. This study aimed to determine the effect of experiencing a surgical impacted-tooth removal on the pain perception-related anxiety and hemodynamic status. METHODS: Twenty-seven healthy patients aged 15–30 years (mean age, 24 years), for whom surgical removal of bilateral lower third molars was advised, were included. This prospective, randomized, controlled, split-mouth study involved operations on both sides of the mandibular arch, with a 1-month washout period in between. Blood pressure and heart rate were measured before the surgical procedure, during and after the injection, preoperatively, and postoperatively. Pain perception was evaluated using a 100-mm visual analog scale during the injection, preoperatively, and postoperatively after the numbness disappeared. Differences in the blood pressure, heart rate, and pain perception between the two appointments were analyzed using the paired t-test. For all statistical analyses, SPSS version 11.5 was used. RESULTS: The mean pain perception values during the injection and preoperatively showed no significant differences between the two appointments (P > 0.05); however, significant differences in the blood pressure and heart rate were noted before the surgical procedure; preoperatively, the blood pressure alone showed a significant difference (P < 0.05). CONCLUSIONS: There was a significant decrease in the blood pressure and heart rate preoperatively; hence, experiencing a surgical impacted-tooth removal can reduce the subsequent preoperative anxiety in healthy patients.
Anxiety* ; Appointments and Schedules ; Blood Pressure ; Dental Anxiety ; Heart Rate ; Hemodynamics* ; Humans ; Hypesthesia ; Molar, Third ; Pain Perception ; Prospective Studies ; Visual Analog Scale

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The use of general anesthesia to facilitate dental treatment in adult patients with special needs.

Mathew Albert Wei Ting LIM ; Gelsomina Lucia BORROMEO

Journal of Dental Anesthesia and Pain Medicine.2017;17(2):91-103. doi:10.17245/jdapm.2017.17.2.91

General anesthesia is commonly used to facilitate dental treatment in patients with anxiety or challenging behavior, many of whom are children or patients with special needs. When performing procedures under general anesthesia, dental surgeons must perform a thorough pre-operative assessment, as well as ensure that the patients are aware of the potential risks and that informed consent has been obtained. Such precautions ensure optimal patient management and reduce the frequency of morbidities associated with this form of sedation. Most guidelines address the management of pediatric patients under general anesthesia. However, little has been published regarding this method in patients with special needs. This article constitutes a review of the current literature regarding management of patients with special needs under general anesthesia.
Adult* ; Anesthesia ; Anesthesia, General* ; Anxiety ; Child ; Dental Anxiety ; Dental Care for Chronically Ill ; Dental Care for Disabled ; Humans ; Informed Consent ; Methods ; Surgeons

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Use of local anesthetics for dental treatment during pregnancy; safety for parturient.

Ji Min LEE ; Teo Jeon SHIN

Journal of Dental Anesthesia and Pain Medicine.2017;17(2):81-90. doi:10.17245/jdapm.2017.17.2.81

Pregnancy induces significant anatomical and physiological changes in the mother. Many pregnant women need dental treatment due to poor oral hygiene related to pregnancy. However, most dentists are reluctant to provide, and most pregnant women are reluctant to receive, dental treatment during pregnancy. Theoretically, maternally administered drugs are transferred to the fetus. Depending on the types of drugs and the stage of pregnancy, the effects of drugs on the mother, as well as the fetus, may vary. Local anesthetics are the most widely used in dental treatment. It is, therefore, important to understand the potential effects of local anesthetics during pregnancy. In this review, we will focus on the maternal and fetal effects of local anesthetics widely used in dental treatment with consideration of the use of local anesthetics during pregnancy.
Anesthetics, Local* ; Dental Care ; Dentists ; Female ; Fetus ; Humans ; Mothers ; Oral Hygiene ; Pregnancy* ; Pregnant Women

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Authors' Reply to Letter to the Editor “Effects of airway evaluation parameters on the laryngeal view grade in mandibular prognathism and retrognathism patients”.

Myong Hwan KARM ; Kwang Suk SEO

Journal of Dental Anesthesia and Pain Medicine.2017;17(1):79-80. doi:10.17245/jdapm.2017.17.1.79

No abstract available.
Cephalometry ; Prognathism* ; Retrognathia*

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Anesthetic management for simultaneous drug-induced sleep endoscopy and maxillomandibular advancement in a patient with obstructive sleep apnea.

Tae Seong KUK ; Eunsun SO ; Myong Hwan KARM ; Jimin KIM ; Seong In CHI ; Hyun Jeong KIM ; Kwang Suk SEO ; Sung Woon ON ; Jin Young CHOI

Journal of Dental Anesthesia and Pain Medicine.2017;17(1):71-76. doi:10.17245/jdapm.2017.17.1.71

Drug-induced sleep endoscopy (DISE) is used to identify areas of upper airway obstruction, which occurs when patients with obstructive sleep apnea (OSA) snore. DISE enables effective diagnosis and appropriate treatment of the obstruction site. Among surgical treatment methods for OSA, maxillomandibular advancement surgery (MMA) is performed to move a jaw forward; the surgery has a high success rate for OSA treatment. In DISE, anesthetics such as propofol and midazolam must be administered to induce snoring while the patient is deeply sedated for an accurate diagnosis to be made. When inducing deep sedation in a patient with OSA, airway obstruction may increase, causing oxygen saturation to drop; airway interventions are necessary in such cases. Effective DISE and MMA surgery can be performed by administering propofol through target-controlled infusion while monitoring the bispectral index (BIS).
Airway Obstruction ; Anesthetics ; Deep Sedation ; Diagnosis ; Endoscopy* ; Humans ; Jaw ; Midazolam ; Oxygen ; Propofol ; Sleep Apnea, Obstructive* ; Snoring

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Dental treatment in patients with severe gag reflex using propofol-remifentanil intravenous sedation.

Sooil SHIN ; Seungoh KIM

Journal of Dental Anesthesia and Pain Medicine.2017;17(1):65-69. doi:10.17245/jdapm.2017.17.1.65

Patients with severe gag reflex (SGR) have difficulty getting the treatment they require in local clinics, and many tend to postpone the start of their treatment. To address this problem, dentists have used behavioral techniques and/or pharmacological techniques for treatment. Among the pharmacological methods available, propofol IV sedation is preferred over general anesthesia because it is a simpler procedure. Propofol in combination with remifentanil is characterized by stable sedative effects and quick recovery, leading to a deep sedation. Remifentanil acts to reduce the pain caused by lipid-soluble propofol on injection. The synergistic effects of propofol-remifentanil include reduction in the total amount of drug required to achieve a desired sedation level and anti-emetic effects. In this case report, we outline how the use of propofol-remifentanil IV sedation enabled us to successfully complete a wide range of dental treatments in a patient with SGR.
Anesthesia, General ; Antiemetics ; Deep Sedation ; Dental Care ; Dentists ; Gagging ; Humans ; Hypnotics and Sedatives ; Propofol ; Reflex*

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Flexible laryngeal mask airway management for dental treatment cases associated with difficult intubation.

Masanori TSUKAMOTO ; Takashi HITOSUGI ; Takeshi YOKOYAMA

Journal of Dental Anesthesia and Pain Medicine.2017;17(1):61-64. doi:10.17245/jdapm.2017.17.1.61

Nasotracheal intubation is generally a useful maxillofacial surgery that provides good surgical access for intraoral procedures. When nasotracheal intubation is difficult, laryngeal mask airway (LMA) insertion can be performed, and the flexible LMA™ (FLMA) is also useful for anesthetic management. However, the FLMA provides limited access to the mouth, which restricts the insertion of instrumentation and confines the surgical field available. Here, we present our experience using the FLMA airway management for dental treatment cases involving difficulty with intubation.
Airway Management ; Anesthesia, General ; Dental Care ; Intubation* ; Laryngeal Masks* ; Mouth ; Surgery, Oral

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Creating protective appliances for preventing dental injury during endotracheal intubation using intraoral scanning and 3D printing: a technical note.

Jin Hyung CHO ; Wonse PARK ; Kyeong Mee PARK ; Seo Yul KIM ; Kee Deog KIM

Journal of Dental Anesthesia and Pain Medicine.2017;17(1):55-59. doi:10.17245/jdapm.2017.17.1.55

Digital dentistry has influenced many dental procedures, such as three-dimensional (3D) diagnosis and treatment planning, surgical splints, and prosthetic treatments. Patient-specific protective appliances (PSPAs) prevent dental injury during endotracheal intubation. However, the required laboratory work takes time, and there is the possibility of tooth extraction while obtaining the dental impression. In this technical report, we utilized new digital technology for creating PSPAs, using direct intraoral scanners and 3D printers for dental cast fabrication.
Dentistry ; Diagnosis ; Intubation, Intratracheal* ; Printing, Three-Dimensional* ; Splints ; Tooth Extraction

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