Background: Patients who report to be difficult to anesthetize for dental procedures are commonly encountered.Determining their frequency and shared characteristics could improve understanding of pain management failures. Methods: Categorical and continuous variables of 24 demographic, medical history, and dental history variables were compared in a deidentified cross-sectional study using electronic health records (EHR) of patients at the University of Iowa College of Dentistry. Individuals who self-reported to be difficult to anesthetize in their dental health history form were compared to those who reported no complications with local anesthesia. Descriptive, univariate regression, and multivariable regression statistical analyses were completed on the demographic, medical history, and dental history EHR variables. Results: A total of 12,400 deidentified patient records met the inclusion criteria with a 11.4% (n = 1,411) prevalence of difficult to anesthetize self-reports. Eight categorical variables were found to have statistically significant (95% confidence interval [CI]) adjusted odds ratios (AOR) in the multivariable regression of difficult to anesthetize reporting patients: female gender (AOR = 1.61, 95% CI: 1.32-1.96, P < 0.001), dental fear (AOR = 3.60, 95% CI: 3.01-4.31, P < 0.001), mental health disorders (AOR = 1.21, 95% CI: 1.00-1.46, P < 0.045), problems with general anesthesia (AOR = 1.46, 95% CI: 1.11-1.89, P = 0.005), neurologicalerve disorders (AOR = 1.30, 95% CI: 1.05-1.60, P = 0.015), temporomandibular joint clicking/popping (AOR = 1.31, 95% CI: 1.08-1.60, P = 0.006), needle anxiety (AOR = 29.03, 95% CI: 23.80-35.52, P < 0.001), and history of root canal treatment (AOR 0.82, 95% CI: 0.68-0.99, P = 0.035). Conclusion A clinically relevant percentage of patients self-reported being difficult to anesthetize for dental procedures. The relationship between local anesthesia inadequacies and variables such as female gender, dental fear, mental health, and neurological disorders requires further investigation. The use of evidence-based local anesthesia approaches and communication practices is suggested to minimize pain experienced and subsequent fear of dental care.

1p36 deletion syndrome is characterized by a genetic deletion that frequently causes central nervous system, craniofacial, cardiac, and musculoskeletal anomalies. Perioperative management of patients with 1p36 deletion syndrome presents unique challenges due to multiple anomalies and potential complications. We present the successful anesthetic management of a 16-year-old patient diagnosed with 1p36 deletion syndrome who underwent general anesthesia for multiple dental procedures, including dental fillings, extractions, and tartar removal. The patient had micrognathia, hypotonia, flat eyebrows, a short neck, inability to sit without support, absence of speech and self-care skills, limited ability to follow simple commands, and poor cooperation. These factors increase the risk of difficult mask ventilation and intubation. To minimize aspiration risk, we successfully intubated the patient using rapid-sequence induction and intubation (RSII) method with cricoid pressure. A perioperative multidisciplinary team approach and comprehensive preoperative evaluation are crucial due to the existing anomalies, developmental and motor delays, and potential airway complications associated with this syndrome.

Oral flavored solutions are effective for pain management. The intraoral application of sweet solutions at the injection site or on the tongue before local anesthetic administration leads to lower self-perceived pain than any other intervention. This systematic review aimed to evaluate the effect of sweet taste on injection pain in patients undergoing dental procedures. This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42024571962 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). An initial electronic search without a time limit up to September 2024 revealed 1,087 studies from indexed databases (PubMed, Scopus, Embase, Cochrane, and Web of Science). The Cochrane Bias Assessment Tool was used to evaluate the risk of bias. After eliminating duplicate and automated records, 103 studies were screened for inclusion. After reviewing the titles and abstracts and assessing the eligibility of the studies, three were excluded and eight RCTs were considered appropriate for inclusion and analysis. This review highlights that all the included studies reported significantly reduced pain perception after sweet solutions, regardless of the specific type or concentration.

Background: Patient age, preoperative anxiety, dental requirement, risks associated with pharmaceutical management, safety, parental expectations, and cost influence the choice of pharmacological behavior management.Thus, this randomized controlled clinical study aimed to compare the effectiveness and acceptance of intranasal dexmedetomidine and midazolam for sedation in children aged 5–8 years using a mucosal atomizer device (MAD). Methods: A total of 48 participants with Frankl’s II behavior were randomly divided into two groups: Group I received intranasal midazolam (0.25 mg/kg), and Group II received intranasal dexmedetomidine (1.5 μg/kg).The primary outcomes assessed were drug acceptance, onset and effectiveness of sedation, and pre-and post-treatment anxiety levels. Secondary measures were also evaluated pre- and post-treatment. Results: Intranasal dexmedetomidine demonstrated significantly better drug acceptance (P < 0.001). Midazolam had a faster onset but was less effective than dexmedetomidine (P < 0.001). Additionally, dexmedetomidine exhibited better anxiolytic properties than midazolam (P < 0.001). Conclusion Dexmedetomidine was better accepted by children aged 5–8 years, was more effective, and had superior anxiolytic properties compared with midazolam.

Background: The inappropriate use of opioids in the United States continues to pose a significant challenge to public health. For a look into how the next generation of practitioners may be trained, this survey study sought to evaluate the current opioid prescribing patterns among Oral and Maxillofacial Surgery (OMFS) residency programs in the United States. Methods: A 16-question survey was sent to 100 residency program directors, with responses from 27 programs.The survey aimed to assess the program’s strategies for postoperative pain management, including the use of opioids, non-opioids, and other available modalities such as localized long-acting bupivacaine. Results: The results showed that 74% of the responding programs still taught the use of opioid prescriptions for third-molar removal, and 40% of the surveyed programs used prescription narcotics for other extractions as well. One-third of residency programs have adopted the use of localized long-lasting bupivacaine to limit the amount of narcotic medication required for dentoalveolar procedures. Conclusion This study highlights the implications of these prescription habits and raises questions regarding future improvements to OMFS resident training programs.

Background: General anesthesia (GA) in dentistry is crucial for managing patients with special needs, enabling comprehensive care for individuals who cannot tolerate conventional procedures. This study aimed to analyze the demographic characteristics and trends in dental treatments performed under GA. Methods: A retrospective analysis of 2,458 dental treatments performed under GA at Dankook University Jukjeon Dental Hospital was conducted between January 2015 and October 2024. Data on sex, age, GA duration, and type of disability were collected and analyzed. Results: Of the 2,458 cases, 89.5% (2,199) involved patients with disabilities. Male patients accounted for 60.0% of the total cohort, and 61.3% of patients with disabilities were male. The mean age of patients was 34.1 ± 13.4 years, with younger patients more frequently treated under GA. Intellectual disabilities were the most prevalent (56.3%) followed by autism spectrum disorder (14.6%). The average GA duration was 174.8 ± 61.5 minutes, with longer durations observed in patients with disabilities (177.2 ± 61.1 minutes). Conclusion The increasing demand for GA, particularly among patients with disabilities, underscores the need for tailored guidelines and enhanced education on dental treatment performed under GA. These findings provide a foundation for future policy development.

Aromatic L-amino acid decarboxylase deficiency (AADCD) is a rare autosomal recessive neurometabolic synthesis disease with sympathetic autoregulation deficiency. Perioperative management of AADCD presents unique challenges due to autonomic dysfunction, impaired sympathetic regulation of heart rate, and potential airway complications. Herein, we report the successful anesthetic management of a 14-year-old male patient with AADCD under total intravenous anesthesia during extensive dental procedures. We applied the rapid sequence induction and intubation method with cricoid pressure to minimize the risk of pulmonary aspiration due to the potential difficulty in mask ventilation and intubation, limited mouth opening, microcephaly, micrognathia, and poor cooperation. Intubation was performed without any complications. Due to the autonomic dysfunction, potential airway complications, and developmental, mental, and motor delays in this disorder, perioperative management requires a multidisciplinary approach with comprehensive preoperative evaluation.

This review aims to evaluate the safety of remimazolam for intravenous sedation during dental treatment and oral surgery. The protocol was registered in the Open Science Framework (registration DOI: 10.17605/OSF.IO/RFPSZ), and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Literature searches and screenings were conducted using PubMed and the Cochrane database, with additional records manually reviewed from various sources. The selected studies, published in English, investigated the safety of remimazolam for sedation in dental and oral surgery. An initial search identified 20 studies, of which five prospective studies met the inclusion criteria. All included studies used an initial bolus administration of remimazolam. Primary outcomes assessed were the sedation success rate, incidence of adverse effects, onset time, awakening time, recovery time, and postoperative side effects. This scoping review indicates that all studies validated the superiority of remimazolam over other sedatives for dental treatment and oral surgery. The development and research of innovative technologies to reduce dental pain and anxiety presents opportunities for interdisciplinary collaboration and improved patient care in dental practice.Future clinical studies should focus on determining the optimal timing for additional dosing and discontinuation when remimazolam is administered continuously.