Oosterink FM, de Jongh A, Aartman IH. What are people afraid of during dental treatment? Anxiety-provoking capacity of 67 stimuli characteristic of the dental setting. Eur J Oral Sci. 2008; 116:44-51 https://doi.org/10.1111/j.1600-0722.2007.00500.x
Armfield JM, Stewart JF, Spencer AJ. The vicious cycle of dental fear: exploring the interplay between oral health, service utilization and dental fear. BMC Oral Health. 2007; 7 https://doi.org/10.1186/1472-6831-7-1
Locker D, Shapiro D, Liddell A. Negative dental experiences and their relationship to dental anxiety. Community Dent Health. 1996; 13:86-92
Nusstein J, Reader A, Beck FM. Anesthetic efficacy of different volumes of lidocaine with epinephrine for inferior alveolar nerve blocks. Gen Dent. 2002; 50:372-375
Renton T. Optimal local anaesthesia for dentistry. Prim Dent J. 2019; 7:51-61
Malamed SF. Handbook of Local Anesthesia, 7th edn. : Elsevier Health Sciences; 2019
Kaufman E, Weinstein P, Milgrom P. Difficulties in achieving local anesthesia. J Am Dent Assoc. 1984; 108:205-208
Meechan JG. How to overcome failed local anaesthesia. Br Dent J. 1999; 186:15-20
Meechan JG. The use of the mandibular infiltration anesthetic technique in adults. J Am Dent Assoc. 2011; 142:19S-24S
You TM, Kim K-D, Huh J The influence of mandibular skeletal characteristics on inferior alveolar nerve block anesthesia. J Dent Anesth Pain Med. 2015; 15:113-119
Takasugi Y, Furuya H, Moriya K, Okamoto Y. Clinical evaluation of inferior alveolar nerve block by injection into the pterygomandibular space anterior to the mandibular foramen. Anesth Prog. 2000; 47:125-129
Kim C, Hwang K-G, Park C-J. Local anesthesia for mandibular third molar extraction. J Dent Anesth Pain Med. 2018; 18:287-294
Afsar A, Haas DA, Rossouw PE, Wood RE. Radiographic localization of mandibular anesthesia landmarks. Oral Surg Oral Med Oral Pathol Oral Radiol Endodont. 1998; 86:234-241
Hannan L, Reader A, Nist R The use of ultrasound for guiding needle placement for inferior alveolar nerve blocks. Oral Surg Oral Med Oral Pathol Oral Radiol Endodont. 1999; 87:658-665
Harris SC. Problems of experimental algesimetry and a comment on the tooth pulp method. J Chron Dis. 1956; 4:52-58
McLean C, Reader A, Beck M, Meyers WJ. An evaluation of 4% prilocaine and 3% mepivacaine compared with 2% lidocaine (1:100,000 epinephrine) for inferior alveolar nerve block. J Endod. 1993; 19:146-150
Mikesell P, Nusstein J, Reader A A comparison of articaine and lidocaine for inferior alveolar nerve blocks. J Endod. 2005; 31:265-270
Certosimo AJ, Archer RD. A clinical evaluation of the electric pulp tester as an indicator of local anesthesia. Oper Dent. 1996; 21:25-30
Vreeland DL, Reader A, Beck M An evaluation of volumes and concentrations of lidocaine in human inferior alveolar nerve block. J Endod. 1989; 15:6-12
Hinkley SA, Reader A, Beck M, Meyers WJ. An evaluation of 4% prilocaine with 1:200,000 epinephrine and 2% mepivacaine with 1:20,000 levonordefrin compared with 2% lidocaine with:100,000 epinephrine for inferior alveolar nerve block. Anesth Prog. 1991; 38:84-89
Renton T. Trigeminal nerve injuries. Aust Endod J. 2018; 44:159-169
Kung J, McDonagh M, Sedgley CM. Does articaine provide an advantage over lidocaine in patients with symptomatic irreversible pulpitis? A systematic review and meta-analysis. J Endod. 2015; 41:1784-1794
Hargreaves KM, Keiser K. Local anesthetic failure in endodontics. Endod Topic. 2002; 1:26-39
Fowler S, Drum M, Reader A, Beck M. Anesthetic success of an inferior alveolar nerve block and supplemental articaine buccal infiltration for molars and premolars in patients with symptomatic irreversible pulpitis. J Endod. 2016; 42:390-392
Nguyen V, Chen Y-W, Johnson JD, Paranjpe A. In vivo evaluation of effect of preoperative ibuprofen on proinflammatory mediators in irreversible pulpitis cases. J Endod. 2020; 46:1210-1216
Wallace JA, Michanowicz AE, Mundell RD, Wilson EG. A pilot study of the clinical problem of regionally anesthetizing the pulp of an acutely inflamed mandibular molar. Oral Surg Oral Med Oral Pathol. 1985; 59:517-521
Roy ML, Narahashi T. Differential properties of tetrodotoxin-sensitive and tetrodotoxin-resistant sodium channels in rat dorsal root ganglion neurons. J Neurosci. 1992; 12:2104-2111
Gold MS, Reichling DB, Shuster MJ, Levine JD. Hyperalgesic agents increase a tetrodotoxin-resistant Na+ current in nociceptors. Proc Natl Acad Sci U S A. 1996; 93:1108-1112
Pulikkotil SJ, Nagendrababu V, Veettil SK Effect of oral premedication on the anaesthetic efficacy of inferior alveolar nerve block in patients with irreversible pulpitis. A systematic review and network meta-analysis of randomized controlled trials. Int Endod J. 2018; 51:989-1004
Shirvani A, Shamszadeh S, Eghbal MJ Effect of preoperative oral analgesics on pulpal anesthesia in patients with irreversible pulpitis-a systematic review and meta-analysis. Clin Oral Investig. 2017; 21:43-52
Corbella S, Taschieri S, Mannocci F Inferior alveolar nerve block for the treatment of teeth presenting with irreversible pulpitis: a systematic review of the literature and meta-analysis. Quintessence Int. 2017; 48:69-82
Kaladi SR, Tegginmani V, Mitta S Effectiveness of pre-operative oral medication of ibuprofen and ketorolac on anesthetic efficacy of inferior alveolar nerve block with irreversible pulpitis: randomized controlled trial. Cureus. 2019; 11
Parirokh M, Ashouri R, Rekabi AR The effect of premedication with ibuprofen and indomethacin on the success of inferior alveolar nerve block for teeth with irreversible pulpitis. J Endod. 2010; 36:1450-1454
Shantiaee Y, Javaheri S, Movahhedian A Efficacy of preoperative ibuprofen and meloxicam on the success rate of inferior alveolar nerve block for teeth with irreversible pulpitis. Int Dent J. 2017; 67:85-90
Saha SG, Jain S, Dubey S Effect of oral premedication on the efficacy of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a prospective, double-blind, randomized controlled clinical trial. J Clin Diagn Res. 2016; 10:ZC25-29
Bidar M, Mortazavi S, Forghani M, Akhlaghi S. Comparison of effect of oral premedication with ibuprofen or dexamethasone on anesthetic efficacy of inferior alveolar nerve block in patients with irreversible pulpitis: a prospective, randomized, controlled, double-blind study. Bull Tokyo Dent Coll. 2017; 58:231-236
Aggarwal V, Singla M, Kabi D. Comparative evaluation of effect of preoperative oral medication of ibuprofen and ketorolac on anesthetic efficacy of inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis: a prospective, double-blind, randomized clinical trial. J Endod. 2010; 36:375-378
Oleson M, Drum M, Reader A Effect of preoperative ibuprofen on the success of the inferior alveolar nerve block in patients with irreversible pulpitis. J Endod. 2010; 36:379-382
Shahi S, Mokhtari H, Rahimi S Effect of premedication with ibuprofen and dexamethasone on success rate of inferior alveolar nerve block for teeth with asymptomatic irreversible pulpitis: a randomized clinical trial. J Endod. 2013; 39:160-162
Yadav S. Anesthetic success of supplemental infiltration in mandibular molars with irreversible pulpitis: a systematic review. J Conserv Dent. 2015; 18:182-186
Kanaa MD, Whitworth JM, Meechan JG. A prospective randomized trial of different supplementary local anesthetic techniques after failure of inferior alveolar nerve block in patients with irreversible pulpitis in mandibular teeth. J Endod. 2012; 38:421-425
Haase A, Reader A, Nusstein J Comparing anesthetic efficacy of articaine versus lidocaine as a supplemental buccal infiltration of the mandibular first molar after an inferior alveolar nerve block. J Am Dent Assoc. 2008; 139:1228-1235
Gao X, Meng K. Comparison of articaine, lidocaine and mepivacaine for buccal infiltration after inferior alveolar nerve block in mandibular posterior teeth with irreversible pulpitis. Br Dent J. 2020; 228:605-608
Meechan JG. Infiltration anesthesia in the mandible. Dent Clin North Am. 2010; 54:621-629
Leonard MS. The efficacy of an intraosseous injection system of delivering local anesthetic. J Am Dent Assoc. 1995; 126:81-86
Dunbar D, Reader A, Nist R Anesthetic efficacy of the intraosseous injection after an inferior alveolar nerve block. J Endod. 1996; 22:481-486
Nusstein J, Reader A, Nist R Anesthetic efficacy of the supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in irreversible pulpitis. J Endod. 1998; 24:487-491
Stabile P, Reader A, Gallatin E Anesthetic efficacy and heart rate effects of the intraosseous injection of 1.5% etidocaine (1:200,000 epinephrine) after an inferior alveolar nerve block. Oral Surg Oral Med Oral Pathol Oral Radiol Endodont. 2000; 89:407-411
Meechan JG. Supplementary routes to local anaesthesia. Int Endod J. 2002; 35:885-896
Olley RC, Renton TF, Frost PM. Intraligamentary local anaesthesia for posterior mandibular extractions. Dent Update. 2020; 47:213-216
Kämmerer PW, Adubae A, Buttchereit I Prospective clinical study comparing intraligamentary anesthesia and inferior alveolar nerve block for extraction of posterior mandibular teeth. Clin Oral Investig. 2018; 22:1469-1475
Webber B, Orlansky H, Lipton C, Stevens M. Complications of an intra-arterial injection from an inferior alveolar nerve block. J Am Dent Assoc. 2001; 132:1702-1704
Haas DA. An update on local anesthetics in dentistry. J Can Dent Assoc. 2002; 68:546-552
Hillerup S, Jensen R. Nerve injury caused by mandibular block analgesia. Int J Oral Maxillofac Surg. 2006; 35:437-443
Tzermpos FH, Cocos A, Kleftogiannis M Transient delayed facial nerve palsy after inferior alveolar nerve block anesthesia. Anesth Prog. 2012; 59:22-27
von Arx T, Lozanoff S, Zinkernagel M. Ophthalmologic complications after intraoral local anesthesia. Swiss Dent J. 2014; 124:784-806
Baldi C, Bettinelli S, Grossi P Ultrasound guidance for locoregional anesthesia: a review. Minerva Anestesiol. 2007; 73:587-593
Jung I-Y, Kim J-H, Kim E-S An evaluation of buccal infiltrations and inferior alveolar nerve blocks in pulpal anesthesia for mandibular first molars. J Endod. 2008; 34:11-13
Brandt RG, Anderson PF, McDonald NJ The pulpal anesthetic efficacy of articaine versus lidocaine in dentistry: a meta-analysis. J Am Dent Assoc. 2011; 142:493-504
Poorni S, Veniashok B, Senthilkumar AD Anesthetic efficacy of four percent articaine for pulpal anesthesia by using inferior alveolar nerve block and buccal infiltration techniques in patients with irreversible pulpitis: a prospective randomized double-blind clinical trial. J Endod. 2011; 37:1603-1607
Parirokh M, Satvati SA, Sharifi R Efficacy of combining a buccal infiltration with an inferior alveolar nerve block for mandibular molars with irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endodont. 2010; 109:468-473
Oulis CJ, Vadiakas G, Vasilopoulou A. The effectiveness of mandibular infiltration compared to mandibular block anesthesia in treating primary molars in children. Pediatr Dent. 1996; 18:301-305
Smith T, Urquiola R, Oueis H, Stenger J. Comparison of articaine and lidocaine in the pediatric population. J Mich Dent Assoc. 2014; 96:34-37
Meechan JG, Ledvinka JI. Pulpal anaesthesia for mandibular central incisor teeth: a comparison of infiltration and intraligamentary injections. Int Endod J. 2002; 35:629-634
Jaber A, Whitworth JM, Corbett IP The efficacy of infiltration anaesthesia for adult mandibular incisors: a randomised double-blind cross-over trial comparing articaine and lidocaine buccal and buccal plus lingual infiltrations. Br Dent J. 2010; 209:E16-E16
Corbett IP, Kanaa MD, Whitworth JM, Meechan JG. Articaine infiltration for anesthesia of mandibular first molars. J Endod. 2008; 34:514-518
Heller AA, Shankland WE. Alternative to the inferior alveolar nerve block anesthesia when placing mandibular dental implants posterior to the mental foramen. J Oral Implantol. 2001; 27:127-133
Professor of Oral Surgery, King's College London; Honorary Consultant in Oral Surgery, King's College Hospital NHS Foundation Trust and Guy's and St Thomas' NHS Foundation Trust, London
Local anaesthesia is a sine qua non for pain management in dentistry. Optimizing local anaesthesia practice reduces intra-operative pain, and ultimately ameliorates patient comfort. Many patients still report experiencing intra-operative pain despite being anaesthetized. This is commonplace with inferior alveolar nerve blocks, the current routine approach to mandibular anaesthesia. This technique has been shown, in many cases, to fail at first attempt and can be uncomfortable for patients. It has a higher positive-aspiration rate than other techniques, increasing the risk of systemic complications.
CPD/Clinical Relevance: Clinicians should be aware of more effective techniques for mandibular anaesthesia for optimal and safe pain management, and ultimately a better patient experience.
Article
Generally, the anticipation of painful or invasive procedures is the greatest source of anxiety for patients in dentistry.1 Evidence suggests that patients who have high levels of dental anxiety avoid appointments, and so may have poor oral health.2 This ‘vicious cycle of dental fear’ (Figure 12) highlights the significance of optimizing pain control in the dental setting.
Local anaesthesia (LA) is key to pain control in dentistry, and there is a plethora of articles suggesting how its use can be optimized. Nevertheless, the most commonly reported adverse event in dental practice is intra-operative pain.3 In a representative sample of the general population, 71% reported having painful dental experiences,4 implying that pain management in dentistry has yet to reach its pinnacle.
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