Scaling and root planing, or non-surgical treatment, represents the first therapeutic line of periodontal disease. It is a procedure that is not necessarily painful yet still uncomfortable, because it is slow and relatively invasive.

Evaluating alternative methods to the injection method is primarily useful in the prevention of dental anxiety and, more generally, of the discomfort related to the procedure. In addition, it may be particularly useful in those local areas, such as in the United States and in Europe, where the dental hygienist, who specializes in causal therapy of periodontal disease, is not legally authorized to perform local anesthesia. Another article previously appeared on the following pages dealing with the legislative framework.

For these reasons, this discussion aims to evaluate the characteristics of a topical anesthetic product specifically aimed for use during scaling and root planing procedures. In this regard, it should be noted that topical anesthesia differs from local anesthesia in that it is limited, by definition, to the most superficial portions of the oral mucosa. For this reason, it is also commonly used to control pain during the anesthetic injection itself.

The product in question, evaluated by the Moraes and colleagues study recently published in the Journal of Applied Oral Science, is a gel containing lidocaine and prilocaine in a combined liposomal formula. This was compared with another anesthetic gel on the market and with a gel containing no anesthetic molecules as a control.

The study involved a total of 40 patients with moderate or severe chronic periodontitis who underwent periodontal therapy in at least three sextants. The model used was randomized, double-blind, cross-over. Each patient was randomly assigned to one of the three groups, which differed only in the alternation of the gel used in the three sessions spaced one week apart. Each group, therefore, had the opportunity to test both the two anesthetic gels and the placebo. Each participant provided feedback on the pain experience related to each session.

The results did not reveal significant differences between the procedure groups in relation to the frequency and intensity of the pain stimulus during the scaling and root planing maneuvers. The authors therefore, concluded that they found limited indications regarding such clinical use.

Other variables affect the periodontal pain stimulus, such as the probing depth, a maneuver for which, recently, the superiority of topical anesthesia compared to placebo has been demonstrated.

The impact of dental anxiety is also noteworthy. In a procedure that is often painful, the clinician will have to do everything possible to facilitate acceptance of local injection anesthesia, perhaps using alternative methods.


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