In the approach to the paediatric patient, the control of intraoperative pain is fundamental to the success of the treatment, especially in the case of extractions, where a patient experiences strong proprioceptive stimulus on which the local anesthetic is not effective. At the same time, injection anesthesia itself is a strong trigger for dental anxiety. It would therefore be clinically useful to be aware that sufficient anesthesia can be ensured in a single step.

Starting from these assumptions, Rathi and colleagues conducted a study to evaluate the effectiveness of a single vestibular infiltration, experimenting with two different local anesthetic molecules, in the extraction of a deciduous molar.

The study, published in early 2019 in Anesthesia Progress, involved a total sample of 100 patients aged between 7 and 12 years, all healthy, cooperative (positive or very positive score according to Frankl’s behavior rating scale), and indicated for the extraction of a  deciduous molar.

Each patient was randomly assigned to one of the two groups. The procedure used was the same, conducted by the same operator; the variable compared was therefore properly the anesthetic molecule. In fact, articaine 4% was used with adrenaline 1:100000 and lidocaine 2% with adrenaline 1:80000, respectively for groups A and B.

The needle was inserted at the level of the mucobuccal fold at the apical region of the target tooth. After a double aspiration test, the equivalent of 1/3 of a cartridge was administered within 20 seconds. Sensitivity at the level of the soft tissues surrounding the tooth was assessed, and only in cases where there was no effect at the lingual/palatal level was a second administration (0.2-0.3 mL) added directly to this site. The extraction procedure began 5 minutes after the anesthetic procedure.

Pain perception during the procedure was assessed using the Facial Pain Scale. Also in the intraoperative phase, hemodynamic parameters (blood pressure and heart rate) were monitored. The data collected were statistically analyzed by Wilcoxon-Mann-Whitney’s test.

The FPS value was significantly lower in group A, where a significant intraoperative decrease in heart rate compared to baseline was also observed. No significant differences in blood pressure were observed. These data are certainly also to be correlated with the anesthetic (upper) and vasoconstrictor (lower) concentration present in the articaine cartridge.

All patients treated with articaine had a valid effect also at the lingual/palatal level, so as not to require additional infiltration, which was, on the contrary, necessary in all patients treated with lidocaine.

It can be concluded, net of the limitations of the study, that articaine is the most suitable drug to be used in a single injection procedure for the extraction of a deciduous molar in a paediatric patient.

 

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