In an age where the patients’ needs are high and communicative mediation with the public is fundamental, it is essential to clarify what is meant by these terms. This is to protect their professionalism and to avoid that the expectations of the patient himself may remain unfulfilled.
In this sense, in recent years, there has been an increased interest, both among clinicians and patients, for the methods of painless anaesthesia. These two terms may seem to be in perfect contrast as dental anaesthesiology is basically based on local injection methods.
Recently, paedodontist, Fred Margolis, published an exciting article on clinical methods that can actually be included in the definition of painless anaesthesia. The issue is of particular clinical interest as the injection procedure is one of the fundamental triggers of dental anxiety, which, in turn, can be one of the factors that can interfere the most with the treatment, especially in the paediatric patient.
Topical anaesthesia: it is undoubtedly a painless method, extremely effective if used correctly (especially concerning time), but it has the function of pre-treatment to local anaesthesia, compared to which it is not a real alternative.
Erbium laser: it acts by conditioning the mucous membrane, thus inducing analgesia. It is a method that lends itself to those cases – particularly the restoration in the paediatric patient – that are often not approached with normal injective anaesthesia, because they are not subject to pulpal pain stimulation.
Single Tooth Anesthesia (STA): derived from intraligamentary anaesthesia, actually lends itself to the implementation of different techniques. It involves the computer-controlled release (CCLAD) of the anaesthetic solution. It has a rapid onset and allows the saving of pharmacological doses, which ensures further prevention of the dose-related toxicity risk. It only affects the tissues, surrounding the target element, thus lowering the risk of self-inflicted trauma; at the same time, it lends itself to a multi-quadrant approach.
Ashkenazi tested the system on almost 200 children aged between 2 and 13 (all cases were with intra-sulcular technique of deciduous molars), detecting a reduction in pain-related behaviour. In fact, Jalevik’s study attests that the instrument insures an effective reduction of the painful symptom, especially in the anxious patient. One of the advantages of the system, according to Margolis, is the design of the handpiece, which is more like a pen than a syringe.
Another aspect of interest is the needle penetration mode – characteristics of the needle – which, in the STA method, does not perforate the soft tissues, but is inserted into the dental sulcus, like a probe.