Scott Thayer1, Janice A Townsend2, Mathilde Peters3, Qingzhao Yu4, Mark Odom1, Kent A Sabey1. 1. Department of Endodontics, Louisiana State University Health Sciences Center, School of Dentistry, New Orleans, Louisiana. 2. Division of Pediatric Dentistry, The Ohio State University College of Dentistry, Department of Pediatric Dentistry, Nationwide Children's Hospital, Columbus, Ohio. 3. Cariology, Restorative Sciences, and Endodontics, University of Michigan, School of Dentistry, Ann Arbor, Michigan. 4. Biostatistics Program, Louisiana State University Health Sciences Center, School of Public Health, New Orleans, Louisiana.
Abstract
OBJECTIVE: An ideal local anesthetic would be effective, minimally reduce pulpal blood flow (PBF), and not require injection. This study compared the effects of 3% tetracaine plus 0.05% oxymetazoline nasal spray (Kovanaze; KNS) and injections using 2% lidocaine with 1:100,000 epinephrine (LE) or 3% mepivacaine plain (MP) on PBF, anesthetic efficacy, and participant preference. METHODS: In a double-blind cross-over design, 20 subjects randomly received a test anesthetic and placebo at each of 3 visits (KNS/mock infiltration; mock nasal spray/LE; or mock nasal spray/MP). Nasal sprays and infiltration apical to a maxillary central incisor were delivered ipsilaterally. PBF was evaluated by laser Doppler flowmetry, and local anesthetic success was assessed with electric pulp testing. Postoperative pain levels, participant preference, and adverse events were also assessed. RESULTS: LE injections demonstrated significant reductions in PBF at all time intervals compared with baseline (P < .05), whereas KNS and MP did not. Pulpal anesthesia success rates were higher for LE (85%) compared with MP (35%) and KNS (5%). Participants reported significantly higher postoperative pain levels for KNS compared with LE and MP. Additionally, KNS was the least preferred of the anesthetics administered and resulted in more reported adverse events. CONCLUSION: Although KNS showed no significant effect on PBF, it was not effective in achieving pulpal anesthesia as used in this study.
OBJECTIVE: An ideal local anesthetic would be effective, minimally reduce pulpal blood flow (PBF), and not require injection. This study compared the effects of 3% tetracaine plus 0.05% oxymetazoline nasal spray (Kovanaze; KNS) and injections using 2% lidocaine with 1:100,000 epinephrine (LE) or 3% mepivacaine plain (MP) on PBF, anesthetic efficacy, and participant preference. METHODS: In a double-blind cross-over design, 20 subjects randomly received a test anesthetic and placebo at each of 3 visits (KNS/mock infiltration; mock nasal spray/LE; or mock nasal spray/MP). Nasal sprays and infiltration apical to a maxillary central incisor were delivered ipsilaterally. PBF was evaluated by laser Doppler flowmetry, and local anesthetic success was assessed with electric pulp testing. Postoperative pain levels, participant preference, and adverse events were also assessed. RESULTS: LE injections demonstrated significant reductions in PBF at all time intervals compared with baseline (P < .05), whereas KNS and MP did not. Pulpal anesthesia success rates were higher for LE (85%) compared with MP (35%) and KNS (5%). Participants reported significantly higher postoperative pain levels for KNS compared with LE and MP. Additionally, KNS was the least preferred of the anesthetics administered and resulted in more reported adverse events. CONCLUSION: Although KNS showed no significant effect on PBF, it was not effective in achieving pulpal anesthesia as used in this study.
Entities:
Keywords:
Kovanaze; Laser Doppler; Local anesthesia; Pulpal blood flow
Authors: Sebastian G Ciancio; Adam D Marberger; Fadi Ayoub; Davis A Garlapo; Eugene A Pantera; Carole T Pantera; Sultan Al-Mubarak; Benita D Sobieraj; David Y He; Srinivas R Myneni Journal: J Am Dent Assoc Date: 2016-02-15 Impact factor: 3.634
Authors: Elliot V Hersh; Andres Pinto; Mana Saraghi; Najeed Saleh; Lisbeth Pulaski; Sharon M Gordon; Douglas Barnes; Gary Kaplowitz; Ira Bloom; Mohammad Sabti; Paul A Moore; Sean Lee; Michael Meharry; David Y He; Yiming Li Journal: J Am Dent Assoc Date: 2016-01-25 Impact factor: 3.634