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- EBOOK [P.D.F] Monheim's Local Anesthesia and Pain Control in Dental Practice Full PDF Online
- EBOOK [P.D.F] Monheim's Local Anesthesia and Pain Control in Dental Practice Full PDF Online
- Techniques for effective local anaesthetic administration for the paediatric patient
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Local Anesthetic and Pain Control
Caruaru, PE, Brazil. So, our study aimed at identifying factors established by the scientific literature as determinants of this painful experience. CONTENTS: Pain during dental treatment is more associated to invasive procedures, tooth extractions and surgeries, but it may also be associated to noninvasive procedures.
Local anesthesia is referred to as a painful procedure generating anxiety. Although some patient-related factors may influence pain perception, few studies have analyzed such factors, with the exception to anxiety. There are controversies with regard to the role of patient's sociodemographic variables. With regard to children, studies have shown that dentists do not believe in pain referred by children and tend not to use available methods to control pain.
There are evidences that dentists' attitudes are determinants for pain. In Dentistry, pain may be associated to oral cavity diseases or to dental procedures. With regard to procedures, if pain is adequately controlled by local anesthesia, the procedure will mildly interfere with painful sensitivity 1. Psychological aspects may also influence the vision they have about dental treatment, so that patients' level of anxiety, state of attention and emotions may lead them to overestimate the pain they felt 3.
Several factors may influence pain awareness, being this a complex process. Details about the participation of each factor are spread throughout the literature so the scientific evidence of their participation is not very clear. This study aimed at carrying out a broad and thorough review of studies about pain awareness during dental treatment to identify factors established by the literature as determining such painful experience.
We have selected 36 articles pointing to some clinical or not clinical factor associated to pain during dental treatment. Four were not mentioned in the review because they did not add information beyond those already available. A significant number of adults report pain when visiting the dentist 4. A population study has shown that The risk of feeling pain during endodontic treatment is higher for irreversible pulpitis or acute apical periodontitis as compared to chronic lesions, as well as for posterior teeth treatment with longer sessions 9.
To minimize or prevent pain during dental procedures, local or regional anesthesia is induced. However, fear of anesthesia and pain are factors encouraging patients to avoid the dentist Blocking the inferior alveolar nerve IAN in preschool children is the most stressing method to control pain for some dentists A study has shown that IAN block is the most painful anesthetic technique, followed by periodontal ligament injection. Chin blockade and local infiltrative anesthesia were similar In addition to local anesthesia pain, there is also the possibility of anesthetic failure not controlling pain Pain is not exclusively dependent on the degree of organic injury.
It is believed that cognitive, behavioral, sociocultural, genetic and demographic aspects, oral health status and previous experiences may influence pain awareness 7, A study has shown that a higher number of male patients feel pain during dental treatment as compared to females 6.
However, a different study has not shown significant differences between genders, although females had a higher incidence of pain 9. It seems that the higher is the level of education of patients, the higher is pain intensity report, but marital status is not associated to pain awareness 6.
With regard to age, a study has found that young and adult patients feel more pain that older adults 6 , and another has shown that the probability of feeling pain was lower for individuals above 35 years of age, as compared to those with 35 years of age or less 9.
However, a third study has not shown differences between individuals aged from 15 to 19 years and those above 20 years of age 2. The stimulation level needed to perceive pain differs among individuals being this awareness also linked to their psychological status during the procedure.
Distraction may also decrease pain awareness, as well as positive emotions; negative emotions, on the other hand, may increase pain awareness 3. Among psychological aspects, anxiety has been widely studied 1,4,5,7, Dental treatment anxiety or fear are inferred as dental anxiety, varying in intensity from one patient to the other, or even for the same patient as a function of the type of procedure 14, Dental treatment anxiety is related to its multifactorial etiology, especially influenced by internal individual aspects, the environment where one lives and also the dental treatment itself Previous negative dental experiences seem to determine anxiety 4,5.
A critical aspect is the fact that anxiety may directly interfere with perceived or referred pain with regard to dental treatment 6, Patients submitted to tooth extraction and endodontic treatment with high or low dental anxiety levels were compared as to their pain expectations and awareness with regard to the treatment.
Results have shown that patients with high dental anxiety scores reported more pain, both expected and perceived Similar results were found with regard to dentistry restoration procedures 23 and also among patients coming for emergency tooth extraction In a study evaluating local anesthesia, highly anxious patients have reported higher intensity and longer duration of pain when receiving anesthetic injection, as compared to less anxious patients When dentistry students were asked to read a tooth extraction case scenario imagining themselves as patients, and to refer the anxiety they would have in different moments of the situation, it was shown that referred pain was more severe when anxiety was high in the therapeutic environment, regardless of the anxious personality of the individual Relationship of dental anxiety to some dental procedures and patients' sociodemographic characteristics.
Other situations also mentioned by the literature as inducing anxiety are endodontic treatment, caries 21 and periodontal scaling As to sociodemographic aspects, studies have shown that females are more anxious than males during dental treatment 7,17, However, other studies have not found difference between genders in the level of anxiety 20, There are studies showing that individuals older than 24 years of age have higher levels of anxiety However, other studies could not establish relationship between age and anxiety 17, Patients' level of education and family income could not be associated to anxiety There are many procedures promising to prevent dental treatment pain, such as nitrous oxide, anxiolytic and preanesthetic drugs, in addition to new and different local anesthetic techniques 28, On the other hand, it seems that health professionals do not systematically ask about the presence of pain; they believe that patients will take the initiative of telling them; they do not want to waste time and attribute pain complaint to emotional aspects without reviewing, most of the times, the analgesic regimen being used In a study with Swiss generalist dentists, almost half of them reported that children have difficulties in separating pain and discomfort American and Finish dentists did not ask children about pain; encourage them beforehand to report their more frequent pain; these same dentists do not consider dental procedures as being particularly painful or uncomfortable Studies with children have shown a poor relation between dentists' procedures to control pain and their awareness of pain felt by patients Some aspects, directly or indirectly linked to dentists due to their working condition, seem to influence their attitude toward children.
Demographic factors, such as gender, structural factors such as always working alone and daily seeing children between 3 and 5 years of age, and behavioral factors due to stress during anesthetic block in preschool children and the acceptance of dentists of performing potentially painful procedures without anesthesia, were associated to dentists' procedures to control dental pain Dentists working in private offices used local anesthetics more frequently than those working in clinics 10 , and American dentists used it more than Finish dentists during restorative treatments Pain has been perceived by a significant number of individuals during dental treatment and, most of the times, pain is not mild 2, Pain is not only a consequence of invasive procedures, although being more associated to such procedures 6,8 and anesthesia itself seems to be among most painful procedures 1, However, literature data are not enough to exactly establish which are the most painful invasive procedures and to what extent anesthesia contributes to pain associated to such procedures.
The positive relationship between anxiety and dental treatment pain shown by several studies 6, , added to the fact that procedures reported by the literature as major generators of anxiety are anesthetic injections and minor oral surgeries such as tooth extraction 3,18 , reinforces the possibility of anesthesia being among the most painful procedures, as well as allows to suppose that minor oral surgeries, such as tooth extraction, are among the most painful invasive procedures.
Associating anesthesia, which is in theory the procedure to prevent pain, to pain during dental treatment is something deserving concern. Studies have been carried out to improve this procedure and to minimize pain, such as low-pressure injection 33 or the use of computerized anesthesia which decreases pain during injection However, a lot is still to be done, especially to benefit a larger number of people with the new techniques.
Some authors state that several patient-related factors, in addition to procedure itself, may influence pain awareness, but few studies have directly analyzed such factors 6 , with the exception of anxiety, which has been reasonably studied so that there are enough scientific evidences to indicate it as determining pain awareness during dental treatment 6,18, Still with regard to patient-related factors, specifically sociodemographic factors, it does not seem valid, at the light of current literature, to point them as determining dental patients' pain, considering the scarcity of studies analyzing this aspect added to the negative association found among some of those factors and patients' pain and the disagreement among the few studies, at least in some aspect 2,6.
Patients' sociodemographic factors also do not seem to determine dental anxiety, since most studies have not found relationship between anxiety and studied variables, such as age 26,30 , income and level of education 17,20, While some studies have found significant association between gender and level of dental anxiety, being females more anxious than males 10,20,27 , others have not found this association 23, Based on the association between anxiety and pain, the non association of sociodemographic factors and anxiety reinforces the hypothesis that such factors might not be determinants of dental treatment pain.
Dentists' ability and care to control patients' pain and anxiety with regard to treatment will directly impact patients' pain awareness during future visits. This because past dental painful experience is not only source of dental anxiety 8 , but also impacts current treatment pain, so that the major predictor of pain intensity perceived by patients during local anesthesia may be the pain they felt in previous anesthesias Also considering that the earlier people have painful experiences during treatment, the more fearful they become with regard to dental treatment as compared to those who had late pain experiences 35 , it is possible to imagine the responsibility of professionals treating children and of those working with basic attention.
However, in spite of several techniques available to dentists indicating what they could have done to prevent dental treatment pain, there is little in the literature about what they are actually doing in their daily practice and which factors may be interfering with their modus operandi to cause this high incidence of pain during dental treatment.
With regard to pediatric patients, literature states that dentists are indifferent to children's pain history or profile, deny pain referred by children and do not believe that their information is valid, so they tend not to use available methods to control pain 10,12,31, Dentists are not alike and it is well defined in the literature that treatment decisions vary according to demographics, professional qualification and working structure 36, But in spite of gender 14 , working structure 13,14 and country 34,35 being associated to their attitudes and their procedures to control dental pain, these studies are scarce and just related to pediatric treatment.
So, there is the need for studies directly evaluating which and how dentist-related factors interfere with pain felt by patients, moreover because the literature favors the hypothesis that dentist-related factors are determinants of pain.
Dental anxiety is the best defined variable to determine pain awareness during treatment and painful sensation is related to local anesthetic procedures. There are evidences that patient-related sociodemographic factors do not determine pain, but that dentists' attitudes are an important factor for the presence of pain.
Vassend O. Anxiety, pain and discomfort associated with dental treatment. Behav Res Ther. Effects of psychological state on pain perception in the dental environment. J Can Dent Assoc. Liddell A, Locker D. Changes in levels of dental anxiety as a function of dental experience. Behav Modif. Negative dental experiences and their relationship to dental anxiety.
Community Dent Health. Maggirias J, Locker D. Psychological factors and perceptions of pain associated with dental treatment. Community Dent Oral Epidemiol. What hurts during dental hygiene treatment. J Dent Hygiene. Pain associated with root canal treatment. Int Endodontic J. Pain management in school-aged children by private and public clinic practice.
EBOOK [P.D.F] Monheim's Local Anesthesia and Pain Control in Dental Practice Full PDF Online
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Caruaru, PE, Brazil. So, our study aimed at identifying factors established by the scientific literature as determinants of this painful experience. CONTENTS: Pain during dental treatment is more associated to invasive procedures, tooth extractions and surgeries, but it may also be associated to noninvasive procedures. Local anesthesia is referred to as a painful procedure generating anxiety. Although some patient-related factors may influence pain perception, few studies have analyzed such factors, with the exception to anxiety. There are controversies with regard to the role of patient's sociodemographic variables. With regard to children, studies have shown that dentists do not believe in pain referred by children and tend not to use available methods to control pain.
EBOOK [P.D.F] Monheim's Local Anesthesia and Pain Control in Dental Practice Full PDF Online
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Techniques for effective local anaesthetic administration for the paediatric patient
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The following curriculum was developed by the Department of Oral and Maxillofacial Surgery at Rutgers School of Dental Medicine to meet all the didactic and clinical requirements as set forth by the New Jersey State Board of Dentistry. Twenty hours of didactic and twelve hours of clinical training necessary for certification of a licensed Dental Hygienist in local anesthesia. The didactic portion of this course will be in a format with problem-based learning sessions. During the clinical portion, participants will practice all injections on a manikin and then perform the required local anesthesia on patients in the Oral and Maxillofacial Surgery clinic. Prevent and manage Local Anesthesia and systemic complications. Malamed Published by Elsevier Mosby. ISBN:
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Certification Training for Dental Hygienists
Comparison of the pain levels of computer-controlled and conventional anesthesia techniques in prosthodontic treatment. OBJECTIVE: The objective of this study was to compare the pain levels on opposite sides of the maxilla at needle insertion during delivery of local anesthetic solution and tooth preparation for both conventional and anterior middle superior alveolar AMSA technique with the Wand computer-controlled local anesthesia application. However, these two techniques have the same pain levels for tooth preparation. Key words: Maxillary local anesthesia. Local anesthesia and pain control is one of the most important elements of dentistry, and particularly prosthetic dentistry. According to the American Dental Association, fear of pain is the most important factor preventing patients from visiting their dentists. Different kinds of fear related to previous clinical experience affect patients' attitudes to local anesthesia or dentist
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