Restorative Dentistry & Endodontics

Research Articles

Effects of different topical anesthetics on pain from needle insertion and injection, and the influence of anxiety in patients awaiting endodontic treatment: Fatih Aksoy, Samet Tosun; Restor Dent Endod 2022;47(3):e25. Published online June 7, 2022; DOI: https://doi.org/10.5395/rde.2022.47.e25

Objectives

This study aimed to evaluate the effects of 5% lidocaine and 2.5% lidocaine/2.5% prilocaine topical anesthetic on pain during needle insertion and infiltration injection in the labial mucosa of anterior maxillary teeth, and to assess the relationship between patients’ anxiety and pain scores.

Materials and Methods

The Modified Dental Anxiety Scale questionnaire was applied and recorded. Patients were randomly divided into 4 groups (n = 30), as follows: G1 group: 5% lidocaine and placebo for 1 minute, G2 group: 2.5% lidocaine/2.5% prilocaine and placebo for 1 minute, G3 group: 5% lidocaine and placebo for 3 minutes, and G4 group: 2.5% lidocaine/2.5% prilocaine and placebo for 3 minutes. Before the application of topical anesthesia, one side was randomly selected as the topical anesthesia and the contralateral side as the placebo. The pain levels were measured with Visual Analog Scale (VAS) immediately after needle insertion and injection and were compared. The correlation between anxiety and pain scores was analyzed.

Results

Administration of 5% lidocaine for 1 minute had significantly higher pain scores for both insertion and infiltration injection than the other groups (p < 0.05). There was a significant moderate positive correlation between dental anxiety and the injection-induced VAS pain score in the placebo side in all groups (p < 0.05).

Conclusions

Topical anesthetics significantly reduced the pain caused by both needle insertion and injection pain in comparison to the placebo side. The pain scores of patients with dental anxiety were lower on the topical anesthesia compared to the placebo side.

Trial Registration

Thai Clinical Trials Registry Identifier: TCTR20201217002

Citations

Citations to this article as recorded by

The Case for Transdermal Lidocaine 7.5% in the Management of Localized Pain: A Biopharmaceutical Review
Alexandra LaStella
Scriptum Pharmacologia .2025;[Epub] CrossRef
A Framework for the Modulation and Alleviation of Pain Sensations: A Narrative Review
Rushita Dobariya, Niraj Kinariwala, Nirav Parekh, Dhruvi Gangani, Devshree Dave, Hasti Maru, Nandani Mangukiya, Siddhi Singh
Cureus.2025;[Epub] CrossRef
Phacoemulsification Techniques and Their Effects on Corneal Endothelial Cells and Visual Acuity: A Review of "Direct-Chop" and "Stop-and-Chop" Approaches Under Topical Anesthesia
Devwrath Upasani, Sachin Daigavane
Cureus.2024;[Epub] CrossRef
Local anaesthetics in pediatric dental practice (literature review)
E. V. Ekimov, G. I. Skripkina, A. Zh. Garifullina, N. V. Chumichkin
Pediatric dentistry and dental prophylaxis.2023; 23(3): 211. CrossRef

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Efficacy of buccal piroxicam infiltration and inferior alveolar nerve block in patients with irreversible pulpitis: a prospective, double-blind, randomized clinical trial: Saurav Paul, Sridevi Nandamuri, Aakrati Raina, Mukta Bansal; Restor Dent Endod 2021;46(1):e9. Published online January 26, 2021; DOI: https://doi.org/10.5395/rde.2021.46.e9

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Objectives

This randomized clinical trial aimed to assess the effectiveness of buccal infiltration with piroxicam on the anesthetic efficacy of inferior alveolar nerve block (IANB) with buccal infiltration in irreversible pulpitis, with pain assessed using the Heft-Parker visual analogue scale (HP-VAS).

Materials and Methods

This study included 56 patients with irreversible pulpitis in mandibular molars, randomly distributed between 2 groups (n = 28). After evaluating the initial pain score with the HP-VAS, each patient received IANB followed by buccal infiltration of 2% lignocaine with adrenaline (1:80,000). Five minutes later, the patients in groups 1 and 2 were given buccal infiltration with 40 mg/2 mL of piroxicam or normal saline, respectively. An access opening procedure (AOP) was performed 15 minutes post-IANB once the individual showed signs of lip numbness as well as 2 negative responses to electric pulp testing. The HP-VAS was used to grade the patient's pain during caries removal (CR), AOP, and working length measurement (WLM). Successful anesthesia was identified either by the absence of pain or slight pain through CR, AOP, and WLM, with no requirement of a further anesthetic dose. A statistical analysis was done using the Shapiro-Wilk and Mann-Whitney U tests.

Results

The piroxicam group presented a significantly lower (p < 0.05) mean pain score than the saline group during AOP.

Conclusions

Buccal infiltration with piroxicam enhanced the efficacy of anesthesia with IANB and buccal infiltration with lignocaine in patients with irreversible pulpitis.

Citations

Citations to this article as recorded by

Inferior alveolar nerve block success of 2% mepivacaine versus 4% articaine in patients with symptomatic irreversible pulpitis in mandibular molars: A randomized double‐blind single‐centre clinical trial
Mohammed Fawzy Omar Mohammed Habib, Sovana Tarek, Sara Mohamed Elsayed Teama, Khaled Ezzat, Randa Mohamed El Boghdadi, Abeer Marzouk, Manar Yehia Fouda, Shaimaa Ismail Gawdat, Marwa Mahmoud Bedier, Suzan Abdul Wanees Amin
International Endodontic Journal.2022; 55(11): 1177. CrossRef
Present status and future directions—Mechanisms and management of local anaesthetic failures
Masoud Parirokh, Paul V. Abbott
International Endodontic Journal.2022; 55(S4): 951. CrossRef

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Effect of vibratory stimulation on pain during local anesthesia injections: a clinical trial: Sajedeh Ghorbanzadeh, Hoda Alimadadi, Nazanin Zargar, Omid Dianat; Restor Dent Endod 2019;44(4):e40. Published online October 24, 2019; DOI: https://doi.org/10.5395/rde.2019.44.e40

Abstract PDF PubReader ePub

Objectives

This study aimed to assess the effect of DentalVibe on the level of pain experienced during anesthetic injections using 2 different techniques.

Materials and Methods

This randomized crossover clinical trial evaluated 60 patients who required 2-session endodontic treatment. Labial infiltration (LI) anesthesia was administered in the anterior maxilla of 30 patients, while inferior alveolar nerve block (IANB) was performed in the remaining 30 patients. 1.8 mL of 2% lidocaine was injected at a rate of 1 mL/min using a 27-gauge needle. DentalVibe was randomly assigned to either the first or second injection session. A visual analog scale was used to determine participants' pain level during needle insertion and the anesthetic injection. The paired t-test was applied to assess the efficacy of DentalVibe for pain reduction.

Results

In LI anesthesia, the pain level was 12.0 ± 15.5 and 38.1 ± 21.0 during needle insertion and 19.1 ± 16.1 and 48.9 ± 24.6 during the anesthetic injection using DentalVibe and the conventional method, respectively. In IANB, the pain level was 14.1 ± 15.9 and 35.1 ± 20.8 during needle insertion and 17.3 ± 14.2 and 39.5 ± 20.8 during the anesthetic injection using DentalVibe and the conventional method, respectively. DentalVibe significantly decreased the level of pain experienced during needle insertion and the anesthetic injection in anterior LI and mandibular IANB anesthesia.

Conclusions

The results suggest that DentalVibe can be used to reduce the level of pain experienced by adult patients during needle insertion and anesthetic injection.

Citations

Citations to this article as recorded by

Effectiveness of cold vibratory stimuli on pain perception governing infiltration anesthesia in the maxillary arch in children: a randomized controlled clinical trial
Hoda Mohamed Hambouta, Dina Aly Sharaf, Nadia Aziz Wahba
BMC Oral Health.2025;[Epub] CrossRef
Effect of Vibration on Acute and Chronic Back Pain After Spinal Anesthesia: A Randomized Clinical Trial
Shervin Shahinpour, Fatemeh Refahi, Nader Ali Nazemian
Anesthesiology and Pain Medicine.2024;[Epub] CrossRef
Vibrating toothbrush, ice, or topical anesthetic agent to reduce pain of local anesthetic injection in 5- to 12-year-old children undergoing dental procedures — a randomized controlled trial
Meenu Mittal, Ashok Kumar, Radhika Chopra, Gurvinder Kaur, Sarang Sharma
Ain-Shams Journal of Anesthesiology.2023;[Epub] CrossRef
A Clinical Comparison of Pain Perception and Behavior in Children Using Conventional and Vibraject Injection Techniques
KS Mukunda, Calvin Hilary, C Preeja, G Midhun Mohan
World Journal of Dentistry.2022; 13(6): 623. CrossRef
Topical Anesthesia in Pediatric Dentistry: An Update

International Journal of Clinical Pediatric Dentistry.2022; 15(2): 240. CrossRef
Effect of Photobiomodulation Therapy with 915 nm Diode Laser on Pain Perception during Local Anesthesia of Maxillary Incisors: A Randomized Controlled Trial
Hamid Kermanshah, Nasim Chiniforush, Mahsa Kolahdouz Mohammadi, Fariba Motevasselian
Photochemistry and Photobiology.2022; 98(6): 1471. CrossRef
Comparative evaluation of pain perception during conventional greater palatine injections versus the use of a novel barovibrotactile device - In vivo study
Aishwarya Avinash Gangawane, Sonal Bhavesh Shah, Tanvi Eknath Malankar, Anmol Mathur, Shriya Shrirang Ginde, Manne Lakshmi Priyanka
Journal of Oral Biology and Craniofacial Research.2022; 12(5): 542. CrossRef
Efficacy of Higher Gauged Needles or Topical Pre-Cooling for Pain Reduction during Local Anesthesia Injection: A Split-Mouth Randomized Trial
Srikanth Gadicherla, Mihika Mahandwan, Shane Quek Yi Xuan, Kalyana-Chakravarthy Pentapati
Pesquisa Brasileira em Odontopediatria e Clínica Integrada.2021;[Epub] CrossRef
Auto-controlled Syringe vs Insulin Syringe for Palatal Injections in Children: A Randomized Crossover Trial
Sunny P Tirupathi, Srinitya Rajasekhar, Pushpalatha Tummakomma, Aishwarya Arya Gangili, Abdul Rehman Ahmed Khan, Mohammed Khurramuddin, Usha Purumandla
The Journal of Contemporary Dental Practice.2020; 21(6): 604. CrossRef

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The success rate of bupivacaine and lidocaine as anesthetic agents in inferior alveolar nerve block in teeth with irreversible pulpitis without spontaneous pain: Masoud Parirokh, Mohammad Hosein Yosefi, Nouzar Nakhaee, Paul V. Abbott, Hamed Manochehrifar; Restor Dent Endod 2015;40(2):155-160. Published online March 16, 2015; DOI: https://doi.org/10.5395/rde.2015.40.2.155

Abstract PDF PubReader ePub

Objectives

Achieving adequate anesthesia with inferior alveolar nerve blocks (IANB) is of great importance during dental procedures. The aim of the present study was to assess the success rate of two anesthetic agents (bupivacaine and lidocaine) for IANB when treating teeth with irreversible pulpitis.

Materials and Methods

Sixty volunteer male and female patients who required root canal treatment of a mandibular molar due to caries participated in the present study. The inclusion criteria included prolonged pain to thermal stimulus but no spontaneous pain. The patients were randomly allocated to receive either 2% lidocaine with 1:80,000 epinephrine or 0.5% bupivacaine with 1:200,000 epinephrine as an IANB injection. The sensitivity of the teeth to a cold test as well as the amount of pain during access cavity preparation and root canal instrumentation were recorded. Results were statistically analyzed with the Chi-Square and Fischer's exact tests.

Results

At the final step, fifty-nine patients were included in the study. The success rate for bupivacaine and lidocaine groups were 20.0% and 24.1%, respectively. There was no significant difference between the two groups at any stage of the treatment procedure.

Conclusions

There was no difference in success rates of anesthesia when bupivacaine and lidocaine were used for IANB injections to treat mandibular molar teeth with irreversible pulpitis. Neither agent was able to completely anesthetize the teeth effectively. Therefore, practitioners should be prepared to administer supplemental anesthesia to overcome pain during root canal treatment.

Citations

Citations to this article as recorded by

A Morphometric Study of the Mandibular Foramen, Lingula, and the Incidence of Accessory Mandibular Foramina in Dry Mandibles
Yashaswi Singh, Pratibha Shakya, Noor Us Saba, Heena Singh, Navneet Kumar
Cureus.2025;[Epub] CrossRef
Effect of topical application of amitriptyline and nortriptyline on irreversible pulpitis pain in teeth with failed pulpal anesthesia after a successful inferior alveolar nerve block: A randomized clinical trial
Armita Vali Sichani, Hossein Baharian, Navid Yaraghi, Zahra Khosravani, Asana Vali Sichani
Dental Research Journal.2024;[Epub] CrossRef
The Effect of the Anatomic Variables on the Success Rate of Anesthesia in Maxillary Molars with Irreversible Pulpitis
Masoud Parirokh, Sina Kakooei, Nouzar Nakhaee, Hamed Manochehrifar, Paul Abbott
Journal of Endodontics.2022; 48(6): 707. CrossRef
Present status and future directions—Mechanisms and management of local anaesthetic failures
Masoud Parirokh, Paul V. Abbott
International Endodontic Journal.2022; 55(S4): 951. CrossRef
Local anesthesia in oral and maxillofacial surgery: A review of current opinion
Yu-Hao Wang, Dian-Ri Wang, Ji-Yuan Liu, Jian Pan
Journal of Dental Sciences.2021; 16(4): 1055. CrossRef
ANATOMICAL STUDY OF MANDIBULAR FORAMEN IN DRY ADULT HUMAN MANDIBLES IN BIHAR STATE REGION
Vijay Kumar Singh, Md. Zahid Hussain, Subodh Kumar
GLOBAL JOURNAL FOR RESEARCH ANALYSIS.2021; : 34. CrossRef
Efficacy of buccal piroxicam infiltration and inferior alveolar nerve block in patients with irreversible pulpitis: a prospective, double-blind, randomized clinical trial
Saurav Paul, Sridevi Nandamuri, Aakrati Raina, Mukta Bansal
Restorative Dentistry & Endodontics.2021;[Epub] CrossRef
Different anesthetics on the efficacy of inferior alveolar nerve block in patients with irreversible pulpitis
Juliana Larocca de Geus, Jane Kenya Nogueira da Costa, Letícia Maíra Wambier, Bianca Medeiros Maran, Alessandro Dourado Loguercio, Alessandra Reis
The Journal of the American Dental Association.2020; 151(2): 87. CrossRef
Efficacy of local anaesthetic solutions on the success of inferior alveolar nerve block in patients with irreversible pulpitis: a systematic review and network meta‐analysis of randomized clinical trials
V. Nagendrababu, S. J. Pulikkotil, A. Suresh, S. K. Veettil, S. Bhatia, F. C. Setzer
International Endodontic Journal.2019; 52(6): 779. CrossRef
The Effect of Sphenopalatine Block on the Postoperative Pain of Endoscopic Sinus Surgery: A Meta‐analysis
Do Hyun Kim, Haram Kang, Se Hwan Hwang
Otolaryngology–Head and Neck Surgery.2019; 160(2): 223. CrossRef
Effect of four local anesthetics (tetracaine, proparacaine, lidocaine, and bupivacaine) on intraocular pressure in dogs
Ali Asghar Sarchahi, Mehdi Eskandari
International Ophthalmology.2019; 39(7): 1467. CrossRef
Strategies for managing pain during endodontic treatment
Paul V. Abbott, Masoud Parirokh
Australian Endodontic Journal.2018; 44(2): 99. CrossRef
Is mepivacaine as effective as lidocaine during inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis? A systematic review and meta‐analysis
W. A. Vieira, L. R. Paranhos, G. O. Cericato, A. Franco, M. A. G. Ribeiro
International Endodontic Journal.2018; 51(10): 1104. CrossRef
Injectable local anaesthetic agents for dental anaesthesia
Geoffrey St George, Alyn Morgan, John Meechan, David R Moles, Ian Needleman, Yuan-Ling Ng, Aviva Petrie
Cochrane Database of Systematic Reviews.2018;[Epub] CrossRef
Successful pulpal anesthesia for symptomatic irreversible pulpitis
Melissa Drum, Al Reader, John Nusstein, Sara Fowler
The Journal of the American Dental Association.2017; 148(4): 267. CrossRef
The Effect of Photobiomodulation on the Depth of Anesthesia During Endodontic Treatment of Teeth With Symptomatic Irreversible Pulpitis (Double Blind Randomized Clinical Trial)
Sholeh Ghabraei, Nasim Chiniforush, Behnam Bolhari, Mohsen Aminsobhani, Abbas Khosarvi
Journal of Lasers in Medical Sciences.2017; 9(1): 11. CrossRef
Morphometric study on mandibular foramen and incidence of accessory mandibular foramen in mandibles of south Indian population and its clinical implications in inferior alveolar nerve block
R. Shalini, C. RaviVarman, R. Manoranjitham, M. Veeramuthu
Anatomy & Cell Biology.2016; 49(4): 241. CrossRef
The Effect of Maxillary First Molar Root Length on the Success Rate of Buccal Infiltration Anesthesia
Ehsan Moradi Askari, Masoud Parirokh, Nouzar Nakhaee, Hamid Reza Hosseini, Paul V. Abbott
Journal of Endodontics.2016; 42(10): 1462. CrossRef
Efficacy of Ketorolac Buccal Infiltrations and Inferior Alveolar Nerve Blocks in Patients with Irreversible Pulpitis: A Prospective, Double-blind, Randomized Clinical Trial
Nahid Mohammadzadeh Akhlaghi, Behnoush Hormozi, Paul V. Abbott, Zohreh Khalilak
Journal of Endodontics.2016; 42(5): 691. CrossRef

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