📘 ❞ oral Surgery and Local Anesthesia ❝ كتاب

عن كتاب oral Surgery and Local Anesthesia:
oral Surgery and Local Anesthesia

Local anesthetic efficacy for oral surgery: Comparison of diphenhydramine and prilocaine.
Uckan S1, Guler N, Sumer M, Ungor M.
Author information
Abstract
OBJECTIVE:
Diphenhydramine has been suggested as an alternative local anesthetic agent for patients claiming allergy to local anesthetics. The present study attempted to determine the local anesthetic efficacy of diphenhydramine for oral surgery.

STUDY DESIGN:
Seventeen patients claiming allergy to local anesthetics were given diphenhydramine as anesthetic alternative and compared with seven nonallergic control patients treated with prilocaine. After determining an average value of vitality score of neighboring and contralateral teeth by electrical pulp stimulation, molar and premolar teeth were extracted and postextraction vitality scores determined. Visual analogue scale, anesthesia onset times, and the incidence of pulpal and soft tissue anesthesia were analyzed nonparametrically by means of Mann-Whitney U tests.

RESULTS:
The mean onset time of pulp anesthesia with diphenhydramine (range, 4 to 7.5 minutes), excluding one failure, was not significantly different from that of prilocaine; (range, 4 to 13 minutes). The duration of anesthesia was significantly longer and the visual analogue scale lower in the group receiving prilocaine in comparison with the group receiving diphenhydramine.


Block vs Infiltration
Accurate placement of infiltrations is helped by knowledge of average root lengths and root completion dates
Put the needle on a clean surface and covered with a sterile sheet to hide it from view. The sight of the needle increases patient anxiety, so don't wave it in-front of them.

Check it is safe to do the procedure. It is impossible to be allergic to epinephrine, which is an endogenous vasoconstrictor. Allergy to the LA is uncommon. When allergy does occur, it is most likely due to other components of the LA solution like the preservative methyl paraben. Some dental LA cartridges contain rubber latex. Unstable thyrotoxicosis is a contra-indication for
Most often, needle phobia is the reason that the IANB cannot be performed on an awake patient.

Check what is the maximum does you can administer. This step can usually be ignored until the first injection has not given adequate anesthesia, when you might be thinking about giving more LA. Maximum doses of LA are calculated according to weight and depend on the drug used, and whether a constrictor is present. Hepatic metabolism is another factor. Physiologic decreased efficiency of the hepatic metabolism occurs in the very young and the very old. Pathologic liver damage should also be noted, such as cirrhosis. Generally speaking you would halve the maximum dose calculated by weight in persons with impaired hepatic metabolism.
Describe to patient in non-threatening terms what is going on. Pain has a psychologic component, and research demonstrates people who are told that a procedure will hurt experience more pain. Therefore, describe the procedure as something like this: "I'm going to numb up the bottom teeth, you might feel some coldness at the back of the mouth for a moment." Do not say something like this: "I'm going to stick this huge needle deep into the back of your throat. It's going to hurt like crazy."
Lay the patient flat on an examination bed or dental chair with available bright light. Ideally they would be wearing eye-protection
Ask the patient to close their eyes. This prevents them seeing the needle, and also prevents them from being dazzled by the examination light,
Positioned examination light