The standard of care for nonsurgical periodontal treatment for reducing the dental risk for cardiac disease.

Dent Today. 2007 Nov;26(11):100, 102, 104

Authors: Gottehrer NR, Martin JL

PMID: 18044123 [PubMed - indexed for MEDLINE]

Efficacy of 1% ropivacaine gel for topical anesthesia of human oral mucosa.

Quintessence Int. 2007 Jul-Aug;38(7):601-6

Authors: Franz-Montan M, Silva AL, Cogo K, Bergamaschi C, Volpato MC, Ranali J, de Paula E, Groppo FC

OBJECTIVE: To evaluate the efficacy of 1% ropivacaine for topical anesthesia in dentistry. METHOD AND MATERIALS: Thirty healthy volunteers randomly (blind crossover) received the following treatments: 20 mg of 1% ropivacaine gel (ropivacaine-20), 60 mg of 1% ropivacaine gel (ropivacaine-60), 20 mg of the eutectic mixture of local anesthetics 2.5% lidocaine and 2.5% prilocaine (EMLA cream, AstraZeneca; EMLA-20), 60 mg of EMLA (EMLA-60), 20 mg of 20% benzocaine gel (Benzotop, DFL; benzocaine-20), and 60 mg of 20% benzocaine gel (benzocaine-60), applied on the maxillary buccal fold of the right canine at different sessions. Pain was assessed by visual analog scale (VAS) and 11-point box scale (BS-11) after the insertion of 30-gauge needles. Soft tissue anesthesia was measured by pinprick test. Data were analyzed by Friedman and Pearson correlation tests. RESULTS: All the topical anesthetics evaluated showed similar performance in relation to the pain perceived after needle insertion (P >.05), and there were no significant differences among groups considering VAS or BS-11 (P = .177 and P = .179, respectively). The duration of soft tissue anesthesia was not statistically significantly different for ropivacaine-20, EMLA-20, benzocaine-20, ropivacaine-60, EMLA-60, and benzocaine-60, but EMLA-60 showed significantly longer duration than the other agents (P <.05). CONCLUSION: All topical anesthetics were similar in reducing pain to needle insertion. EMLA-60 promoted longer duration of soft tissue anesthesia.

PMID: 17694218 [PubMed - indexed for MEDLINE]

Comparison of topical anesthetics (EMLA/Oraqix vs. benzocaine) on pain experienced during palatal needle injection.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 May;103(5):e16-20

Authors: Al-Melh MA, Andersson L

OBJECTIVE: The aim of this study was to compare the topical anesthetic effect of 20% benzocaine gel with 2.5% lidocaine/2.5% prilocaine (L/P) cream and gel on the pain experienced during palatal anesthetic infiltration. STUDY DESIGN: Two groups were studied, each containing 20 subjects. Two types of L/P mixtures were tested, an anesthetic cream (EMLA) and a thermosetting gel (Oraqix), and benzocaine was used as control. The topical agents were applied on the palatal mucosa at the canine region. A needle prick was given on each side every 2 minutes during a period of 10 minutes. The subjects recorded their findings using verbal and VAS scales. RESULTS: Pain scores were significantly less (P < .05) with EMLA and Oraqix than with benzocaine. CONCLUSION: Topical application of EMLA and Oraqix before palatal anesthetic infiltration is associated with less pain than with benzocaine gel.

PMID: 17331753 [PubMed - indexed for MEDLINE]

Efficacy of an intrapocket anesthetic for scaling and root planing procedures: a review of three multicenter studies.

Compend Contin Educ Dent. 2005 Feb;26(2 Suppl 1):6-10

Authors: DiMatteo A

In recent years, three multicenter studies have been conducted to evaluate the clinical efficacy of an active 5% dental gel to reduce pain when placed into periodontal pockets before initiating scaling and root planing procedures. In each of the clinical studies, the researchers found statistically significant differences between the pain scores of the active dental gel group and the placebo gel group that favored the active gel for the control of pain during periodontal scaling and root planing procedures. This article reviews each of the three studies and highlights some of the differences among them.

PMID: 17036571 [PubMed - indexed for MEDLINE]

The need for pain control during scaling and root planing.

Compend Contin Educ Dent. 2005 Feb;26(2 Suppl 1):3-5

Authors: Gunsolley JC

Scaling and root planing is a common procedure in clinical practice. Despite the frequency of the procedure, the control of pain associated with scaling and root planing has not been well studied. Recently, studies have pointed out a need for pain control during the procedure in a significant number of subjects-perhaps as many as 30% of patients. This need for pain control is similar to the need for instrumentation during maintenance therapy. The need also is similar whether hand instrumentation or ultrasonic equipment is used. The current most used form of pain control is local anesthesia injections. However, many patients object to the use of "the needle." Therefore, there is a need for a noninjectable form of pain control that is effective.

PMID: 17036570 [PubMed - indexed for MEDLINE]

Efficacy of intraoral topical anesthetics in children.

J Dent. 2006 Jul;34(6):398-404

Authors: Paschos E, Huth KC, Benz C, Reeka-Bardschmidt A, Hickel R

OBJECTIVES: The literature reports mixed results regarding the efficacy of intraoral topical anesthetics. Only a few studies have been performed in children. Some non-placebo controlled studies have been carried out to compare the efficacy in reducing children's injection pain between different topical anesthetics METHODS: In a randomized, double blind, placebo controlled study with split-mouth design 104 children were enrolled to evaluate the efficacy of four topical anesthetics (Gingicain Spray, Gingicaine Topical Anesthetic, Legecain-Solution, EMLA Cr&#xE8;me) when used prior to buccal injections within the conservative treatment of carious upper primary molars. The heart rate change and a Face Pain Scale were used as primary variables. The Visual Analog Scale, the modified Children's Hospital Pain Scale and the Sound-Eyes-Motor Scale were also evaluated. RESULTS: There was no significant difference between the placebo and any corresponding topical anesthetic with regard to the primary variables (HRC and FPS). A significant difference was found in favour of Gingicain Spray and Gingicaine Topical Anesthetic according to secondary variables (VAS, S(E)MS). CONCLUSION: While the secondary variables point to a benefit of the topical anesthetics Gingicain Spray and Gingicaine Topical Anesthetic compared to placebo, the results of the primary variables showed no differences in effectiveness of topical anesthetics and their corresponding placebos.

PMID: 16239059 [PubMed - indexed for MEDLINE]

Evaluating the efficacy of EMLA topical anesthetic in sealant placement with rubber dam.

Pediatr Dent. 2004 Nov-Dec;26(6):497-500

Authors: Lim S, Julliard K

PURPOSE: The purpose of this study was to investigate the efficacy of EMLA (eutectic mixture of local anesthetics, 2.5% lidocaine and 2.5% prilocaine) cream in reducing discomfort from pressure applied by rubber dam clamp. METHODS: A consecutive sample of 31 patients, ages 6 to 12 years who presented for sealants from September 2002 through March 2003, participated in this within-subjects controlled clinical study. The facial pain scale (FPS) measured discomfort of dental dam placement on first permanent molars on opposite sides of the mouth after EMLA and placebo application for 5 minutes on the gingiva surrounding each tooth. RESULTS: 18 subjects (58%) were female, and 13 (42%) were male. Twenty (65%) of the teeth studied were permanent maxillary first molars, and 11 (35%) were permanent mandibular first molars. Fourteen (44%) patients were 9 years old or younger, and 17 (56%) patients were over 9 years old. The mean FPS score for EMLA teeth of 0.47+/-0.27 was significantly lower than that for non-EMLA teeth of 0.64+/-0.24 (P<.001). EMLA vs non-EMLA FPS scores by age, gender, and arch were not significantly different. CONCLUSIONS: The EMLA cream was effective in reducing discomfort caused by the dental dam clamp.

PMID: 15646911 [PubMed - indexed for MEDLINE]

The wand versus traditional injection for mandibular nerve block in children and adolescents: perceived pain and time of onset.

Pediatr Dent. 2004 Nov-Dec;26(6):481-4

Authors: Palm AM, Kirkegaard U, Poulsen S

PURPOSE: The purpose of this study was to compare the perception of pain and time of onset in relation to mandibular alveolar nerve block administered by a computerized anesthesia delivery system (ie, The Wand) and a traditional anesthesia system (ie, the syringe). METHODS: This study was conducted according to a split-mouth design, with both types of injections being given to all patients. Subjects consisted of 33 patients between 7 and 18 years of age requiring local anesthesia for dental restorations in both sides of the mandible. All patients were blindfolded, and the sound from the Wand machine was activated during both types of administration. Topical analgesic was placed in the area of the injection site in all cases. Pain ratings were obtained using a 10-point visual analog scale (VAS). Time of onset was measured, from withdrawal of the needle to numbness of the lower lip was reported. RESULTS: The computerized anesthesia delivery system resulted in significantly lower pain ratings than the traditional syringe. No difference could be found in time of onset between the 2 methods. CONCLUSIONS: Mandibular alveolar block analgesia seems to be less painful when using The Wand than when using a traditional syringe.

PMID: 15646908 [PubMed - indexed for MEDLINE]

Quantification and analysis of pain in nonsurgical scaling and/or root planing.

J Am Dent Assoc. 2004 Dec;135(12):1747-54

Authors: Magnusson I, Jeffcoat MK, Donaldson D, Otterbom IL, Henriksson J

BACKGROUND: Three efficacy studies, comprising a database of 337 subjects, were conducted as part of the clinical evaluation of the noninjectable anesthetic gel Oraqix (AstraZeneca, S&#xF6;dertälje, Sweden). The authors discuss some of the challenges encountered when they interpreted the results of the clinical studies and present the results from an alternative analysis of the anesthetic efficacy. METHODS: The three multicenter studies were double-blind, randomized and placebo-controlled. Clinicians applied gel in the subjects' periodontal pockets before scaling and/or root planing, or SRP. Subjects recorded overall pain on a 100-millimeter visual analog scale, or VAS. In the studies, the evaluation of the anesthetic efficacy was based on absolute treatment difference (active-placebo). Investigators used an alternative post hoc approach to evaluate the effect expressed as a ratio (active:placebo). RESULTS: The studies demonstrated consistent and significant lower pain scores for the anesthetic gel versus the placebo gel, with point estimates of absolute treatment difference being 8, 4 and 10 mm. The alternative analysis verified that the estimated treatment effect in terms of a ratio was close to 50 percent in all three studies. CONCLUSIONS: Treatment effects of the anesthetic gel relative to the placebo gel were described more appropriately by means of ratios instead of absolute differences. In this sample of 337 subjects, it was shown that pain was reduced by 50 percent when the anesthetic gel was used compared with when the placebo gel was used. CLINICAL IMPLICATIONS: The authors found that the anesthetic periodontal gel is effective in reducing pain resulting from SRP.

PMID: 15646610 [PubMed - indexed for MEDLINE]

Plasma levels of lidocaine, o-toluidine, and prilocaine after application of 8.5 g Oraqix in patients with generalized periodontitis: effect on blood methemoglobin and tolerability.

Acta Odontol Scand. 2003 Aug;61(4):230-4

Authors: Herdevall BM, Klinge B, Persson L, Huledal G, Abdel-Rehim M

Oraqix, a novel non-injectable anesthetic gel containing lidocaine and prilocaine and a thermosetting agent has been developed to provide localized anesthesia in periodontal pockets during scaling/root planing (SRP). The aim of this open study was to determine the plasma levels of lidocaine and prilocaine following application of 8.5 g Oraqix (5 cartridges) to 11 patients with generalized periodontitis (> or = 49% of tooth pockets > or = 5 mm and > or = 23% of pockets > or = 6 mm). Oraqix was applied to the pockets during periodontal probing and SRP over a 2.6 3.4 h period. Blood samples were collected up to 10 h after the start of application of Oraqix. Peak plasma levels of lidocaine (0.16-0.55 mg/L) and prilocaine (0.05-0.18 mg/L) occurred 2.0-3.7 h and 2.0-3.3 h, respectively, after the start of application of Oraqix. These levels are well below threshold levels for initial signs of central nervous system (CNS) toxicity. In conclusion, application of 8.5 g Oraqix (212.5 mg of lidocaine base and 212.5 mg of prilocaine base) in periodontal pockets was well tolerated and displayed a wide safety margin with respect to plasma levels normally associated with systemic toxicity.

PMID: 14582591 [PubMed - indexed for MEDLINE]

A placebo-controlled multi-centred evaluation of an anaesthetic gel (Oraqix) for periodontal therapy.

J Clin Periodontol. 2003 Mar;30(3):171-5

Authors: Donaldson D, Gelskey SC, Landry RG, Matthews DC, Sandhu HS

AIMS: Six Canadian dental schools investigated the ability of a thermosetting gel containing 25 mg/g prilocaine and 25 mg/g lidocaine as active agents to produce analgesia in periodontal pockets utilizing a randomized, double-blind, placebo-controlled study. MATERIALS AND METHODS: The study consisted of 130 patients, each of whom received the active or placebo gel in periodontal pockets in one quadrant of the mouth for 30 s prior to periodontal debridement (scaling and root planing). Pain was measured using both a 100-mm Visual Analogue Scale (VAS) and a Verbal Rating Scale (VRS). RESULTS: The median VAS pain score for the patients treated with the anaesthetic gel was 5 mm (range 0-85 mm) as opposed to 13 mm (range 0-79 mm) in the placebo-treated patients (P=0.015). There was no significant difference in the percentage of patients reporting no or mild pain (78% and 76% for the anaesthetic gel and placebo, respectively). No significant differences were seen in patient demographics, or mandible versus maxilla. CONCLUSIONS: The VAS pain scores showed that the anaesthetic gel 5% was statistically more effective than the placebo in reducing pain during periodontal debridement.

PMID: 12631173 [PubMed - indexed for MEDLINE]

Use of EMLA: is it an injection free alternative?

J Clin Pediatr Dent. 2001;25(3):215-9

Authors: Munshi AK, Hegde AM, Latha R

This study was conducted to evaluate the use of Eutectic Mixture of Local Anesthetics (EMLA) for various clinical procedures such as extraction of the mobile primary teeth, root stumps as well as pulpal therapy procedures in the primary teeth. Thirty children in need of routine dental procedures were selected and procedures were done under a single anesthesia of EMLA. Pain perception and the effectiveness of anesthesia were evaluated with the Eland's color scale and Lickert's scale respectively. Results showed that use of EMLA could to some extent eliminate the use of the needle in the procedures performed especially in pediatric dentistry.

PMID: 12049081 [PubMed - indexed for MEDLINE]

The use of EMLA for an intraoral soft-tissue biopsy in a needle phobic: a case report.

Anesth Prog. 2001;48(1):32-4

Authors: Meechan JG

A case is reported of the removal of a leaf fibroma from the mucosa of the hard palate using EMLA topical anesthesia as the sole means of pain control.

PMID: 11495404 [PubMed - indexed for MEDLINE]

A randomised, double-blind, placebo-controlled, comparative study of topical skin analgesics and the anxiety and discomfort associated with venous cannulation.

Br Dent J. 2001 Apr 28;190(8):444-9

Authors: Speirs AF, Taylor KH, Joanes DN, Girdler NM

OBJECTIVES: To compare the effect of topical skin anaesthetic agents on the discomfort and anxiety associated with venous cannulation. DESIGN: Randomised, double-blind, placebo-controlled, within subject, volunteer trial. METHODS: 20 healthy volunteers underwent venous cannulation on three separate occasions having received topical skin application of either 4% amethocaine gel (Ametop), 5% eutectic mixture of lidocaine and prilocaine (EMLA) or E45 cream (placebo). Visual analogue and verbal rating scales were used to assess pain and anxiety associated with the venous cannulation, and anticipated anxiety for future cannulation, under each drug condition. RESULTS: Subjects were aged 22-53 years (mean 32.8 years). The mean visual analogue scores (VAS) for discomfort were found to be significantly lower (p< 0.001) with Ametop (VAS = 18mm) and EMLA (VAS = 29mm) compared with the control (VAS = 38mm). There was a positive correlation (R2 = 72%, p<0.001) between discomfort and the predicted anxiety if cannulation was to be repeated with the same cream. With the placebo a positive correlation (R2 = 19.8%, p = 0.05) was found between the level of anxiety before cannulation and the level of discomfort recorded. CONCLUSIONS: Ametop and EMLA topical anaesthetic agents produce effective skin analgesia for venous cannulation. The use of topical analgesia can reduce perceived anxiety about future cannulation procedures. This has application in the management of anxious patients undergoing intravenous sedation, suggesting that topical analgesia prior to venous cannulation may significantly aid anxiolysis.

PMID: 11352393 [PubMed - indexed for MEDLINE]

The anesthetic onset and duration of a new lidocaine/prilocaine gel intra-pocket anesthetic (Oraqix) for periodontal scaling/root planing.

J Clin Periodontol. 2001 May;28(5):453-8

Authors: Friskopp J, Nilsson M, Isacsson G

BACKGROUND: A new non-injection anesthetic, lidocaine/prilocaine gel (Oraqix, AstraZeneca) in a reversible thermosetting system, has been developed to provide local anesthesia for scaling/root planing (SRP). The aim of this study was to determine the anesthetic onset and duration of the gel for SRP in patients with periodontitis. METHODS: 30 patients were randomized to either 30 s, 2 min, or 5 min of treatment with the gel prior to SRP of a tooth. The gel was applied to periodontal pockets with a blunt applicator. On completion of the SRP of each tooth (2-3 teeth treated/patient), the patients rated their pain on a 100-mm visual analogue scale (VAS). RESULTS: The median VAS pain score was 7.5 mm in the 30-s group, 28.5 mm in the 2-min group, and 15.5 mm in the 5-min group, with a significant difference between the 30-s and 2-min groups (p=0.03). In 2 patients in the 5-min group, but none in the other groups, the SRP was interrupted due to pain. The mean duration of anesthesia measured as pain on probing were 18.1, 17.3, and 19.9 min in the 30-s, 2-min, and 5-min groups, respectively. There were no reports of numbness of the tongue, lip, or cheek, neither were there any adverse local reactions in the oral mucosa. The gel was easy to apply and did not interfere with the SRP procedure. CONCLUSION: Oraqix provides anesthesia after an application time of 30 s, with a mean duration of action of about 17 to 20 min.

PMID: 11350509 [PubMed - indexed for MEDLINE]

Plasma levels of lidocaine and prilocaine after application of Oraqix, a new intrapocket anesthetic, in patients with advanced periodontitis.

J Clin Periodontol. 2001 May;28(5):425-9

Authors: Friskopp J, Huledal G

BACKGROUND, AIMS: Oraqix, a new non-injection local anesthetic, lidocaine/prilocaine gel 5%, has been developed to provide pain relief in association with periodontal probing and scaling/root planing (SRP). The aim of this open study was to describe the plasma profiles of lidocaine and prilocaine following a single dose of Oraqix to patients with advanced periodontitis. METHODS: 10 patients with 18 to 28 teeth with pocket depths of at least 4 mm were included. Oraqix was applied in the pockets around all the teeth in the mouth by means of a blunt applicator. The total dose applied per patient was 0.9 to 3.5 g. Directly thereafter all the pockets were probed and 3 teeth subjected to SRP. The mouth was rinsed out with a glass of water 20-27 min after the application of the gel. Blood samples were collected before and up to 90 min after the start of application of Oraqix. RESULTS: Peak plasma concentrations of lidocaine (99-266 ng/ml) and prilocaine (46-118 ng/ml) occurred 20-40 min after the start of application. These levels were low compared to those reported to cause initial signs of CNS toxicity (5000-6000 ng/ml). Side-effects were few and mild local effects of short duration. DISCUSSION: In conclusion, there is a large safety margin with respect to systemic effects following the application of up to 3.5 g Oraqix in periodontal pockets.

PMID: 11350505 [PubMed - indexed for MEDLINE]

Comparison of topical EMLA 5% oral adhesive to benzocaine 20% on the pain experienced during palatal anesthetic infiltration in children.

Pediatr Dent. 2001 Jan-Feb;23(1):11-4

Authors: Primosch RE, Rolland-Asensi G

PURPOSE: The purpose of this investigation was to compare the pain responses of children during local anesthetic infiltration at bilateral palatal sites prepared with the topical application of benzocaine 20% oral adhesive (Orabase-B) versus benzocaine 20% gel (Hurricaine) or EMLA 5% oral adhesive (EMLA 5% cream in Orabase Plain). METHODS: Forty subjects, aged 7-15 years old, received bilateral palatal injections following topical application of anesthetic agents applied in a randomized, crossover design. Pain responses were compared based upon subject self-report using a visual analogue scale (VAS), changes in the subject's heart rate, and operator assessment using a modified Children's Hospital of Eastern Ontario Pain Scale (CPS) that rated behavioral changes in children. Following the injections, the subjects were asked to choose which agent was preferred based on comfort and taste acceptance. RESULTS: All the agents tested were equivalent in injection pain response comparisons, but Hurricaine had a slight advantage in expressed subject preference and taste acceptance over the other topical anesthetic agents tested. CONCLUSIONS: The selection of EMLA 5% oral adhesive over other commercially available products containing benzocaine 20% is not recommended for palatal site preparation in children. The lack of demonstrated superiority in efficacy and subject preference, the necessity to custom mix the cream into an oral adhesive paste, the extended duration of time required for onset of action, the greater potential for complications associated with systemic absorption, and product cost preclude the use of EMLA 5% oral adhesive as an intraoral topical anesthetic agent.

PMID: 11242723 [PubMed - indexed for MEDLINE]

The efficacy of Emla and 5% lignocaine gel for anaesthesia of human gingival mucosa.

Br J Oral Maxillofac Surg. 2000 Feb;38(1):58-61

Authors: McMillan AS, Walshaw D, Meechan JG

OBJECTIVE: To compare the analgesic effect of a mixture of 2.5% lignocaine and 2.5% prilocaine (Emla) with that of lignocaine gel alone for minor operations on the gingiva. DESIGN: Randomized double-blind trial. SETTING: Teaching hospital, UK. SUBJECTS: 10 healthy dental students (7 men and 3 women, 20-21 years old). INTERVENTIONS: Construction of a reservoir within a splint on each side of the mouth and insertion of splints. The volunteers acted as their own controls, and the sides used for each anaesthetic were chosen at random. MAIN OUTCOME MEASURES: Measurement of pressure-pain threshold by a standard technique. RESULTS: The median (range) duration of anaesthesia after Emla (22.5, 12-30) was significantly longer than after lignocaine alone (12.5, 0-25) (P=0.01), and the area under the curve for the pressure-pain threshold for Emla (2053, 199-4564) was significantly greater than for lignocaine alone (986, 169-2942) (P=0.01). CONCLUSION: Emla is a more effective topical anaesthetic agent than lignocaine alone. Although its duration of action is relatively short it is adequate for minor operations on the gingiva.

PMID: 10783450 [PubMed - indexed for MEDLINE]

Four types of topical anaesthetic agents: evaluation of clinical effectiveness.

J Clin Pediatr Dent. 1999;23(3):217-20

Authors: Tulga F, Mutlu Z

In this study, four anesthetic agents of different forms and contents, namely: EMLA 5% Cream (lidocaine 2.5 percent, prilocaine 2.5 percent), Vision-Gel (benzocaine 20 percent), Anesthetic Tabs (tetracaine hydrochloride 0.68 mg, cincocain hydrochloride 0.02 mg), Xylocaine 10% aerosol (lidocaine 10 percent) were evaluated in terms of effectiveness in decreasing the intra-oral injection pain. Six groups each consisting of 20 children were constituted from 120 children aged between 10-15 years. The responses of the patients to the pain were evaluated using a visual analogue scale. Consequently, of all the other anesthetic agents used in the present study, Vision Gel was observed to be the most effective.

PMID: 10686868 [PubMed - indexed for MEDLINE]

Evaluating the efficacy of commonly used topical anesthetics.

Pediatr Dent. 1999 May-Jun;21(3):197-200

Authors: Roghani S, Duperon DF, Barcohana N

PURPOSE: This study compared the efficacy of commonly used topical anesthetics using an objective measuring scale. METHODS: The following were tested: 5% EMLA cream, 10% cocaine, 10% lidocaine, 10% benzocaine, 1% dyclonine, and a placebo. A special instrument was designed to serve the purpose of pressure application on the gingiva to obtain a threshold discomfort level in grams before and after the topical delivery. The medicaments, in the quantity of 20 microL (2-3 drops) were placed on the maxillary anterior region using Beckman paper wicks in the form of discs. The topical anesthetics were left on the gingiva for 3 min and off for another 3 min. The instrument applied pressure progressively, and the pressure application was stopped when the subjects reported the initial feeling of discomfort. RESULTS: 5% EMLA cream significantly reduced the pain threshold level followed by 1% dyclonine and 10% benzocaine. However, there was no significant difference between 10% cocaine, 10% lidocaine, and the placebo. The placebo effect was observed. CONCLUSIONS: 5% EMLA cream was superior in performance to all other topical anesthetics. The remainder of the agents had no statistically different effect than the saline.

PMID: 10355012 [PubMed - indexed for MEDLINE]

A comparison of 2 topical anesthetics on the discomfort of intraligamentary injections: a double-blind, split-mouth volunteer clinical trial.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999 Mar;87(3):362-5

Authors: Meechan JG, Thomason JM

OBJECTIVE: The purpose of this volunteer clinical trial was to compare the effects of 5% lidocaine ointment and EMLA cream on the discomfort associated with intraligamentary injections. STUDY DESIGN: A double-blind, split mouth study was conducted. Each of 10 healthy volunteers had 5% lidocaine and EMLA cream applied to the maxillary premolar buccal gingiva for 5 minutes before the administration of an intraligamentary injection. Discomfort during the injection was assessed through use of a visual analog scale. Data were analyzed by means of Student paired and unpaired t tests. RESULTS: Injection discomfort on the side on which EMLA cream was applied was significantly less than on the lidocaine side (t = 2.32, P < .05). CONCLUSIONS: EMLA cream reduced the discomfort associated with intraligamentary injections.

PMID: 10102601 [PubMed - indexed for MEDLINE]

Analysis of 50 patients with atypical odontalgia. A preliminary report on pharmacological procedures for diagnosis and treatment.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Jan;85(1):24-32

Authors: Vickers ER, Cousins MJ, Walker S, Chisholm K

Atypical odontalgia is a distressing and unusual chronic orofacial pain condition. It is often difficult to diagnose because it is associated with a lack of clinical and radiographic abnormalities. The condition is poorly understood on a pathophysiological basis, and patients often undergo repetitive and unnecessary dental procedures in attempts to alleviate pain. In this study, 50 patients diagnosed with odontalgia were evaluated by pharmacological procedures, including topical anesthetic application and phentolamine infusion. Results of these pharmacological procedures suggest that atypical odontalgia is a neuropathic pain of the oral cavity that may have a component of sympathetically maintained pain. Therapeutic trials of topical capsaicin were carried out to assess its efficacy for pain reduction. Topical capsaicin was effective in most patients.

PMID: 9474610 [PubMed - indexed for MEDLINE]

Progress in local anaesthesia.

Dent Update. 1997 Jun;24(5):190-2

Authors: Watson K, Rood JP

Research into improving local anaesthetic agents and methods of delivering them in dental practice has been very slow. This article describes some of the progress that is being made in these areas.

PMID: 9515368 [PubMed - indexed for MEDLINE]

A comparison of topical anaesthesia and electronic nerve stimulation for reducing the pain of intra-oral injections.

Br Dent J. 1996 Nov 9;181(9):333-5

Authors: Meechan JG, Winter RA

This paper describes a model for investigating the efficacy of different methods of alleviating the pain of intra-oral injections. The efficacies of the topical anaesthetic EMLA cream and electronic nerve stimulation as means of reducing the discomfort of palatal injections prior to the extraction of maxillary teeth were investigated using the model in one hundred patients. EMLA reduced the pain of injection compared with placebo (P < 0.05) whereas the pain reported after electronic nerve stimulation did not differ significantly from placebo. It is concluded that EMLA is useful in reducing the pain of palatal injections.

PMID: 8972953 [PubMed - indexed for MEDLINE]

A comparison of the effects of EMLA cream and topical 5% lidocaine on discomfort during gingival probing.

Anesth Prog. 1995;42(1):7-10

Authors: Donaldson D, Meechan JG

This investigation compared the use of a 5% eutectic mixture of local anesthetics (EMLA) cream to a "standard" intraoral topical anesthetic (5% lidocaine) as a means of anesthetizing the gingival sulcus in a double-blind, split-mouth study with human volunteers. A 5-min application of EMLA in a customized intraoral splint resulted in a significant increase in the depth of probing of the gingival sulcus without discomfort compared to a similar application of 5% lidocaine. Following application of EMLA, the pain-free probing depth measured at three sites in the upper premolar region increased by a mean total of 2.8 mm compared to an increase of 1.9 mm with lidocaine. This study suggests EMLA may be advantageous in providing periodontal anesthesia where manipulation of the gingiva is necessary.

PMID: 8934955 [PubMed - indexed for MEDLINE]

The intraoral use of EMLA cream in children: a clinical investigation.

ASDC J Dent Child. 1994 Jul-Aug;61(4):260-2

Authors: Meechan JG, Donaldson D

The use of 5 percent EMLA (an eutectic mixture of local anesthetics comprised of a mixture of prilocaine and lidocaine) as an intraoral topical anesthetic in children has been assessed in a clinical investigation. In a split-mouth study in twenty children there was no difference in the efficacy of EMLA and 5 percent lidocaine ointment in alleviating the pain of maxillary buccal infiltration injections of local anesthetics. EMLA did not differ significantly from placebo in the changes in pulpal responses of maxillary primary teeth to electrical stimulation before and after application in a double-blind split-mouth study in twenty children.

PMID: 7989628 [PubMed - indexed for MEDLINE]

Efficacy of a topical anesthetic on pain and unpleasantness during scaling of gingival pockets.

Anesth Prog. 1994;41(2):35-9

Authors: Svensson P, Petersen JK, Svensson H

The efficacy of a topical anesthetic on pain and unpleasantness provoked by scaling of gingival pockets was investigated in 20 patients with mild chronic periodontitis. A eutectic mixture of local anesthetics (EMLA) and a placebo cream, both occluded by Orahesive Oral Bandages, were applied in a balanced, randomized, double-blind, split-mouth design, which enabled within-subject comparison of the anesthetic and the placebo in the upper and the lower jaw. Pretreatment interviews showed that approximately two-thirds of the patients considered gingival scaling to be associated with some degree of pain and unpleasantness. Pain intensity and unpleasantness were evaluated on 100-mm visual analog scales (VAS). Application of EMLA reduced both pain intensity and unpleasantness significantly compared to placebo cream. Median reductions in VAS pain intensity in the upper and lower jaw were 58.9% and 61.9%, and corresponding reductions in VAS unpleasantness were 31.9% and 25.6%, respectively. Generally, the patients accepted the anesthetic procedure well. The residual perception of pain and unpleasantness following topical anesthesia may be dependent on activation of nonanesthetized nociceptive fibers in the tooth pulp. However, the present study clearly demonstrates the efficacy of a topical anesthetic in a clinical situation, which may be recommended as a simple pharmacologic strategy to reduce pain and unpleasantness during scaling procedures.

PMID: 8638858 [PubMed - indexed for MEDLINE]

Pulpal anesthesia from an application of a eutectic topical anesthetic.

Quintessence Int. 1993 Aug;24(8):547-51

Authors: Vickers ER, Punnia-Moorthy A

A new topical anesthetic agent, EMLA cream 5%, was investigated to determine if long application times could produce a degree of pulpal anesthesia. Thirteen subjects underwent testing in a double-blind manner. Pulpal anesthesia was assessed by electrical pulp testing. After the cream was applied for 15 to 30 minutes, 92% (12/13) of subjects reported no pain to the maximum setting of the pulp tester (300 V). The results of this study suggest EMLA cream has potential application in restorative dentistry and deserves further investigation.

PMID: 8272492 [PubMed - indexed for MEDLINE]

Oral surgery for children: 2. Anaesthesia and sedation.

Dent Update. 1993 Jun;20(5):206-7, 209-12

Authors: Meechan JG, Welbury RR

PMID: 8299840 [PubMed - indexed for MEDLINE]

Local anesthetic update.

Anesth Prog. 1993;40(2):29-34

Authors: MacKenzie TA, Young ER

The development of new local anesthetics has not been an area of particularly active research for a number of years. However, as the use of regional anesthesia has expanded, additional anesthetic requirements and techniques have stimulated the search for newer drugs and ways of modifying existing ones. This article reviews some of the more recent developments in this field.

PMID: 8185087 [PubMed - indexed for MEDLINE]

Topical application of 5% eutectic mixture of lignocaine and prilocaine (EMLA) before removal of arch bars.

Br J Oral Maxillofac Surg. 1992 Jun;30(3):153-6

Authors: Pere P, Iizuka T, Rosenberg PH, Lindqvist C

The analgesic effect of topical application of a 5% eutectic mixture of lignocaine and prilocaine (EMLA) was studied in 45 patients undergoing removal of oral arch bars used for the treatment of mandibular fractures. Employing a double-blind technique, either 4 g of the eutectic mixture (EMLA group, n = 15) or 4 g of a similar emulsion containing no local anaesthetic (placebo group, n = 15) was applied to the gingivae using a toothbrush and a standardised technique. In the control group (n = 15), infiltration anaesthesia with lignocaine was used only if requested by the patient during the removal of the arch bars. The patients in the EMLA group had significantly better analgesia (P less than 0.005) of the gingivae just before removal of the arch bars than patients in the placebo group, but by the end of the procedure the difference in analgesia was not significant. The number of patients who found the procedure pain-free was significantly higher in the EMLA group (7/14) than in the placebo group (2/15) (P less than 0.005). The plasma concentrations of both lignocaine and prilocaine were well below the toxic levels. Topical application of EMLA can be recommended for short procedures as an alternative to infiltration.

PMID: 1622957 [PubMed - indexed for MEDLINE]

Anesthetic effect of EMLA occluded with Orahesive oral bandages on oral mucosa. A placebo-controlled study.

Anesth Prog. 1992;39(3):79-82

Authors: Svensson P, Petersen JK

The efficiency of a topical anesthetic occluded with Orahesive Oral Bandage was investigated. Experimental pain was provoked by needle insertions into two palatal test areas in 20 healthy subjects. Pain, estimated on a 100-mm visual analogue scale (VAS), decreased significantly from 23.5 mm to 10.5 mm at the greater palatine foramen and from 51.5 mm to 35.0 mm at the incisive foramen after application of a eutectic mixture of local anesthetics (EMLA). No significant change in pain perception was obtained after placebo application. The EMLA cream and the Orahesive Oral Bandages were well accepted by the subjects, as only two out of 20 subjects experienced slight gagging reflexes and only three considered the taste unpleasant. No other adverse reactions were observed. Occlusion of topical anesthetics seems to be a useful technique for achieving superficial mucosal anesthesia.

PMID: 1308377 [PubMed - indexed for MEDLINE]

Experimental studies of new topical anaesthetics on the oral mucosa.

Swed Dent J. 1985;9(5):185-91

Authors: Holst A, Evers H

In order to reduce pain by injection, a frequently used topical anaesthetic is Xylocaine 5% ointment. This preparation, however, has certain limits in effectiveness. A new topical anaesthetic formulation, EMLA (Eutectic Mixture Local Anaesthetics), has been developed. Promising local anaesthetic properties on intact skin made it interesting to investigate the clinical usefulness of EMLA on mucous membranes and to find a suitable time of application. 30 volunteers, 20-40 yr, took part in the study. In two experimental double blind series, the topical anaesthetic effect was compared for EMLA 5% cream, Xylocaine 5% ointment, placebo cream, dry EMLA emulsion in cellulose discs and placebo discs. Application times were 2 and 5 minutes for the first three preparations, 2 minutes for the cellulose discs. The application areas were the alveolar mucosa in the lower buccal fold and the palatal mucosa. The pain by insertion of 27 or 30 gauge dental needles through the mucosa was registered. Xylocaine 5% and EMLA 5% reduced pain perception compared to placebo. For both Xylocaine 5% and EMLA 5% an application time of 2 minutes was found to be enough to produce a high degree of mucosal analgesia in the lower buccal fold. In the palatal area, however, the pain was not totally blocked by any of the investigated preparations but after 5 minutes of application EMLA showed a higher degree of analgesia. EMLA 5% creams was poorly localized at the applied area while the cellulose EMLA discs seemed to be more useful. No side effects were noticed.

PMID: 3866334 [PubMed - indexed for MEDLINE]