This study aims to compare the effect of topical anesthesia against the use of no topical agent on pain of needle penetration and local anesthesia deposition during buccal infiltration in anterior maxilla. In a randomized controlled trial, 100 adult participants were randomly allocated to the benzocaine group (received 20% benzocaine gel) and no benzocaine group (received no topical agent) prior to buccal infiltration in maxillary anterior teeth. A 27-gauge needle was used to deposit 2% lidocaine with 1:100,000 epinephrine. Pain of needle penetration and local anesthesia deposition was recorded separately using an 11-point Numeric Pain Rating Scale. Results showed that although 20% benzocaine significantly reduced pain on needle penetration during buccal infiltration in maxillary anterior teeth, the difference was small and the clinical significance is not clear. Topical anesthetic did not affect pain of local anesthetic deposition.

The aim of this article was to develop interim workflow guidelines based on specific needs of dental settings in Pakistan, to help navigate through the COVID-19 pandemic. METHODOLOGY: Based on needs identified by a survey of 60 dental practitioners, guidelines and protocols were developed after reviewing documents by international and local professional organizations from the fields of dental health care, public health, and hospital epidemiology and infection control. RESULTS: Recommendations providing details on clinic reorganization, improvement in clinic ventilation, walk-in patient management, PPE use, and environmental infection control, were developed. Protocols have been outlined for performing aerosol generating procedures and for disinfection after procedures. CONCLUSION: This report supplements the Government of Pakistan guidelines for practicing dentistry during the COVID-19 pandemic. Training of dental health care workers in basic, and in COVID-19 infection control is necessary for adequate implementation of these guidelines.

The aim of this study was to identify needs of Pakistani dentists, in order to establish recommendations for essential dental care during the COVID-19 pandemic. METHODOLOGY: Initial needs assessment was performed using social media. A field survey of clinics in 16 localities of Lahore, as well as an online survey of dental practitioners in Pakistan was conducted. RESULTS: There were 60 respondents from 15 cities in Pakistan; 46 general dental practitioners including 3 unqualified practitioners, and 14 specialists. Adequate PPE was available with 60-70% of practitioners. Ventilation was inadequate in most establishments, and in 30%, aerosols generated in the dental surgery had the potential to spread to the entire clinic. Majority (59%) of patients presenting to practices were walk-in. In the 25 clinics inspected, PPE was not being used adequately, or being saved for use on COVID-19 patients. One third of the practices had rubber-dam, high volume suction, and adequate waste disposal. Patient records were not maintained by 28%. CONCLUSION: Needs identified were: infection control training for dental health care workers (DHCWs), patient awareness and compliance, protocols for walk-in patient management, use of rubber-dam and high volume suction, financial aid and loans, availability and correct use of PPE and disinfection supplies, and economically feasible means of aerosol control and improvement in clinic ventilation. The role of governing and regulatory authorities in addressing these needs has been suggested. Guidelines based on the needs identified are presented in part 2 of this study.