New treatment method for pain and reduction of local anesthesia use in deep caries

Abstract

Chemo-mechanical caries removal methods are known to be more effective compared with conventional methods in pain reduction. Carie-care™, a chemo-mechanical caries removal agent, was introduced in 2010 but a systematic review of its efficacy has not yet been performed. The purpose of this study was to investigate the effectiveness of Carie-care™ on the outcomes of treatment of caries in children and adolescents. The primary outcome was pain while the secondary outcomes included complete caries removal (CCR), time, need for local anesthesia and behavioral response changes.A Comprehensive literature search was performed in PubMed, EMBASE, and the Cochrane Library up to 30 September 2018. The following keywords were used in the search: ‘chemo-mechanical caries removal agent’, ‘dental caries’, ‘Carie-care’, ‘chemo-mechanical caries removal’, ‘chemo-mechanical caries excavation’, other related keywords, and their combinations. From 942 studies identified, 16 were analyzed. Finally, 4 studies met the eligibility criteria and 260 teeth in 120 children and adolescents were included in this review.This review showed that Carie-care™ reduces pain during caries treatment but requires a longer time for effective treatment than conventional methods. Local anesthesia was not required in the Chemo-mechanical caries removal (CMCR) group. In addition, dental anxiety decreased compared to the control group, and co-operation was more positive. Therefore, it may be a useful alternative to conventional methods in children and adolescents, but further verification through additional studies is needed.

Efficacy and Patient’s Acceptance of Alternative Methods for Caries Removal—A Systematic Review

“…Although the request for anesthesia is subjective to the patients’ fear towards the intervention and possibly the existence of previous traumatic experiences with conventional techniques, leading to the preventive request of anesthesia to avoid unwanted discomfort, alternative methods induced pain less frequently [ 63 , 64 ]. However, it is important to evaluate the extension of the caries, their progression and the pulpal response before the intervention, as well as the patients willing towards anesthesia.…”

Chemo-mechanical removal versus conventional removal for deep caries lesion

“…Encontramos siete revisiones sistemáticas [9], [10], [11], [12], [13], [14], [15] que incluyeron 34 estudios primarios en 35 referencias [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], de los cuales 30 son ensayos aleatorizados [16], [17], [18], [19], [20], [21], [22], [23], [24],…”

“…Las conclusiones de este resumen son concordantes con las siete revisiones sistemáticas identi cadas [9], [10], [11], [12], [13], [14], [15], las cuales consideran que la remoción químico-mecánica disminuye el dolor, la necesidad de anestesia y aumenta el tiempo del procedimiento. Además, declaran que existe incertidumbre sobre los desenlaces del fracaso de restauración y exposición pulpar, al igual que lo reportado en este resumen de evidencia.…”

Assessment of Technique Sensitivity and Gingival Health in Management of Cervical Lesions Performed Using Subgingival Clamp Versus Retraction Cord: A Randomized Controlled Clinical Trial

“…(20) • Need for local anesthesia It was a patient self-assessment by the patient for discomfort and pain (Yes/No), subjects were asked if they felt any pressure or pain during the application of the retraction cord or the subgingival clamp that necessitate local anesthesia injection Yun et al (2018). (24) • Isolation from crevicular fluids It was assessed visually using magnifying loups (Yes/No).…”